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Home My WebLink About6160-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. Z~.6..0~. ..... Date ......... 0.e.~q0be~ .2.5', ......, 19.7..~. THIS CERTIFIES that the building located at ....~..a~.a..~.a.$. p.a..th ........ Street Map No. ~ ......... Block No.. ~ ...... Lot No....X~..0.~[7....~.~.~..th..o.~.d ............. conforms substantially to the Application for Building Permit heretofore filed in this office i._~__,,~d~ted ....... .0. C*~..~.~ ...... , 1972.. pursuant to which Building Permit No...~.~O.Z. dated ......... 0C.~.o..15! ...... , 19 ~2., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...Pl'i.vat$. &CC$~.Q~Ty. ]~.],dS, .......................................... The certificate is issued to .. le~at, h.~.:l~O. ~l~r .................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No ............................................. 19~ H~a~a~ Pa~ HOUSE NUMBER .............. Street .......................................... ~u~old ui ing nspector I~RM N~. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6160 Z Permission is hereby granted to: at premises located at ..... ~L&w~,t, ll~lt..~&~r~ ............................................................................. t ...... ................................................... 14~t,~l, ......... II,,~,, ....................................................................... pursuant to opplicotion dated .......................~.,~......I.}. .................. , 1~....., end opproved by the Building Inspector. Fee $ ..1..~.e.{~l ........... .................... Building Inspector ~ .... ; ~rO~ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ~.....~..~ .......... , 19....2.Z~'- Approved ~ ( , '( . . ........................................ 19 ........ Pemit No..~../...~......~....~, Application No. ~"/~ 0 Disapproved a/c .......................................................................................... · "( ~' '~'[g~' ' J ;~'~ to r) ........ APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This applicetion must be completely filled in by wpewriter or in ink and submitted in triplicate to the Building Inspector, wit~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an~ giving a detailed description of layout of property must be drawn on diagram which is part of this application. d.C' TheuponWOrkapprovalCoveredof by this application may not be commenced before issuance of Building Permit. \ this application, the Building nspector w I issue a Building Permit to the applicant. Such permit shall be kept ol~ the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have beeJ~- granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zo Ordinance of the Town of Southold, Suffo[h County, New York, and other applicable Laws, Ordinances or Regulations for the construct on'~ buildings, additions or alterations or for removal or demolition as herein described. The applicant agrees to comply with all app icable laws ordnances, building code, hous ng code, and regulations, and to admit authorized nspectors on premises and in build ngs for necessary inspections. ~~ ~ dh 0 ~'~ '~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ If applicant is a corporate, sig ture of duly 'zed officer. 1. Location of land on which propo~d work will ~ done.Map No . Lot No ........... Street and Num~r ..[~~. ~ ..............................................................-~'"' .............. Municipali~ . State exi~ing u~ and o~upancy of premiss and intended ~e and occupancy of propo~ con,ruction: a. Existing u~ and ~cupancy ......... ~~ ........... ~ ........................... ~ ...... ~..~ · Intended u~ando~upancy ..~~ ~~'~--~'"~'-~-~"' ...... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair Removal Demolition ........................ Other Work .................................... .................................................. (Description) 4. Estimated Cost ........... .~.......~...2....~ ....... Fee ~' ..0. ~ . . .............. i[;'be paid on filing thi;';'l~li'~;~i'~r;i ............................. 5. If dwelling, number of dwelling units .....'~-.......;.... Number of dwelling units on each floor ...-- .................................... If garage, number of cars ......T. ......................................................................................................... :~ ......................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ............................. ~ ..... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ..... Depth ........................................ :.... Height ......................................... Number of Stories ....................... v-- ............. Dimensions of entire new construction: Front ......... .~'..~...~. Rear ........ .~.....~r_.~....... Depth ..~....~..~ ........... Height ....... .,~..~ ................7 ....... Number of Stories' ........ ;2g .................................... '_'"):~ ...... '",'"_'"'~'"';g~;: 9. Size of lot: F~oont ....../.~...~: .......... Rear ...~.~..~ ............... Depth .~.~.~.....Z~..~:i. · 10. Date of Purchase ................... Name of Former Owner ...... ~:.....~....~...¢.V..~.../..~c ........................... 11. Zone or use district in which premises are situated .................................................... .~ .............. ~ ...... 7 .......... ,r"~;. ~ 12. Does proposed construction violate any zoning law, ordinance or regulation: .................. '~" ................... ~ 13. Will lot be regraded ~.,~......~. .................. Will excess fill be removed from premises: [ ] Yes j~ No 14. Name of Owner of premises ....................................................................... (Address , Phone No.) Name of Architect ................... ..'~-~ ......................... i~,'~l;J~-~'~i .......................... i;...' ................. (Phone N(L)" ............... Name of Contractor .............. ~ .......................... i~;J~') ............................. ; ...... il~'t~'~;~i ............... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back, dimensions from property lines. Give street and block number or description according to deed, and show street names 'and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ) COUNTY OF ....,?"~,~,..~-,.~.~.~ ...................... ) SS L~,, .~r~.~, .,~.._~.%~'~?... ~),~,,~t. ~-.,~., ..................... being duly sworn, deposes and says that he is the applicant above named. ...................... He is the ................................. ~),Lt,~,.~..~ .......................................................................................................................................................... {Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that statements contained in this application are true to the best of hi~s knowledge and belief; and that the work will be performed in the manr set forth in the application fi~ed therewith. TERRI LEE ELAK ,.~ un-~,~v PUBLIC, State of New Y' ............ .,~.. .............. day of Notary Public, ~~ ........ County ..~-~"~.~;;~