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Home My WebLink About6184-zI~ORM NO. ~ TOWN OF SOUTHOLD BUH.BING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. 2,~2~ ..... Date ...J...1~..~..~ ................. , 19..7~.. THIS CERTIFIES that the building located at 68~ I/oC~um l~o Street Map No.....~).~.~.'. .... Block No ........... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...0.e..~. b.e.r...]..8. ....... , 19..7.2. pursuant to which Building Permit No. dated ...~.t~.b.e.~...3..8. ........ , 197.2. ., 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 Aac#~oz? Butldln~ The certificate is issued to ........ .C..h~...],.e.~...H.~....~....~..~'~ .~ ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ .N.~..l~.~ ....................... UNDERWRITERS CERTIFICATE No ................. l~9.R., ........................ HOUSE NUMSER ....~.~ ....... Street..~..C..~.....~..? ............................ ..................... ~.1. ~.0..S..~.~..t~....P~.?? ...... ........ ' '~'~'~'-'{'~'~-"~ ...................... ...... ' '~Building Inspector / FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6184 Z × Permission is hereby granted to: ~ ~ / / . ........ /..~.~,~Z~..~(~../ ..... ....... ............................................ ;'"'~ ............. ~ ........ ~'"'7Z .................... ~'-"- .............................. ,, pr.~,,,, ~,~ ~, ..... ~.,....~ .......... ~ ........ .~--...~~ ......................... ...................................................... ........................................... Building Inspector. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .................... , pr ,ed .................... Pem,f ..... Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT Do e ..................... ...... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector,'W~thr~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas~c~" giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kel~ on 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 havelbee~). granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zon~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described, The applicant agrees to comply with all applicable laws~ ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ............. ~....c.......d..h..~.~..~;~.......~Z~.~ ...... ~~ ~~ ,~ (Address of applicant) State whether applicant is owner, les~e, a~nt, architect, engineer, general contractor, electrician, plumber or builder; .............................. ~.~,~ .................................................................................................................................................. ~ame of owner of promi~s ...... ~, .................................................................................................. If applican~ is a corporate, signature of dulg authorizod officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ...5~-~.J~../. ..... Lot No......~'... .................................... ...A~..~..../.~. ~'. .............. ,,5~M.~.. ~ ,~/,J..,.~./,~,xe z~ ,s ............ .(;. ~ ~r~.~../Z. ................................. Street and Number ~ Z ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~.E$/.~. ~./~..~ .~ .. b. Intended use and occupancy ..... ~.~.~/~..E.....g~.....~,~.~(~....~,~.~.z.~...;~-~.~,/../~.. .............................................. 3. ~ Natuf~ of work (check which applicable): New Building .~...~...~...d~.~.... Addition ..................... A teration: ......... ' ..... Repair ......................... Removal Demolition ........................ Other Work ........................... (Description) 4. Estimated Cost ~ ,~.~, ..~... Fee ............... (to be paid on filing this application} 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ......................................... If garage number of cars .................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ......... :Z...°..../... Rear ........ ,~....~.../. .......... Depth ......~.~../. .................... Height ~...~.~.(J./Y....~/~'~.~L ......................... Number of Stories .........../...~.~..q...~,~.. ............................................... Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... 9. 'Size of lot:' Front- ...................................... Rear .......................................... Depth .................................................. Height .................................................. .. Number of Stories .................................................................................. .. .. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ....................................... .'~J. ....................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be recjraded ....... _/~....o. ...................... Will excess fill be remo~d frompremjses: [ ] Yes [4 No 14. Name of Owner of premises .(~,~.,E~/:~-~...,~.,.....Z.~../.~ ................. ~.~...(Z.~.&(.,~Z....~..~. ............. ~.,~..~.r../~..~.~.. ........ (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address} (Phone No.) Name of Contractor ............................................................................................................... (Address} (Phone No.} 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. ,1' I I STATE OF NEW Y,Q, RK~ r~ . ) COUNTY OF ...... . .~...~...~..q:..~...~. .................. ) ~ ,(-.. /20' ~. ................... · f~-~[~.~c~,.~-~..-.~.........~t.:..-.-~'..-~-~ ............................ being d~ly sworn, de~s and says that be is the appli~nt above ,amed. {Na~e of indivi~l si~ing con~acO is tbe ................................ ....................................................................................................................................................... {Con.actor, a~nt, co.rate offi~r, etc. } o? said owner or owners, and is duly authorized ~o ~orm or haw ~r~ormad tbe said work and to make and file this application: that all ~tatements contained in thi~ a~plication are true to t~ ~st o~ his knowled~ and belief; and that ~be work will be ~rform~ se~ ~orth in the application filed th~r~wlth. ~ TERRt LEE ~ ~.O~Y P~SLIC, State o~ ........ ~.~~a~t~sa~g ............. ~ua f ed tn folk .............. .................................. (S~m~ of ~pli~0 A