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Home My WebLink About6196-zNO. 4 TOWN OF SOUTHOLD BUff.BING DEPARTMRNT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the bui]d!,~g located at . .l/~&l;a~.$, Rg. ad ......... Street Map No..N.a.s..s.a.u..P..t. Block No ........... Lot No..3.8J ..... .C.u..tq.h.o.g~..~ ............. conforms substantially to the Application for Building Permit heretofore fried in this office dated .........0.c..t...2.~. ..... , 19..7.2. pursuant to which Building Permit No..6.~.9.6.Z... dated ............0.e.t....2~...., 19 ?.2.., was issued, and conforms to all of the require- ments of the applicable provisions oI the law; The occupancy for which this certificate is The certificate is issued to . .g.r..T.h. 9.~..s....z~..e..r ........ .o~m..e..r ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N;.~.: ............................... UNDERWRITERS CERTIFICATE No..P.e..~...~ .................................... HOUSE NUMBER ...~.~..~. ....... Street ...H..~.y~. ?..t.e.r.s...B.o.a.d. ...................... Building Inspecto~ FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6196 Z Permission is hereby granted to: C. ~*2.aws]r.S. A/C Thor ~&ke~' ............ ~Jt, cl~o~g .............................................. to .~S.lA..m.. ~4$~l,e~..e~.. ~4,s.t, iz~g.. ~veX.1Ang. ............................................................... at premises located at ...~/,~;...~'l. ........... .ll~a~.&lt.l~...P.~.~l~. .......................................................... ............................................ ~...~...~....~.,...~:~ ............. .c..~?.~?..~.? ............................................... pursuant to application dated ............................ .0..~;.....~. ............ , 19..~..~..., and approved by the Building Inspector. Fee $...~.~:X~ ......... Building Inspector 4' TOWN OF SOUT~OLD ~ ~~' ~ BUILDING DEPARTMENT ', '/~ / d. ~, ~ TOWN CLERK'S OFFICE ~ ~)// J~ ~ ~ ~ ~UTHOLD, N.Y. ~~~~ ~. ~ ....... .......... , ....... ........................................ , 19 ........ Pemit No ........................... ~ Di~ppr~ed o/c ............................................................................................ ~ ............. ................................. APPLICATION FOR BUILDING PERMIT Date ..~..~....~....(. ......................... , :, INSTRUCTIONS w~ a, This applieetion must be completely filled in by Wpewriter or in ink and submitted in triplicete to the Building Inspector, 3 of plans, accurate sets 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. 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 kept 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 have beerJ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zonec~ Ordinaqce of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all appliceble 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) ............. i,. .... ......................... i~;~'b'II; ;F;~p,cant) . State whether app cant $ owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises-...~..~...~...~...P~.~ .................................... ,. ....................................... .. if applican~ is a corporate, signature of duly authorized officer. (Name and titl® of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ...~...O....{a ....... Lot No.....3.".~..../. ............................ Street and Number ..... 1_ ...~ ..~..~ ...~,,,-a~hfi~se~.....~...~.,.. ....... ~...:..:~..~..: ............. 0 "~-- 5' L/~4- O Munlcq:fality 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy b. Intended use and occupancy ....... e C'~.~.....~...~...~.__:. ............................. 3. Nature of work (check which applicable): New Building ........... ? ........... Addition .....~ ..........Alteration ....... , ....... Repair ......................... Removal ......................... Demolition ........................ Other Work .............................. (Description) · / 4. Estimated Cost ........~...~::~...d.. ...................... 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 usa ...... .--. ............................. 7. Dimensions of existing structures, if any: Front ...... .~......~.. ..... Rear ...... .~..;.o. .............. Depth ......~....o. ....................... Height i ~' ~ · ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front ....... .'~...d. ............ Rear ........ ~...O. ........................... ¢ Depth ......... .~....(e ........................... Height ..... /,.~...t. ........................... Number of Stories .......~...;..o. .......................... 8. Dimensions of entire new construction' Front ...... ..~7,. .............. Rear ................ ~ ........ Depth ...'~.. ............................ Height '"' Number of Stories ! 9. Size of lot: Front ....... ".~'../...,,g~....;... Rear ......... Z;.~...: .................. Depth .....~....,~:.....O.. .............................. Height .................... ..';.. ............................ Number of Stories ............'. ......................................................................... 10. Date of Purchase ...~1~...~....acT./..~...~. ...... Name of Former Owner ..... ~...~ ........................... 11. Zone or use district in which premises are situated ..... ~..~ ............................................................. 12. Do~s proposad construction violate any zoning law, ordinan~ or regulation: .........~.........~ ........................................... 13. Will lot be regraded ...... ~r:~R....'~.. .............. Will excess fill be_removed from premises: [ ] Yes [~ No (AddressY / (Phone No.) Name of Architect ..................................................................................................................................................... ,,~ ~.~ ,~, ,~ . ,,JAddress) , (Phone No.) Name of Contractor ....~....~ ........ ~....J?....~.....7.~l~(;~.~ ........ PLOT DIAGRAM Loca{e clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-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 ...................................................... ) ........ ~ ....... t/~ ~ /')' "/~...~:[C~...~~ ................................. being duly sworn, deposes and says that he is the applicant above named. -- {Name o/individual signing contract} ~ ' He ia the ................................................................................... ~.). ......................................................................................................... ~ 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; tha~' all statements contained in this application are true to the best of his knowledge and belief; and that the work will he performed in the manner set forth in the application filed therewith. ! {",/tA~i~ OF I,,~ANI3 NASSAU J::~O i' NT