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Home My WebLink About6242-zFOEM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupency No. ~602t ...... Date ........... Ju.l.y.-. ~'9 ...... , 197~. THIS CERTIFIES that the building located at . ~r.~llage . Lane ............ Street Map No.y,~x .......... Block No.. XX ...... Lot No... ~. ~r~.er~c..N..X, ........... conforms substantially to the Application for Building permit heretofore filed in this office dated ............ NOV...t0.., 19.72, pursuant to which Building Permit No. 62t~2Z,. dated ........ I~ov... ~.~ ..... , 19.72., 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 .. Pr~.vate- ~ne..f. am~..ly -4w~l.t~ng, · ,w~tl~ .an. adcl:l,t.ion ................ The certificate is issued to . .ESt,...El~a!ve~,,h .¥anNoStran~l ...... Owner ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .I~I~R~ ............................. UNDERWRITERS CERTIFICATE No...P~.~g .................................. HOUSE NUMBER .... ~1~-2~ ..... Street .. ~rillag~ .L~ ......................... .Building Inspector/ I~OI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE SouTHOLD, N~. Y. · ~ BUI~LDi~G PERMIT 'ER/~I~',MuST BE KEP'~ ON THE PREMISES UNTIL FULL 'I'ON OF THE WORK ~UTHORIZED) t grorited to: ........ ........ ................... to ;~ an ac~d:Lg~ton .on e=c:l. . ............................................................ purs Buil,~ Fee raises located at ...~l..l~.~.O.....~;:J,3-~..~J~a-~),-, ............. :"~ ........................................................... Orie~ ~¥, ....... ~ ........................................................... rant to application dated ........................ ~.0~. ....... .j¢~'....! ....... , 1~2,...., and approved by the ~g Inspector. ~.4. -o THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY [~ J FtnuaT*y 30, 1-8'-Sj~JOHN97 STREET, NEW YORK, NEW Y.OI~K 10038 b7606.B App,,c..,..,o...,,,e N 140959 THiS CERTIFIES THAT tvas examination an uary [] 2nd FI. outside Section Block and found to be in compliance tvlth the requirements of this Board, .x.u. I F,XTU.S OUTLETS ECEPTACLES SWITCHES FL~(~ESCEm DRYERS ~RHACE KTORS ~TU~E__ A~AHCE KEDERS SKCIAL REC'F SERVICE DI~NKT l K, OF I S E i~T' 100~' ~ ~. 1~ l~3Wx 3~3w 3~4w NO. OFpERCC. COND.~ 2 OTHER ~ARATUS: OF CC. COND. EXHAUST FANS DIMMERS NO. OF HI-LEG A.W.G. NO, OF NEUTRALS A W G OF HI-LEG OF~NEOT~AL ~&S Cont ract~[n~ PO Box 215 Southold, I,.I. 11971 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. I~M 1~0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ SOUTNOLD, N. Y. ................................ ~'"'"----"~{ B u i Id i n~l I r/~l~:tor) APPLICATION FOR BUILDING PERMIT ..........." ............ , .... Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, w 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. 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 e 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 be~ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone 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) .... ............................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; Name of owner of premises ...~.~../~.....~....~.~..~.~.~./~...JE~...~/~f~.&/..~[~'~..4',~).4~..~ ........................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. Street and Number .../..~./..~...,.~./..~....~..~.~..,~.~ ........ .~...~..~..~'..~../..'~... ............................................................................ /~'~:~"'0 Municipality 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy ............ Z~f~,,~7~.,~,~'~'~ .................................................................................................. b. Intended use and occupancy ........... ~./,~"4~'.~,~f. ................................................................................................ · '3. Nature of Work (check which applicable): NeW Building ....................... Addition ...... ~ ....... Alteration.....'. ......... 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 ..... ~.'~... ....... Rear ...~..."~-.: ............ Depth .....-~...~..../. .................. Height ................ .~...~. ..................................... Number of Stories ......... .'~.......~........~.....O. ............................. Dimensions of same structure with alterations or additions: Front ........ ~...~. ........... Rear ....... .~....~. ........................... Depth .................. ..~...~......! ............. Height ....... ~.....i ..................... Number of Stories .........,~... .......................... ! 8. Dimensions of entire new construction: Front ........ ~..~.. .......... Rear ......... ./..~..../ .......... Depth ...... ..,~....c~.. ................... Height ................. ./~.. ......................... Number of Stories ...........~.. ........................................................................... 9. Size of lot: Front ............. ~..,~....~.. ............. Rear .............. /..~...~.. ................ Depth ........... /..~..~.....i ......................... Height .................................................... Number of Stories .................................. ~L' ............................................... 10. Date of Purchase .......... ./..~r~.~.. .............. Name of Former Owner ....... ~allllfJl~l~..~..~..~...~... ................................ 11. Zone or use district in which premises are situated ............. ~ .................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~ ............................................ 13. Will lot be regreded .......... ~ ................... Will excess fill be removed ,from premises: [ ] Yes [~J No 14. Name of Owner of premises ..... ~.~.~........~..~......x~.~.~.~,,..~.~'~(..'.~'...~.~k'...Z~..(?..5..~...~ .................................. (Address) (Phone No.) Name of Architect ................ .-T.. .................................................................................................................................. (Address) {Phone No.) Name of Contractor ...~..,....~.~._..J~....~....X?~.~/~d~..~.....~../..~...~./..~ ................ ~....~....?.~ ................ {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. STATE OF NEW YORK, ) COUNTY OF .....,_~...___________________~.~ ....................) ~ t:.~.l 4~.L.V...'.ff..'....~..v..?.R.L.~.~./'R',..~....°~. ............... being duly sworn, deposes and says that he is the applicant above named. {Name of individual signing contract~ He is the ............ ~Z,~;~ ~ ................................................................................................................................................................................. {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 all statements contained in this application are true to the best of hi~t:~Ji~f~Rad that the work will be performed in the manner s torth m the apphcat~on filed therewith, e. ,52-0455~*~ ~te o~N'e~ ~ ~ . C /I/. . [ ~tPare~ Z~m~.~ ~,,ua~ Notary PuPil ...................... ~o~W .......... ~.,,.~T ............................... - ~ (S~ of applic~t)