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Home My WebLink About6244-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy 1...~te~ .., lg/S Sout~ I~rl)oz~ THIS CERTIFIES that the building .w,, ~,., .............. .... 't ........ Street Map No....r~.. ....... Block No...xx. ....... Lot No...n~..,,, .S.o.u..~.h.O.l.d., .N.: .Y: ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. N. Oy.....~., 19.~,~. pursuant to which Building Permit No...6. 2~.~ dated .......... 1~0¥ ....16..., 19.72., was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...P.r.J..~.a..1;.e..o.n. ?. f..a~..~.]-.l[., .d.~..~.3...~t~.,,, .~..t~.., .a~., .a.d.d. $.t.~.o.n. ................ The certificate is issued to .R.~.c..h~..r.d...14.o.n..t$.o.~.? .r~. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Heaith Approval ....NAR.? ............................ UNDERWRITERS CERTIFICATE No...p.e.n~...~.g ........... i ...................... HOUSE NUMBER .... ~ 0 ........ Street .. ~QUt, h..~.arb~, tio~d ................... FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING prERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6244 Z Permission is hereby granted to: ...... ~im~,h~,ct ...................................................... to ...~_ ..~...Z...a......~......a..a.~$..t..t..o..~...f...A.t..t..~.e..b.c ~... r,~,z~ Z..~ ...e~t.~ ~ ..~ ............ ~ ..... at premises located at ........... ig,/~..,,20~tt,~at'~o~..F~a~. ................................................................... Southo~d ................................................................................ pursuant to application doted .......................!1~0~. ...... .~. ................ 19..~2., and approved by the Building Inspector. ' ~q~ TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ TOWN CLERKS OFFIGE ~ ~ ' ~UTHOLD, N. Y. ...... ............. , ........................................ , 19. Pemit No ........... Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT Date ....................... /././..~.. .............. , INSTRUCTIONS it~ 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 prem scs, relationship to adjoining premises or public streets or areas, a~L.) 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 Bud ng Permit d. Upon approval of this application, the Building Inspector will issue a Bui d ng Perm t to the app icant Such permit shall be kept 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 bee~n 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, Suffoih 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 aH aPplicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessai:y 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 ...... ,f~a,~Y,c~z:~ ...... ~26~j~ .xT.x:3~,r~z¢;~;~.~...-. ................................................................. 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 ~.~k-/~......,~.~.'.~R.e~......:,,~T~7~a(,~,~$¢~'....~'~, ..................................... . Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~-~v~.~.~.'~.. ................................................................................................. b. Intended use and occupancy .... _.~_~It~ca'::.. ............................................................................................................. 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, ~f any. Front .....................Rear .......... ~.~-... ......... Depth .....~L~ ...................... Height ............. ~...~....~. ................................... Number of Stories ........ ./.. .................................................................. 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 ............. ~....~J~..~ ............... Rear ........... .~.~',',',',',',',',Z~ ...................... Depth ......~.~..~....~. ............................. . Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ....~.O~f,l~.....~r"~- .................................... 11. Zone or use district in which premises are situated .......-'~f,~;l~--~ZT..~/.:.~. .............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ~Z:.....,t~...Rzz~....~ke~.~,~fa.~... Will Iotberegraded-~zE-~.-, .................... Will excess fill beremoved from premises: [ ] Yes ~ No 13. 14. Name of Owner of premises .~z~,~-~,w....~,~,.,~.~- ""'~"~(Ad~re'~) .......................................................... (Phone No.) Name of Architect ...... 2~.~..~..~-.~..--~.. ............................................................................................................................. (Address) (Phone No.) Name of Contractor .~O,f,~2.~z.~....~[P~...'~'.-.~-~ ............................................... ~'~'"'-'"~'Y"~'~' .............. (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 YOR~ ~ .' } ~ ~....~~.Z ............................ ~i~ duly sworn, ~s and says that he is the appli~nt above named. (Na~ of indivi~l si~ing con~acO ........ .......................................................................................................................................................... { ~ntractor, a~nt, coyote o~r, etc.} of said o~nar or ownara, and i~ duly authorized ~o ~orm or hav~ ~r~ormad th~ aaid ~ork and ~o maka and fil~ thia application: ~at all s~atement~ contained in ~hia apOlieafion ar~ trua to t~ ~a~ o~ hia knowl~d~ and ~li~f: and that th~ work will ~ set forth in ~h~ appll~ation filad tharaw;th. ~ER~I LE~ E~K ~ ~Y P~BLI~. S~at~f New York f No. 52- 6 9~ ......................... o ................. _. . _ .......... o.n. .............