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Home My WebLink About6246-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .~..o?., .~..C..c..K.7.,..~..o.9 .C:~ .... Street =~p,,o...m ....... Block,,o. ....... ~' ...',ot,,o. ~... ../g. ~T~...T.~ ~.~..~Y' conforms substantially to the Application for Building Permit heretofore filed in this office dated ~f/) d [ ~ 1~ .~".. pursuant to which Building Permit N~.~t~ {) ~-~ dated ~ ' ' 1 .~"'. ....................... , .., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to/{ ~.~..~. 'J .... /~:..,~ ~-. ¢..~.,.--e~-... ......... O .0$4/.C .R~.~. .... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... t?.t. f.~,, .......................... UNDERWR TERS CERTIFICATE No /~t', ~..., HOUSE NUMBER.~. ~..~..~. ..... Street...~. ,~..,e.r./c,....~.q 6.~. ............................. l/uilding Inspector / FO~ NO. 2 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? 6246 Z Permission is hereby granted to: ..... ~...~.~.....~....~ ........................................... ............ ]~l~t~t ~.t~k.~ ............................................. at premises located at ....,~,.~laML..o~...~,~o:x,..B'll~k..~o~. ............................................................. I~tt~tuek pursuant to application dated ........................~.ffi~F......~.~....., 19~..., ~nd opproYed by the Building Inspector. Fee $ .~. ~'.e.t[~I ............ Building Inspector BUILDING DEPARTMENT TOWN CLE~I('$ OFFICE ~)U'I'HOU), N~ Y. ~v. ...................... ~.~ ............... , ,,.:.;... ~.~,, ,o..~..~.~..~...~ Disapproved a/c ..................................................................... :. ....................... APPLICATION FOR BUILDING PERMrT ~ ............................... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showin.g, location of lot and of buildings on premises, relationship to adjoining premises or public streets or~'~-J areas, and giving a detaded description of layout of property must be drawn on the diagram which is port of this application.~ TM 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 progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy~--% sha~l have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to theN 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. (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. ........................................... .o..~..~..~..~ ............................................................................................................................... Name of owner of premises ....... i.~.J~.~..~,.'I ............ ~,~.~.~'~,.~,.~. ........ .~..~......~...,,.~. .............................................................. 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 ............. '.~....~...~..5..c..~....~F~.~..~ .............. .~.~...~~ .............................................. Municipality 2. State existing use and occupancy of premises ~gnd/nt .4n.~)ed u~andoccupancy of proposed construction: o. ........... .................................................................... u, ............................................................. ......... 3. Nature of work (check which applicable): Now. Buildiqg ~.~ ................ Addition ..... .~... Alteration .................. Repair .................. R~rnoval ..................Demo~!i~i0ff~:~i..:.~:...' ..... Other Work (Describe) ........................................ 4. Estimated Cost ..... ..~...,~.~.~..~..~... ........ (to be paid on filing this application) 5. If dwelling, number of dwelling units .......................... i.Number of dwelling units on each floor ............................ If garage, number of oars .............................................. ~ ................................................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structures, if any: Fr°nt .......~.~.:~..~ .......... Rear ........ ~,/.*J!....~.. ............ Depth ....,~..~.:...~.... Height ........................ Number of Stories ................. ~ ........................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Nu~nber of Stories ................................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........~.0.: ............. Rear ......... .~.,.,~.~.....: ........ Depth ...... ~..~...~.,...~.,~. .... 10. Date of' Purchase ..~.D..~.. ...... /...~.. ....... /.~...~....~ ......... Nome of Former Owner ...,~J~.J~.~-......~....~-~,~..~...~,) 1 1. Zone or use district in which premises are situated ..................................... ~ ........................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ,~..0. .......... : ............................... 13. Name of Owner of premises .................. :.~...~ ........ Address ................. :...~, ..................... Phone No ..................... Name of Arch,tect ......... .~. ........ ..~.~../~.-~..,.~.,4 ....... Address ....~.....~.~:.~., ....... Phone NO~..~..~..r..~..~..~./ Name of Contractor ..~....~././,~.'......Acklmss ~..~...~..~.~r~....~-~ ~-:~t~ ~/~ Phone No.~.~.~..=~.~.~./ Locate clearly and distinctly all build'ngs,~ 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 whether i~terior or corner lot. Roe SoS. .being duly swam, deposes and soys that he is the applicant above named. He is the ....~.~.~9.g. ......................... ~ ........... ~ ................................................................................................ (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 Jn this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this L.7. - f °' "'" z,-/ .................... aayo ......... Notary "'T 0 'JO 0 WEsTpHALIA RoAD Unaulhorlzed alteration or addition to this survey ;s a vlolatbn of section 7209 of the New York State Educotlon Law. Copies of this survey map not bearing the land surveyor's ~n~ed seal or embossed seal shall not be considered to be a valid copy. ~;arenl~ or ceHi!ications indicaled hereon shell run only to ~he f~,~:~- ~r whom the ~urvey is prepared, and on his behah~ to the SURVEY FOR HENRY E~. ~t ELIZABETH A. ALEC AT MATTI FUCK TOWN OF SOU FHOLD SUFFOLK COUNTY, N.Y. SCALE: i"=60, OCT. 27~ 1~7~