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Home My WebLink About6281-zFOKM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's O~ice Southold, N. Y. Certificnte Of Occupnncy No.. Z5~71 .... Date .......October. .18~ ........ , 19.73 THIS CERTIFIES that the building located at . Nassau .l?oint .Rd, ........ Street Map No..Nassau. P~,Block No... J(X ..... Lot No...~.% ....... Cuf,~,hogue ........... conforms substantially to the Application for Building Permit heretofore filed in this office ~~d ....... Sept:., .28~ ..... , 19.7.2. pursuant to which Building Permit No. 6281Z.. ted ....... 8cpi;..28~ ...... , 19.72., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ... Prt.v. ate..¢ace~.~so~.), s.torage, l~l.d$.... The certificate is issued to .. ttor.t~ha, l~as~l. ...................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...~:B.o. ............................ UNDERWRITERS CERTIFICATE No .... ~:~.° ..................................... HOUSE NUMBER .. 7.32[ ....... Stree~ ... N&~sal~ .P.o~.la.'l~ .It~811 .................. .............................................. Ctttcho gne ....................... ....... .......... FO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6281 Z Date ............................ Deoe~eF.....l~., 19....72 Permission is hereby granted to: . .E~.~.~h~...~'~.~ ~.~. ~. .............................................. .... .~.~.~.~ ~u .. ~.o ~uL ..~o~ .................................. ......... .g..~..~.~.~g~ .l~......~..t.~., ................................... ~o ..~.~,~ ..~e~...~C C~O r~....Cmto ~ag~ ;L ~u~,3/,~ ~. .............................................................. .................. P~P.I~;r.~.~.~...1~Y...]~.¢..~i~ p.~ a J, ~ ......................................................................................... at premises located at ...... ~Q~..~...~,~.....Ka~.-~a~,..~.r~t...~.;~op ..................................................... ................................ ~.~..~as~all..2alnt..~oaa ......... ff, u~h~f~e .............................................. pursuant to applicotion doted ............................ .~e~/L....2// ......... 1~2...., and a~proved by the Building Inspector. Fee $...~.Q..QQ .......... , ~ FORM NO. 1 'tOWN o:: SOU~,OL~\ SOUTHOLD, N. Y. ~ ....... ~i~fion ~o ................................ Examined ..... ~ ......................, 19~ ~-r~ed ~ .~ 't ..... ~ ~ .... .......... ~; ........... , ,, ........ ~,~, ,o ................................... -.. Oi~pprov~ a/c ......... ~m ...... ~ .... ~~ · : ..... ,, ................... ............................... ..... ........... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi 3 s~l:s 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, 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 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, Suffo[l~ County, New York, and other applicable Laws, Ordinances or Regulations, for the construction o buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable law= ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. State whether applicant is owner, lessee, ag (Signature of applicant, or name, if a corporation) .~....~.~.,.~......P...~.:..g..4..~..~.{-.~.~: ~...e_... (Address of applicant) nt, amhitect, engineer, general contractor, electrician, plumber or builder~ Name of owner of premises ..... 1~.~O,~ If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done.,Map No.: ~..a.R~.R.v....~.l/'Lot No.......~..~ .............................. Street and Number ......~.....~_...7.....~......¥...~.~,'~....~. L~.......P...o..(...~..~....~...~....-....~....~..~b.~M~v...~.~., ........................ r Municipality 2, State existing use and occupancy of premises ,and intended use and occupancy of proposed construction: ad Ex st ng use and occul3ancv ~.,,,~,,. I ~ ~- t-~ ~ Intended u~ and o~upancy ......................... ~. .............. ~ ....... ~.~ ........... ~ ...... .~.....~ ................... ~ Nature of work (check which appli ): New Building ........ d .................... Alteration ............... Repair ......................... Removal Demolition ........................ Other Work .................................... ......................... { Description) 10. 11. 12. 13. 14. Estimated Cost ....I, Lq..~....L~.. ......................... cee t .~...x ................................................. (to be paid on filing this application) If dwelling, number of dwelling units .................Number of dwelling units on each floor ......................................... If garage, number of cars ............................................................................................................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... Dimensions of existing structures, if any: Front ..................... Rear ........................... Depth ................................... Height .......................................... ~: ............... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front.......................... Rear ............................... . . ... ..,.. Depth ............................................. Height ......................................... Number of Stories ........................................ Dimensions of entire new construction: Front ...... j.~...l. .......... Rear ....... {...°....(. ............ Depth .......J.....~...~. ................ Height ............ .~. .................................. Number of Stories ...........°..t'Z~-~ .................................................................... Size of lot: Front ......... j[..c~....~.. ................... Rear ........... ./...o...~.. ...................... Depth .......;~...~..~;~ ................................. Height .................................................... Number of Stories .................................................. c .................................. Date of Purchase I Name of Former Own? ..... [~.;...~;.. ......... ..~. ~.. Zone or use district in which premises are situated ~z~ .~h ~+- ~ ~ ('- Does proposed construction violate any zoning law, ordinance or regulation: ...'~'...~.,,~ ................................................ Will lot be regraded ....... ~.....~-- .............. Will excess fill be removed from premises: [ ] Yes [ ] ~ ~ Name of Owner of premises ..... ~..~..~.....-~.....~. --'~.-...~..~...~'....~.. ........................................................................... (Address) (Phone No.) Name of Architect ............... ..~....o....~...~ ........................................ i~;~'~'~i .................................................................. (Phone No.) Name of Contractor ............ .../~..~J~---~ ...................................................................................................................... (Address) (Phone No.i 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, a~d show street names and indicate wheth- er interior or corner lot. ~oJf....~',~' N'~"/';:3,'T~'' N'c~.f,,...~'~ F::)o/~'lI~ ~l~ ~o~-~ Ie STATE OF NEW YORK.~ COUNTY OF .................... ,%..; ........................ i~k SS ......... ...~.....~.[~J~...~....~'....~.......~... ........ ...~... ........ ~.~ ..... being duly sworn, depo,s and says that he is the applicant above named. (Name of individual si~ing con~act) He is the .................... ~.~.~ ................................................................................................................................................................. % (Contractor, agent, corporate officer, etc,) of said owner or owners, and is duly authorized to ~rform or have performed the said work and to make and file this application; that all statements contained in this application are true to t~ best of hie knowledge and belief; and that the work will ~ ~rmed in the ~nner T[RR[ LEE set forth in the application filed therewith. NOTARY pUBLIC, State 01 New York ...................................... dayof ......................... Notary Public. ~~.~-.... County ........................ : .................................................................................. (Signature of applicant )