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Home My WebLink About5987-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificste Of Occupnncy No. ~..~ ...... Date ....... $.ep.t..e~..~.e.r..~.9, ...... , 19.~3. THIS CERTIFIES that the building located at . .6.~.0..B.~..A.v. 9.* ............ Street Map No....X~. ........ Block No.. ~ ...... Lot No...;~. .... .G~l..~..(~0.. ~..e ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ .J'.~. Y..~! ...... , 19..~2. pursuant to which Building Permit No...~9.8.~.Z.. dated ........ .~.~. Y.. ~ ....... , 19.~.., 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 ...1~..:[~a.~;.e..A.e.¢0.~.~.o..ry..b..u~. ~.d.]..n.g ....................................... The certificate is issued to ...1~_~..e.! .~..X.:..~.a.~.l...11~... ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... 1~,i~'~ ........................... UNDERWRITERS CERTIFICATE No ..... I~.I~. ........................................ HOUSE NUMBER... ~.6.~0 ..... Street ......B.~..~.~.0.. ................................... .............................................. Cuteho~ue ........................ Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 5987 Z Permission is hereby granted to: ~ ~ .. .......... ~_:...-...:..~:~.....;.~.....~..~2:~.~o~ ,o ............. ............ ~2..~ ................................................................................................................................... ~ at premises I~ated at ....~-2 ............ ~.~.-,~ .......:~...; ....... ; ........................................................... ...t ......................................... '.........2~:~Z,:,.,~: ............ ~.~. ................................. pursuant to application dated .................. ~.: : ............., 19. . and approved by the Building Inspector. Fee $/. ...................... FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Examined ....... ~ ......... , ] 9.?.....~ Approved ........................................ , 19 ........ Pemit No .............................. Disapproved a/c ...... ~ ...... ~~. ....................... App,co,ion ............ APPLICATION FOP, 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, witl~kJ~) 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 o~' public streets or areas, 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 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 been granted by the Building Inspector. ./~,PPL_I_CATION 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 Count,/, New York, and other applicable Laws, Ordinances or Regulations, for the construction of bu$1dings, 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, oFn~, if a corl~at_io~ ~,~.~, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~.~..~..~...C..~..'.~.....~.,....~...~...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 N~.: ..................................................... Lot No ............. Street and Number ....J~....1~.....?..{~. .... ,. ~[.~...~,.,....C~' .~..! ......... ~.~....~, ........................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existi~g usea~docc~pan~y~3*/~-~-~j~`~L~-~-~-~-~1?~w~/~-~jI''"''' ~" -- ........ ~.¢;~Z/.~ ............................ b. Intended use and occupancy .............. 3. '-~lature of work (check which applicable): New Building ....................... Addition ..................... Alteration .............. .~ Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... 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 usa ..................................... 7. 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 ........................................ 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. 10. Date of Purchase ..................................... Name of Former Owner .................................................................... , ....... 11. Zone or usa district in which premisas are situated ..................................................................................................... 12. Does proposad construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ..................................... Will excess fill be removed from premisas: [ ] Yes [ ] No 14. Name of Owner of premisas ....................................................................................................................................... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ................................................................................................................................................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposad, 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, ) SS COUNTY OF ...................................................... ) .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the ................................................................................................................................................................................................................. {Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly aJ/~r~z~cl~.rl~rfor~,pr have performed the said work and to make and file this apl~lication; that all statements contained in this appli~ ~le~¢rtieat~ ~t~,.a~u°~_ his knowledge and belief; and that the work will be performed in the manner set forth in the application filed them~i~i~.449a3 .................... ......... ..........