The URL can be used to link to this page

Home My WebLink About6044-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTME~NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy NoZ~;3.~ ....... Date .J...t~...~.6 ................... , 19..7.~. THIS CERTIFIES that the building located at ...1.2..0Q...P..a~'..k~..a~. ........... Street Map No. I~21~.1 ...... Block No ........... Lot No ....... 7. .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .....A..u~l...~..7. ........ , 19..7.2. pursuant to which Building Permit No. 6~:t: Z dated .....~.t..7. ........., 19..7.?, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which tiffs certificate is issued is ~ivate ~ P~ol Charles R. Va~ Duze~ The certificate is issued to ........................................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....... .N., R, ........................ UNDERWRITERS CERTIFICATE No. HOUSE NUMEER.. ~..~. ....... Street.. ?~ .~..~..:..S.O.~..U~...X.d.:..~..?.:,.. ~..~.. FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 604~ Z Permission is hereby granted to: B ch~,rd Yal~t~er .......... &outkel~ .................................................. at premises located at ..... ~05 ................ ~O~,h:'~O~l~ ................. '.: ...................................................... ..... : ................ i., ................ ~'"~"~7 ......... .~ ~'0~o1.¢ ....~.;~.,. ................................................. pur'suant fo application dated ......................... ~l,.~...~. ....... .?. .............. 19..~.~..i, and approved by the Building Inspector. Fee $i~*~.~,I;~0 .......... PEILMIT INCLUDL:, TO REMOVE EX~ES~ [iLL FROM ABOVE PREMISES ~F_GRADING LOT ' '?NAY CONSTRUCTION ' CONSTRUCT FORM NO. 1 TOWN OF $OOTNOLD BUILDING DEPARTMENT' TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Approved ........................................ , 19 ........ Pemif No ..................................... Application No ............ Disapproved a/c ..... ................ ~. ..... (Building ..... 1. _~.. .~.::.. z, g~.~) ................................. APPLICATION FOR BUILDING PERMIT Date ........... Z~2. z~ ............................ , 19..~.< ....... INSTRUCTIONS a. This apphcatlon must be completely filled m by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b, PIct plan showing location of for and of buildings on premises, relationship to adjoinin9 premises or public streets or areas, and giving a detaded 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 Budding 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 been granted by the Building Inspector, APPLICATION IS HEREBY MADE to the Bugding Department for the isguance of a Budding 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, add~bons or alterations, or for removal or demolition, as herein described. The applicant agrees to comply witj~¢all applicable laws ordinances, building code, housm9 code, and regulations, and to admit authorized inspectors on premises and in buildings fo,~ecessary inspections. ........... ............................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, genera~ contractor, electrician, plumber or builder. Name of owner of premises ....... ~!).r.z.]~',!~(.{!!,,,~.r...~:(~,,rj....T!?,~*.z,.~.z.: .......................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer} 1. Location of iand on which proposed work will be done. Map No.: ..................................................... Lot No ............. Street and Number ....... .I.?J:~!.c,~,??,~,.~...!~.9.t~?).~.°..g.~.~..*.~..°,J.~..lJ',~?.~.d: .................................................................................. Municipality 2. State.existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy ............... (5.':¢J.!~.~,~,.~..D.9.¢.~ ..................................................................................... ............ v,,,u,, appJ~cable): New Building ....................... Addition ..................... Alteration.....~.~.Q~, Repair ............. . ............ Removal ......................... Demolition ........................ Other Work .................................... / ~'- ~ { Description) 4. Estimated Cost '7, ~o t ~[ 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 Wpe of use ..................................... 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 use district in which premiss are situated ..................................................................................................... 12. Does proposed construction vie(ate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded .................................. Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ............................................................................. ~ (Address) ~ (Phone No.) ........ ~ Pal_ lools Zt~c. Rte 2~A. }{ock~ Zoint ~16-1{~-~Q Name of ~ntractorJ ................................................................................................................................................... (Address) (Phone No,) PLOT DIAGRAM kocate clearly and distinctly all buildings, whether existing or proposal, 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. .......................................................................................................... boin~ duly s~orn, do~s~s and sags that ho [Name of individ~l ~i~ing contracO Ho is tha ................................................................................................................................................................................................................. ~ Contr~to[ agen[ corporate officer, etc. J of said owner or owners, and is dul~ authorized to ~rform or have performed the said work and to make and file this appli~tion; that all s~tements contained in this appli~tion are true to the best ef ~is knowledge and belief and that the work will be performed i~ the manner set forth in the application filed therewith.