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Home My WebLink About6062-zFOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Cerfi[icate O[ Occupancy No.z~.~O2 ....... Date .. J1J~r. 2(~ ................. , 19.73. THIS CERTIFIES that the building located at . 2.0.0...).~],9¥..~.qn.~..~.~..~$... Street Map No. 338~ ........ Block No ........... Lot No ...... 2..2 .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated . .~ugua~;. 2~ ......... , 19 .~.2. pursuant to which Building Permit No.. ~0.?? .Z. dated . .Au~t. 23 .......... , 19.72., 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 .... P~4,va~e. $~.l~lllg .Poo~ .......................................... The certificate is issued to ..... ~r..~. ~.~. ~e~.Oy..0.~;~$.10.. ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ......... N.,R, ...................... UNDERWRITERS CERTIFICATE No. Pending HOUSE NUMBER ...2.0..0 ........ Street ....W.l.1..19.W..P..o.n.d....L~n..e.~...S.o.u.t.h..o.l.d. ~., .~.,.~.: Building Inspector l~ORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6062 Z Permission is hereby granted to: ~ &u..d,.o..~.......~.~:..-..:...T.r...,...~...~..~. .......................... ...~ ....... ~.~.~ ........ g~.~.~.../. ....... at premises located at ............................................................................................................................ ...................... ~ ............... .~ ........ ~.....~ .................................................................................... pursuont to opplication dat~:l /~' ~" 19'~.......~-., ond opproYed by the Building Inspector. Fee $:..../...~.~-~...~... PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADING LOT .... DRIVEWAY CONSTRUCTION ...... CESSPOOL CONSI'RUCTION ..... CELLAR CONSTRUCTION OTHER '-~0 o ) Building Inspector FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomined ...................................... , 1 ..... ^pprove ................... 1...2. mifNo ...... ~sapproved a/c ...................... ~ ..................................................... (Building Inspector) Application No. ~D ~ ~)-~ APPLICATION FOR 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, with 3 sets,elf plans, accurate plot plan to scale. Fee according to schedule. b. P'Jot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and 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 availabJe for inspection throughout the work. e. No building sbell 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 Building Department for the issuance of a Building 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, 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. State whether a,~cant is owner, lessee, agent, ~t, engi eer,.gene I contractor, electrician, plumber or builder. ,a me o, owner o,' ............. If applicant is a corporate, signature of duly authoriz~d~of~ic~r. ~ ......... ~ ........................................................... (Name and title of corporate officer) 1. Location of land on which proposed ~vork will be don~,~Vlap No,; ........... ,, ........ ..~....~..~ ...... Lot NO ............. Street and 'NUmber ......~. ~).~iiiii~..~......~?~... ...... ~ ...... ~ ............. (-~ Municipality 2. State existing use and occupancy of premises and~intended use an~ occupancy of proposed construction: a. Existing use and occupancy ......... ~ ............................... ; .................. 7~ ......... ;; ...... b Intended use and occupancy 3. Nature of work (check which applicable): New Building ....................... Addition ......... ~on,.,.,y ....... ;. Repair ..... · Removal ......................... Demolition ........................ Other 4. Est,mated Cost ...~.~I ~..~ .................... Fee .......................................................... ~ .o.n...~......~... ~ (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, 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 p~emises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~..:. ............................................ Will lot be regraded ----~[~...~ .................. Will excess fill be removed from premises: ~ Yes [ ] No 14. Name of Owner of premises ........ i ........... 7~,~......~...~. ,,~*.., .... . {Phone No.) Name of Architect ......~,....;....~,.....). ........ ~:~ ........ ~7-~'"~'*".'"'"~,~J~-~';~' ....... ~".' ........ ~ ........ i~;~"~'~'.i'"'~,"~'~,'"~_~ Name of Contractor ~ ...... ~ ........ ,~..;...~ ....... ~...~-..~..~.~.~.~..x[r -- (j {Addr~fs) 0 U (Phone No.) PLOT DIAGRAM I'ocate 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. ' {Contractor, a~nt, co.rate of~cer, etc.} of said o~r or owners, and is duly authorized to ~r{orm or hav~ ~rform~d the said ~ork and to mak* and fil~ this a~lieation; that all stat*m~nts eontainad in this a~lieation ar~ tru~ to t~ ~st o{ his knowlad~ and ~li~f; and that th~ work will ~ ~dormad sat forth in th~ ~lieation filad therewith. [~g ~ .......... .................... ....... ........ _ , _ _ ..................... ~~ ~ ~ (~mr* Ol appl~cantJ