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Home My WebLink About6944-z1~0~ NO. 4 TOWN OF SOUTHOLD BUILBING DEPAR'~ Town Clerk's Office Southold, N. Y. Certificate Of Occupancy conforms substantially to the Application for Building Permit heretofore filed in thi.~ office dated .........~..C.:.. ~-... ?..~, 19. ?.~ pumuant to which Building Permit No...~. ?..~.~ dated O C~ ) ~ 19 ~ , was issued, and conforms to all of the require- ments of the~ap, plicable provisions okthe~.Law. The occupga!cy for which ~ds certificate is issuedis .................. h'~'d~/ lq Alii/i% b~5';5'[ ~ The certificate is issued to ........................................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... · . .... HOUSE NUMBER .............. Stree; ../. ...................................... Building Inspector FOB, M NO. s~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P'P, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 694 Z Permission is hereby granted to: ~o ..... ~..~....~..~..~.L~;I,~..m~..ax~.~l~m~ ........................................................... at premises located at ..~.a....ltg&l~lL;~llll~.(J[~l~ ..................................................................... ............................................................ .~.....t~. ...... ~.~;~.. ...................................... ~ .............................. pursuant to application dated ...................... J~l~t~....~.~......[~ ......... , 19.~..., and approved by the Building Inspector. TOWN CJ.ERK'S OFFIGE SOUTHOLD, N. Y. Approved ........................................ , ! .. Permit No. Application No ........................ DisapprOved o/c ...................... ................. ...................... ii..iiiiiiiiiiiiiiii.iiiiiii.iiiiii .'"// ............... ......................... APPLICAT'~ FOR BUILDING PE~IT Date ~o~. ~ 19 INSTRU~IONS d~ a. This applicatJ~ must be completely fill~ in by ~writer o~ in ink and s~mi~ in triplicate ~ the Bull Insp~t0r, with 3 ~ of pl~s, aocumte pl~ plan to ~ale. F~ aoco~ing to ~h~ule. b. P~t plan showing ~ation of lot and of buildings on premiss, relationship to ~joining premises or public struts o~ ar~s, and giv~ o detailed d~ription of Io~ut ofpr~e~ must be drawn on the diagram which is ~ of this applicati~. c. ~e work c~er~ ~ this a~licati~ may n~ ~ c~me~ed before i~uance of Building Pe~it. d. U~ ~el of this applicati~, the Building Inserat will issue a Building Permit to the applicant. Such permit shall be ~t ~ the pr~i~ ~ailable for in~ti~ ~r~h~t the ~ork. e. No buildi~ ~all be ~cupi~ or u~d in ~ole or in pa ~ for any pu~e whatever until a Ce~ificate of ~cu~ncy shall have b~n gmnt~ by ~e Buildi~ In~r. 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 demolitian, as herei.n described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, ~:J regulat,ons, and to admit authorized inspectors on premises and in buildings for necessary inspections. . ' . .~ (Signature of al~icant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Owne~- Cont~act~ . Name of owner of premises ...~.L"O.~'~.,../~a~.ris ............................................................................................................ If applicant Lg~ corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.i ........................................ Lot No ......................... Street and Number ........... ~'~..~.°....'~,~P...,~.~.Aa...~",Jg,*~.~'bU.(~k ......................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... .]~W..~.~.~LT~..~QI~.e ......................................................................................... b. Intended use and occupancy ..... ax~cLLY,£omal...D14el,~,~Za~:.a.p&o~ .......................................................... ~... Natum~f~work (check which applicable): New Building .................. Addition .....~ ...... Alteration Repair ....; ............. Removal .................. Demolition ........ .....~ ...... Other Work ..................................................... 4. EstimotedCost ....... $,~0g.0A.(~ .................................. Fee //~'--?~"~ (Description) (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. O me~s onS of ex sting structures, if any: Front .....~: .................. Rear ....... ~.4. .................... Depth ....... .~. .......... Height .......~..8..! ............ Number of Stories ...... ~,~r~ ..................................................................................................... Dimensions of same structure with alterations or additions: Front ....... ~J~....~,.~.! ........Rear ....~1,~. ................... Depth ....... ;...~. ~ ................ Height ...1..8..! .................... Number of Stories ..........,],~ ................ 8. Dimensions of entire new construction: Front 12.I. ........ Rear ..... ,~.2 .................. Depth ..~,.~1. ............... Height ...... .8..~. .......... Number of Stories .............~, ...................................................................................................... 9. Size of lot: Front ....... ],0.Q~ ..................................... Rear ..... ,1~....~1.~0.~. ............ Depth ...... ].~OS .................. 10.' Date of Purchase ...........'.:...1..c2~.], ................................ Name of Former Owner ..... ~.cl:L.bJl .~'~t~ ........................ 11. Zone or use district in which premises are situated .................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ]~O .............................................. t3.' Will 10t be regmded ....... ~O.:,.... ......... Will excess fill be removed from premises: ( ) Yes (X) No Name of Architect .............................................................. Address ................................ Phone No. : Name of Contractor ...~.tJ~O,.~...~.~..~.~,~{t .................. Address ................................ Phone No ....................... PLOT DIAGRA~ 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, and show street name~ and indicate whether interior or carrier lot. , / STATE OF NEW,,.Y,O~. ~' J ~ ~ ............................. .~..~..../t77.I.~ ............................. being duly sworn, d~poses and says that he is the opplicom (Nam~j/of individual §ignmng contracf) · above .named. (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 in this application are true to the best of his knowledge and belief; and ~,ha~ the work will be performed in the manner set forth in the application filed therewith. ; ' !:~rn to before me this JUDITH T. BOKEN ' -k~'- (Signature of applicant) Netary Public, Stale of New York / Ne.52-0344963 Suffolk Coun. t~ ' ' J "' ~ .... Commission JF. xpires March 30,