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Home My WebLink About7011-zFOI~ NO. 4 TOWN OF $OUTHOLDi BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at 3/~..I~0r.th .Road. (¢B27.)... Street Map No.. Xx ........ Block No... XX ..... Lot No... xZ~.. ~.~utho;l.d.. ~.o.Y, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... D.e.e.,.. ~ ..., 19 72 · pursuant to which Building Permit No.. 7.Q11Z. dated ........... D. eC.. ~ .... , 19.7.3., was issued, and conforms tb all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P.z':l..v~te. ctwe~L].~,-lg, with. gar~g®. & .add'lltS. on...alad..fence. .......... The certificate is issued to . ]~L~cl~a~d. fl&sz®r, ftc .lg~.~e. ..... (l~ene~'s ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N.o.R... ................................ UNDERWRITERS CERTIFICATE No.. ~Noit. ...... ~ HOUSE NUMBER .. 5~8.0. Q ...... Street ...$'9?.t.b... 5,.o.a.~., .(.C..R27.) ................... ~FORi~I NO. 2 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) No. ?011 Z Permission is hereby granted to: ~h ~ct..&..R~1~b:Le...(~s se~'. ...... i-.. .~ ............ ......... Ro~.t~.3J~L ............................ ~ ................. ......... ~.e..o....g.~;t.~..~lL ;jLe.~..o..e...~.e.~.. ~ .o. ~..~ ............... ~ ........................................................ at premises located at ....~.~,.,~)-~:~,~,.J~ ....................................................................... .................................................... ~t~,t~o3~l,.... ~[ .,~:~ ........................................................................... pursuant to application dated ........................~..~,~.....,~ ............ L..., 19~.'.., and approved by the Bui.lding Inspector. Fee $!~.~...~...~.0......' ~ ~F. O0 Building Inspector ........................................ , 19 ....... Permit No .............................. Disapproved a/~ ................................. ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS completely filled in by typewriter De in ink and submitted in triplicate to the Building~ This application must be Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedu · b. Plot plan showing location of lot and of buildings on premises, relationship to adjo ning prem ses or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the 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. Nobuilding shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. HEREBY APPLICATION IS ng DePartment fOr the issuance of a Building Permit pursuant to the~,~l MADE to the Build 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. (Signature of applicant, or name, if a corporation) (Address of opplicant) State whether applicant is owner, leSSee, agent, architect, engineer, general contractor, electrician, plumber or builder. (Name and title o~ corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Nome of ~ner of premiss ....................................... ~ ..................................................................................................... If a~licant is a co~mte, sig~ture of duly a~horiz~ officer. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which propped work will be done. Map No.: //0~' Lot No. Street and Number ~'.~ ~'oo /~o~-~/ Munici~li~ State existing u~ ond ~cu~ncy of premises ~nd intended use ond ~cu~ncy of p~ed construction: a. ~isiting u~ a~ ~cupan~ ~ ~ ~ ~0~ b. Intend~ u~ and ~cu~ncy 4 3. Nature of work (check which'applicable): New Building .................. Addition .................. Alteration ..... ~ ..... Repair ..... ~ .........Removal .................. Demolition ........ ; ....... ,.. Other Work ...~..w.~.~.~....~.~.~/.C......~..e..f.....~..~.~....... (Description) 4. Estimated Cost ............................................................ Fee .......................................................................................... (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 ........... ~ .............................................................................................................................. 6. If business, commercial or mixed occupancy, speci~ nature and extent of each type of use .......... ~ ............. 7. Dimensions of existing structures, if any: Front: ...... ~...~. ............... Rear .......... .~..~ ................. Depth ..~,~..~. ......... Height ....... ./..~.. ............ Number of Stories .............~ .................................................................... L ............. .~ ............. Dimensions of sa,me structure with alteration~ or additions: 'Front .............. .~..: .............. Rear ....... ~ ................. Depth .......... ~.~ ................. Height ........ /..~i .............. Number of Stories .........~ .................... 8. Dimensions of entire new construction: Front ............. ~ ................... Rear ............. '--. .............. Depth ....... ~ ............. Height ......... ~ .......Number of Star~es ..... ~ .............................................. ~ ................................................. ; ........... 9. Size of lot: Front /~[ ' Rear ............. /..~.../. ..................... Depth 10. Date of Purchase ............... .~ ....................................... Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................... .~....,~...~.., ...................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........... ../~...~. ....................................... 13. Will lot be regr~aded ....~..~...~...'~ .............. Will excess fill be removed from premises: ( ) Yes ( ~<~N~o 14. Name of Owner °fpremises ............. ,~...~.../?~..~.. ........................... 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 proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, a0d show street names and indicate whether interior or corner lot. ' ' STATE OF NEW..y~'RK,//. ,~ Z~ ~: c COUNTY OF~?''~ ............................... ~../~. ........................................................... being duly sworn, d~oses and says that he is the applicam (Name of individual signing controcf) above nam~. He is the ................................................................................................................................................................................. (Contractor, agar, co~orate officer, ~.) of said ~ner or owners, and is duly authorized to perform or have perform~ the said work and to ~ke ~nd file this application; that all statements contain~ Jn this application are t~ to the best of his knowledge and belief; and .tha~ t~ work will be performed in the manner set fo~h in the application fil~ therewith. Swam to~e this ,, ~ _ ............. ........ . ........... ................................... (Signo~re of applicant) JUDITH T. BOKEN J4eta~' Public, State of New york No.52-0344963 Suffolk Coun~ Camm~sio~ Expires March 30, 19~..~