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Home My WebLink About6991-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF No Z--23026 Date THIS CERTIFIES that the buildin~ Location of Property 400 SU~RLANE House No. County Tax Map No. 1000 Section 78 Subdivision JUNE 2, 1994 STRUU-,.uRES SOuTHOLD~ N.Y. Street Block 9 Lot 22 Filed Map No. Lot No. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated SEE NOTE BELOW pursuant to which Building Permit No. SEE BR~X)W dated SEE NOTE BELOW was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH ADDITION & ACCESSORY BUILDINGS * The certificate is issued to JOHN S. RAGSD~T.R & SUSAN NEVERS ( owner s ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R. VILLA- 4u~.Y 1969 UNDERWRITERS CERTIFICATE NO. N-748719 - ~u~.Y 30, 1969 PLUMBERS CERTIFICATION DATED N/A *NOTE: THIS CO UPDATES CO Z-7141 DATED JULY 28, 1976 FOR BP ~ 4244Z - (DWI~.T.ING & ACCY BUILDING) BP %4891Z - (ACCY BUILDING) - BP ~6991Z -- FOE~ NO. 2 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) 6991 Z Permission is hereby granted to: ...... ..... ~o .... ~.~.~..D. ........... ~. ......... ~.C~...~.~.~.~.~.~. ....... ~.L~..9..L~.~ ........................ nt premises located at ............................................ .~ ..................... ,/. .................................... .~ ................. .................... :...~...~ ......... .e....~. ....... ~....~AY...~..,..~..~: ....... ..?...~.~.~.~...q..~ .......................... pursugnt to application doted . /~ /(V"'~'...~., 19Z..~....' and appro~,ed by the Building Insl~ector, Fee $...../.~...~ ...... Building Inspector Examined ....................................... /, ! ........ Approved FORM NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. ........................................ , 19 ........ Permit No .................................... D,sapproved a/c .......................................................................................... (Build~ng Inspector) APPLICATION FOR BUILDING PERMIT Date .: ............... .~.,~..~..~.. .......... (....b..., 1~.. INSTRUCTIONS o. This apphcot~on must be completely filled in by typewriter or in ink and submitted in tripJicote to the Buildin, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of Jot and of buildings on premises, relationship to adjoining prem,ses or public streets o areas, and g~ving o detoded description of layout ofproperty must be drawn on the d~ogram which is part of this appiicotior- c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d Upon approval of this apphcation, the Building Inspector w~ll ~ssue o Budding Permit to the applicant Such permi shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or ~n part for any purpose whatever until a Certificate of Occuponc shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances o Regulations, for the construction of buddings, additions or alterations, or for removal or demolition, as herein describe~_ The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulations, and t. admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budde~ Name of owner of premises ..... ~.'~'..22..~..~ .............. ~ .... ~:.L2.' ......... ~..~....~..; ............. ~'..~,, ............................... If opphcant is a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................ Electrician's License No ............................................ Other Trade's bcense No ...............................................q'x~%,~ ..~..:....~..' ~ , I. Location of land on which proposed work.~w,II be done. Map N~?.~'~ ......... ~..d:~.¢..~kot No..%~..:.....-:¢.. .......... Street and Number ...... ..~.....~.-...C~ ........... .~.~2..~.:..,O..~..V...'.'.~ .......... .~:.~ .......................................................................... Municipalify 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Exisiting use and occupancy ........................................................................................................................... b. Intended use and occupancy ........................................ ..~....c...~..~....~ .................................................................. 3. Nature of work (check which applicable) New Building .................. Addition ............. Alteration .... ', Repair .................. Removal .................. Demoht~on .............. Other Work ........................................ (Description) 4. Estimated Cost .......................................................... Fee ........................................................................... (to be pa~d on filing th~s application) 5 If dwelling, number of dwelling umts ......................... Number of dwelhng umts 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 D~mensions of existing structures, if any: Front ......................... Rear ................................ Depth .............. Height ........................ Number of Stories ............................................................................................... D~mens~ons 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 Stones ........... : .......................................................... 9 S~ze of lot: Front ........................................................ Rear .......................................... Depth ............................ 10 Date of Purchase .............................................. Name of Former Owner ......................................... .~ .... 11. Zone or use d~strict Jn which premises are situated ......................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation 13 WHI lot be regraded ............................ WHI excess fill be removed from premises ( ) Yes ( ) No 14 Name of Owner of premises .................................................. Address ................................ Phone No ...................... Name of Architect .......................................................... Address ................................ Phone No ...................... Name of Contractor .............................................. Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~sting or proposed, and indicate all set-back d~mens~ons fran property lines. Give street and block number or description according to deed, and show street names and ind~cat: whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................................ ............................................................................................... being duly sworn, deposes and soys that he ~s the apphcaq (Name of ~nd~wdual signing contract') above named. He is the ............................................................................................................................................................. (Contractor, agent, corporate officer, etc) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and th~s application; that all statements contained in th~s application are true to the best of his knowledge and belief, that the work will be performed in the manner set forth in the application filed therewith Sworn to before me th~s ..................... .., day of ............ , pub i~...~.....-./.~'. ~¢.,~u n t y~'~ ~''~' ~ .... Notary (Signature af apphcant) JUDITH T BOKEN Nolary Pubhc, Stale of New York No 52-0344963 Suff~lk~ Courl~ ~' r-c,,.-~,~s~on ~xp~res M:'ch ~0, 191~