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Home My WebLink About6996-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 7..~89.3 ..... Date .. F~a~, 8 ..... , 19.7.3. THIS CERTIFIES that the building located at R. 0 ~;4,. 0l, iental .Ave .. Street Map No.. ~m Block No..Xx ...... Lot No.:~.. Fislao~.B · I sland...1~ ,Y.,... conform~s substantially to the Application for Building Permit heretofore filed in this office dated ..... Sept 12, 19.?~ pursuant to which Building Permit No. 6996Z. dated NOv '21 , 1973., 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~ivata. aha .f,,n~ ly. ~lliug .............................. The certificate is issued to .. O~;is Hom%. & -W~£~ · 0wner.$ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval II,R, .................... UNDERWRITERS CERTIFICATE Alo.. pelldin~ ...... 4 ........................... HOUSE NUMBER .......... Street ......................................... ..... .. Building Inspector 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) 6996 Z Permission is hereby granted to: 0~t 8.. &.. ,l~a.~ 3J~. ,V~.~ .............................. ...:...~e.~.,...~..a ~......~.,X, ......................... to .~"~..~..~.~..~.~..~...~.e....~..z.~..~.~.~.~.*....~...~.~..~.~...~.z...z.....~. .................. at premises located at .~/t.~.~.~......~/..~..,~l~Xt~]-..~ ................................................................. .......................................... ~.~.~.~....Z.~],~ .............. ~.~., ............................................................ pursuant to application dated ............................. ~t~.~. ...... .~,~. ...... 19..~., and approved by the Building Inspector. Building~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................................ 19 ........ Permit No. D~sapproved a/c .~ ...... ~....~. APPLICATION FOR BUILDING PERMIT Applicabon No.....~....?....~...~.. .......... INSTRUCTIONS Date Sept 12 19...7..3... a. This application must be completely filled ~n by typewriter or' in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocabon of lot and of build~ngs on premises, relabonsh~p to adloming premises or public streets areas, and giving a detailed descnption of layout ofproperty must be drawn on the d~agram which is part of this applicati, c. The work covered by this apphcabon may not be commenced before issuance of Building Permit. d. Upon approval of this apphcot~on, the Budding Inspector w~ll ~ssue a Bu~td~ng Permit to the apphcant. Such perr shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used m whole or in part for any purpose whatever until o Certificate of Occupar shall have been granted by the Building Inspector. APPLICATION IS HEREBY /VC. DE to the Building Department for the ~ssuance of o Budding Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other opphcable Laws, Ordinances Regulations, for the construction of buddings, additions or alterat.ons, or for removal or demolition, as herein describ, The apphcant agrees to comply with oll apphcable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (S~gnature of apphcant, or name, if a corporation) Fishers Island ~'T .~. 0,~ 35'0 (Address of apphcant) State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build C~zner - builder Name of owner of premises ...... .0.~..&..S.....]:.!.O..~.Z3. ....................................................................................................... If apphcant ~s a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) Builder's License No ..................................................... Plumber's L~cense No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1 Location of land on which proposed work w~ll be done. Map No ...... ..;:~.'..c ...................... Lot No ......~.?. ........... Street and Number ......... .................. Municipality 2 State ex~stmg use and occupancy of premises and in.~ended use and occupancy of proposed construction: a. Ex,siting use and occupancy rS~,,~'e- ling b Intended use and occupancy oaz, te ~¢ith addition 3. Nature of work (check which applicable)' New Build,ng .................. Addition ...X...~.~. ....... Alteration ...~X Repair .................. P~emoval .................. Demolition ................. Other Work ......................................... (Description) 4 Estimated Cost .......................................................... Fee ..J..~'.,..0..O. .................................................................... (to be pa~d on filing th~s application) 5. If dwelling, number of dwelhng umts ....... .O..D.?.. .............. Number of dwelling 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 Dimensions of ex~stmg structures, if any: Front ........................... Rear ................................ Depth ................. Height ........................ Number of Stories ............................................................................................................ D~mensions 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 premises are situated .......... ~.t..~..t.~....c~t.$~& ................................................................ 12 Does proposed construction violate any zoning law, ordinance or regulation ..... .~..O. ..................................... 13 W~II lot be regraded ..........EL0. ............. Will excess fill be removed from premises ( ) Yes (X) No 14. Name of Owner of premises ..0.~±.S...t.T,q~L ......................... Address ..g.:E.~,.~.:~.9,~...~l..ff..e... Phone No ..................... Name of Architect ................................................... Address ................................ Phone No ..................... Name of Contractor ...... .$.9,~. ......................................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exk~tmg or proposed, and indicate all set-back dimensions fror property lines. Give street and block number or descnpt~on according to deed, and show street names and indicat whether interior or corner lot STATE OF NEW XOI~I~, _, ~ S S ' COUNTY OF ..... ~..~..Z...z...o.&..tf. .......... ~ · ~.. .......................... .O..'l~.~q...'.L.~..O.~ ........................................... being duly sworn~ deposes and says that he ~s the apphcar (Name of ind~wdual s~gnlng contract) above named He ,s the ............................... .o.},.r~?...z'..-..~..?:.j:..~.c.]:.e..~ .................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the so~d work and to make and this application; that all statements contained m th~s apphcat~on are true to the best of his knowledge and belief, on tk, ar the work will be performed m the manner set forth in the application filed therewith Sworn to before me this ................ Z.~.. day of ......... ~ ............... 19.Z~ ~~..~ Notary Pubhc, . ................................................... County .. ~ ................ (Signature of apphcant)