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Home My WebLink About6506-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy blo....Z.9.~(5.7. ........ Date ....~.o.b..v~..~.z~...8 ................. ] 9 .t30 THIS CERTIFIES that the building .......................................... ~J.~'/~'S Location of Property .............. E./.~..~.e. r3..~?..o-.~...Ay.e.13.~..e' .a.~...~/.e.a.~...ITI.ap.b.o..z' .... ~..~.]..~.~.c]., House No. Street Hamlet County Tax Map 1~o. 1000 Section .... ,'I0. ..... Block .... 1 .......... Lot ...... 8 ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....A.p.r. + .~..2.4. ........ , 19.7.~. pursuant to which Bnild~ng Permit No .... .6.5.0.6. Z. ............ dated .... .Apgg;..2.tf .............. 19 7.~., 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 ......... .... AC~s. OTT'..1~4.5..~.~.~.n.g...(~. $,s.h..S..~97.a. gg, .~.a.q..e.s.,.. Ic.e Stg.xq.a.g.e~..e.~.9.,.)..' The certificate is issued to .......... F'galac:[.6. ~D.c~sr 9la .................................. (owner, ~ of the aforesaid budding. Suffolk County Department of Health Approval ........ .H./..R ............................. UNDERWRITERS CERTIFICATE NO .................. H../.R ............................. Building Inspector Rev 4/79 FO]I/~ NO. 2 TOWN OF $OUT~OLD BUILDING DEPARTME, NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERA41T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6506 Z Permission is hereby granted to: ............................................ ............ · F.:t. shere,..i.$.len(l. ................................. al premises located at .......E~.S...Ce~a~..A,~e..~..~e~,t;...Ha, b~:~ ............................................... ................................................ F~,sher-~..I, sland .............. ~]~¥~ ........................................................ pursuont to applicotion doted ............................. J~l:)r.~]~ ....... 2~..., ]9.,'.~,~, ond approved by the Building Inspector. Fee $ .'J-~ ~'..-~ ............ .. N,. -., TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .... ~....~....¥. ............, 19..?.?... Approved ........................................ , 19. . Pemit No .................................... Application No. ~/~'4) ~ Disapproved a/c ............................................................................................ ......................... ......................... APPLICATION FOR BUILDING PERMIT Date ............... ~.?...~.. ........ , 197...?. ..... 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 of plans, accurate plot plan to scale. Fee according to schedule. b. Pict 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 available for inspection throughout the work. e. No building shall 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 Count,/, 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, .... ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · Name of owner of premises ~A-~k/~..1:..~ .......... ..D...o..y...,~.....,~... ................................................................. If applicant is a corporate, signature of duly authorized officer. IName 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 ...... ,~........~:.. ........................... Lot No...~......~. ............... Street and Number ...... .(..m-.. ........................................ ~.:..r.. ............................................................................... Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy. ~?~4~/~`~-~/~V~!~5~~ ............... b. Intended use and occupancy ...~i..~...t~....~........~..!...~...1~......~....O...C...~..~.~..~....~....../..~..u...~..~...D...~.,,A~.(P....~.~..-~.~.. 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration.....~ .......... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... f (Description) 4. Estimated Cost ............................................... Fee ................................... .. (to be paid on filin~';'l~i;';'l~ii'~;'t'i~'i ............................... 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 occuDancv, specify nature and extent of each tv,e of use. ~.~.$~.A/~'~,~,~O r, T 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 ........................................ Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ............................................... . ..... Size of lot: Front Z.~.....7..:..~......-'~.. .... Rear ...~..~..~'.; .~.....~ .........Depth Date of Purchase ..................................... Name of Former Owner ............................................................................ Zone or use district in which premises are situated ...... .'...~...~ . Does proposed construction violate any zoning law, Will lot be regraded ............... ~ ............... Will excess f~l be removed from~3remises: [ ] Yes [ ] No Name of Owner of premises ...[,...~...~...O....~...1:..5.. ~...O. ~..~. ~ ............ ..~.~.~.~.~r..~...~.../-~ .~..~. ..................... (Address) (Phone No,) Name of Architect ...................................................................... ...................... .... )c Name of Contractor .................................................................... i~,;~'~'~') .................................... il~'l~'~'j~i ............... 10. 11. 12. 13. 14. 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, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORKe~ __ _ ) COUNTY OF .............. ~.t~.~ ~. .................. ) SS ................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing con_tract) He is the ....................................... ~...., .~,., .,~....~.-,,, [~. ............................. (Contractor, agen't~';~r~)~'~"a"C; ~y?;'e'~';'t'c:") ..................................................................... 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 that the work will be performed in the manner set forth in the application filed therewith. · (Signature of applicant~"-~r .......................... MOBIL PRODUCTS Fuel Oil - ~oasoline IX GSS ISLAND SERVICES, INC. FISHERS ISLAND, NEW YORK 06390 A~to Repairs Telephone 311 r ~.~n e Service DATE: (~$~,). c( hE~O~E bACKHLL ,G F. UN, ,~N OR S~AR~ ~KA BEeOR~ C~V~RH~G ~'~ LIN. *.,~T RESPONSIELE FOR OESIGN OR