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Home My WebLink About6522-zTOWN OF SOUTHOLD BUILT~ING DEPARTMENT Town CAerk'8 Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~k~e.~l~d.~..~ ........ Street Map No~a~.~J~IA. Block No...~ ...... Lot No. ]~ .........~O~,~O. ldt..~,~, .... Park conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........Ape'S,3..30~., 19.73. pursuant to which Building Permit No..6~79~. dated ...........~kP~'~.. 30~., 19. ?~, 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 ... ~O~e. ~,~d ...................................................... The certificate is issued to . .~.e~e~.~. ~e~' .................................... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER . .~ ......... Street. ]~.~et~tmtt. J~O~ ..................... ........................................... 8m~t,,ho3.~,~ .1/'o~.,....L1.gTJ, .......... Building Inspector TO~N OF $O~TNOLD BUILDIN~ DEF~RTMFNT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6522 Z Date .......................... A~'ri'l' ....... Permission is hereby granted to: .. ~'me~l...&.. A~rzLeazz~ .... t~e ~b e,~ ...................... ............ So~;hol~L ................................................ to ..huJ-L~..~e~..ac~e~o~.~...¢~tor~ge.)...bu~.l~.$ag .............................................................. at premises located at .....~.~)~6...st~; ....... 811t~,~"J:e][d'-'~Z~l¢ .............................................................. .......................................... ~ai~a~..~t ........... $o~the~ ....................................................... pursuant to application dated ..........................&p'~$t ........ 30'"", 19e/L~'"', and approved by the Building Inspector. Fee $.1C1.~0 ............ Apprc~ed ........................................ , TOWN CLERK'S OFFICE ,~ ~ (~ SOUTHOLD, N.Y. ~ ,~,~,~ ~ . , . F ................................ ./ Disopproved o/c ............................................................................................ ......................... "'iBuildi--ng Inspector)/ ............ APPLICATION FOR BUILDING I)ERMIT 0 Dote . .... ...~..~.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit ~h~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an _d:'~ giving a detailed description of layout of property must be drawn on diagram which is pert 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 pert for any purpose whatever until a Certificate of Occupencv 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 Z 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, i~ a corporation} ......... {Address of applicant} State wheth~applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a 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 .................................................. l ._-~... /'~,a~ ~,~ / /c 1. Location of land on which prop, ol~d wo~rk w. ill be do. ne.,~lap No~~..~l:ot No' ...~.~. ............... Street and Number ~..., ~,~.w.~.~v¢.~.,.~.~-..~;l~T~7/f~I{/f ('~'~- ~:,,~1....~ ........ ~=/-~.~..~:.~-...: ........................................ Municipality 2. State existing use and occupancy ~,j3)re/~ m~i.se~,nd_~:t~nded use and occupancy of proposed construction: a. Existing use and occupancy ';"~~~"7~/'~'~ ................................................................................. b. Intended use and occupancy ,~......~...~-~...~.....~4~...~... .................... , ....................... i- .................................. 3. Nature of work (check which apl31icable): New Building ........[Z. ........... Addition ..................... A teration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... C~ (Description) 4. Estimated Cost ............. ~ .~..~ ............. Fee ................................................................................................. (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 occuoancv, specify nature, and extent of each type of usa ..................................... 7. Dimensions of existing structures, if any: Front ....... ~...~.. ...... Rear ...... ~.~ .............. Depth .......~... ........................ Height ........... ~...~.;....; ................................ Number of Stories ......... .~.~..~ ....................................................... Dimensions of same structure with alterations or additions: Fr~ont .......................... Rear ......................................... Depth ............................................. Height .................... '~ ............. j ..... Number of Stories ........................................ D mansions of entire new construction' Front ~/..~. Rear ... (.0 ..... De~,~ / ~ 8. . · , .............. / ............ ~,,, ................................. Height ................. ~.. ............................ Number of Stories ................................................................... 9. Size of lot: Front ........... /~.,~......~ ............ F~ear .............. /..~..~.. ........ /;) ....... Der~h ........ ..Z,,~..~.... ............. d ............... 10. Date of Purchase ...~...~.~'..'./.~.. .....Name of Former Owner .,~Z/.~.....~..¢..~.~~ 1 1. Zone or usa district in(~ty6ich premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .........,~...-. ....................................... 13. Will ,o, be regraded ......../.~....~.....,....c Will,flxcqr/ill,be, r~q:mved from ~r~misas:_~] ,Yes ,~ [ ] No__ 14mName of Ovmer of premises ...~.~.....~.:..(~..~...~....~..~..~~/~f~;C//~, ....... f/..~.~..~..-.~/,.Z-- (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 sat-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 YORK,_ _ ) COUNTY OF ...... .<~.%,L ..~...~...~. ~..~.. .................... ) ~ (Narae of individual signing contract] He is the ......................... .(~...,k~,~..~..~-'-~ .............................................................................................................................................................. {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 ell 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. ....5.....o.. .................... dey ,,o -- ....... q'" ' - .......... ' ............................. ~ ' ($~nature of applicant}