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Home My WebLink About6576-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ottice Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .P.~.r.~.dlls~.. $h.o.~.~8. P~I ..... Street conforms substantially to the Application for B~g Permit heretofore ffl~ ~ this office dated . .. ~r. 26.. , 1973. pursuant to which Bufld~g Pemit No.. dated ..... ~. l~. -, 19 ~}., was issued, ~d conforms ~ ~ of ~e req~ ments of the applicable prov~ions of the law. The oceup~cy for which this ee~ificate The certificate is issued to ~l~. ~', .}J~.~..(.~ ~ .ap~iea~on..). ......... (owner, lessee or ten~t) of the aforesaid bmlding. S~olk County Dep~tment of He~ Approval N,R~ .......................... UNDERWRITERS CERTIFICATE No.. ~$ ................................. HOUSE NUMBER ~9~0... Street . Rara~se. Shores .Road .... Bffil~g I~p~ FORM 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) N? 6576 Z Permission is hereby granted to: W~'-'&'-Hw~n"~ar tin ........................................ ....... · ~..~i.s~Z.e-~.-~ve ..................................... ....... ~,...C~lda, e.~ ....... ~,J., ........................... to .. J3~i~d..aa..ad~.tic~n..~n.. ~ ~ s.ti~g.. ~e~ling. ............................................................ at premises located at .... ~ ....... ]~a;I.~ad~tts~..S~;l,.~s...l~c~ ............................................ ........................................................ ~tk~t~[.... K,.~., ........................................................................ pursuant to application do~ed .............................. A~.--..~-.--, 19-~-3-.-, and approved by the Building Inspector. Fee $.~.~(~ ........... Building Inspec_tor~ TOWN OF SOUTHOLD ,,~;~'~ )/~'~,/ /)~,~,,r-~( BUILDING DE~RTMENT~ ~ ~ ~.. TOWN CLERKS OFFICE '/~h~ ~ ~ ~ ~ ~UTHOLD, N. Y. ....... ...... . ................................. ' r H '~ ' p ·~ ' Di~rov~ a/c ...... ,~ t (Suildi~ APPLICATION FOR BUILDING PERMIT ............. I N$TRU~IONS ~. Thi* ~pplimtion mu~I ~ ~m~l~t~l~ fill~d in b~ ~rit~r or in ink ~nd ~ubmitted in tri~licat* to th~ Buildinfl Im~etor, b. ~lot ~l~n ~ho~in~ Io~fion of lot ~nd o~ buildin~ on ~r*mi**~, r~lation*hip to adjoinin~ ~r~mi~ or ~ublie ~tm*t* or ~i~in~ , d~t~il~d d~ri~fion of I~out o~ ~ro~ mu*t b~ drawn on diagram which i~ ~a~ of thi* ap~li~tion. ~. T~ wo~ ~r~d ~ thi* ~li~tion m~ not ~ eomm~nmd ~or~ i~uan~ of 8uildin~ ~rmit. d. O~n *~ro~l of thi~ ~limtion, th~ 8uildin~ In*~etor will i~u~ a Buildin~ ¢~rmit to th* ~limnt. Such ~rmit ?h~ll th~ ~r~mi~ ~il~bl~ for in*~etion throughout th~ work. ~. ~o buildin~ ~h~ll ~ ~u~i~ or u~ in ~hol~ or in ~ for ~n~ ~ur~o~ ~hat~r until ~ ~ifi~ of Oeeu~ne~ ~h~ll ha~ ~rln~ b~ th~ 8uildin~ In~or. ~I~TIO~ I$ ~8~ ~fi ~o th~ 8uildin~ D~rt~nt for th~ i~*u~nm of ~ 8uildin~ ~rmit ~u~u~nt to th~ 8uildin~ ~o~ Ordin~n~ of th~ To~ of ~uthold, Su~lh CounW ~w ~o~ *nd other ~lie~bl~ k~*, Ordin*ne** or ~ul~tion~, for th~ ~n*tru~tion ~uild~n~, ~diti~n~ or ~lt~r~tion~, or for mmo~l or d~molition, ~ ~r*in d~mrib~d. ~ ~li~nI ~r~*~ to ~om~l~ with ~[ ~li~bl~ I*w~, offiin~n~, buildin~ ~, hou~in~ ~, *nd m~ul~tio~, ~nd to ~dmit ~uthori~d in~etor~ on pmmim~ ~nd in buildin~ for ~r~ ~ C c~ ,.~ (Signature of applicant, or name, if a corporation) /~. (Address of ap~icant) State whether applicant is owner, le~, a~nt, archit~t, engin~r, general contractor, electrician, plum~r or builder. ....................... , ................................................. , ......................................................................... Name of owner of premi~ ....... ~/~. ........ .~ ....... ~a.:~.~ ...................................................................... If applicant is a corporate, signature of duly authorized officer. Builder's ki~nse No .......................................................... Plumber's License No ......................................................... Fleetrician's License No ..................................................... Other Trade's License No .................................................... 1. Location of land on which proposed, work will be done. Map No .............................................. Lot No.~...~..~..,..t .......... .IO.I, (~')'~ -', //~. ~'''~,, O ,,-~I/, /-~ I- ''F',', I', .-~'' ,'~] '~O Street and Num~:~~Z~`~.~/~//~`~/4~LF~`~)~~~ ........... / ! / Mdnicip~lity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy .................................................................. 3., Nature of work (check which applicable): New Building ....................... Addition ........ Alta tion Repair ......................... Removal ......................... DemOlition ........................ Other Work ................................... ...~..~. ' (Description) 4. Estimated Cost w..~... .............................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 occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of e.~(i~ting structures, if any. Front-e:~..[. ........ Rear ,.....~,:~ .............. Depth ..~.(~ Height ......... ~ ................................................ Ur' Number of Stories .~..,~,~ ................................................................ Dimensions of same structure with alterations or additions: Front ..~,~...(. ............ Rear ....,~...J. ..................... .......... ~:~(~ ............................. Height ...... x..~....., ......................... Number. of Stories~2.~..l~ ............................ Depth 8. Dimensions of entire new construction: Front .....~. .................. / Rear· ....... .~..../. ............ Depth ../~.../.. Height ....... ~.0. ............... ._....,~ .............. Number of Stories ...4~..~.. ................................................................. Size of lot: Front ....~....'"~'~ -- ..................... Rear ........ ~.~.....~.... .................. Depth ......----/.~.ff r ;~.~..F..a.~.~-.-'"'"".'"'"'"'"' 9. 10. Date of Purchase ...-~.....~....~.,~3 ...........Name of F~/q~m ~/_~/;t~mer~O nar .~'~3 .S....~t~..l~CZ~.°~...~.c~./'~.'--~ ~. ........... 11. Zone or use district in which premises are situated ..v..x~,.~4~.~./9~,~.~...[_.. ........................................................ 12. Does proposed constructi~p violate any zoning law, ordinance or regulation: ...~..0. 13. Will lot be mgreded -----~-~..~.w...t-//U ...... ..~.... ~ill e~fce~s fill be ~d f/'om premises:;;~LYes t,[ ] No~ 14. Name of Owner of premises ~1~.~.)3...~·~...~.r]l~.~.~'/.~.,.,~)~.~.'~..~'..~..~J~..~..~./~..~.~..~.~,~ ! (Address) ( Ph o n ~ N o. ) ~-~..~/-~ 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 prope~r.t~lines. Give street and block number or description according to deed, an.d show street names and indicate wheth- er~er_io~r corner lot. STATE OF NEW YORK, ) COUNTY OF ...................................................... ) SS .Lct ........ {. ......... ,. ..... ~1. ..[ ~... ......................... being duly (Name of individual signing contract) 3 I sworn, deposes and says that he is the applicant above named. He is the ................................................................................................................................................................................................................. (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 all statements contained in this application are tr~e tother~ ~fl~i~k~LTV edge and belief; and that work will be performed in the manner set forth in the. applicatio~ filed therewith. '~ROTj¥ PUBLI; OF N~W JERSEY the of ........... '.°. ................. ........ day ~976 .................... .... ......... ............................ ture of applicant}