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Home My WebLink About6583-zFORH NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .F.lse. twood.. ?q..~.d. .. Street Map No.. ~x .... Block No. ~.x ........ Lot No. ?..x.. C.u.~¢h.o.g.~..~...It o.~., ..... 'conforms substantially to the Application for Building Permit heretofore filed in this office 'Jated .......... ~Y al , 19.7.3. pursuant to which Building Permit No. 6583Z dated i/ay 21.., 19 73, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ss~ed is ~riYa¢o on~ fa~aiZ~ a.~.?.~.~.~¢, v.C~h a.a.a.~,.~.~?.a .................. The certificate is issued to of the aforesaid building. Dr. &~qn. S.q.h.wa.r. tz (owner, lessee or tenant' Suffolk County Department of Health Approval lq, R, UNDERWRITERS CERTIFICATE No. po.l~.d.ing ........................... ~ 81+~ Street .~jk.e.eC..~..o.o.d..R.?.a.d. ...................... HOUSE NUMBER "87~ East Road Building Inspector FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTH*OLD, N. Y. BUILDING PERMIT (THIS PEP, MIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORE AUTHORIZED) N? 6583 Z Permission is hereby granted to: ~ ..... ~..z~~...~.~~....~ - ................ ~ ~.~.~..~.5~..~... ~o .................. ~.~.z.~.r....~~.~.~..~...~.~...~z/ ................. ~.~~~ ..... ~ ........ ~.~.~...~.~ ...... ~.~...: .............. ....................................................... ~.~o~...~.:~:. ........................................... Buildln~ In~ector. ..... Bui~ TOWN OF $OUTHOLD BUILDING DEPAI~TMENT TO~VN CLERK'S sOuTHOLD, N. Y. Examined .............. ~./,~/.. ....... 1 ~..~... Di.~pproved o/c ............................................................................................ Application No ....................... APPLICATION FOR BUILDING PERMIT Date ..... .~~...~..~. ............ ,I INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted ntr plic~te to the Building Inspector~itl 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, am g~wng 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 kel3~or 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 b~eer~ 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 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, ordinancas, building code, housing code, and ragu lations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premiseac~.~,..a~.,~.~,~.a~....J~.~....m~.~.~.~...~ ~ If aPplicant is a corporate, signature of duly authorized officer. ~Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No.....~Valg'~,y~..~¢~ ......... Electrician's License No. '"~.~..4r&¢~.. ~ ~13&~r~,~ -- Other Trade's License No...~ ............................................... 1. Location of land on which proposed work will be done. Map No ............................................... Lot No ......................... Street and Number ......'~...~.¢~..~..~.......~~...j~..~,~.~, ............ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Intended use and occupancy ......................~./. ................. ./...~......~ ........................ ~ "t~ 3.' Nature of work (check which applicable): New Building . Addi 'on ...... Demolition ........................ Other Work .................................... Repair ......................... Removal ......................... ~ (Description) 4. Estimated Cost ................. ~ ........................... Fee ......... i[~ '1~;; 'l~i'~l' ;;~' '~i'li;;~' ~'1; i;'; i:;~ii'~;~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 occupancy, spec~¥ nature and extent~f .e~ch ~pe of use ..... ~u~....v~ ....... .~ ............ 7. Dimensions of e~i~ing str,,uctur~, if e. ny: Front ...~......~...--...~.. ..... Rear ......~.,_..~....~...~.. ....... Depth ......~......~.....~.....~.. ........... · /~1~ "..~... /';O ~.O.~..~.'. Number of Stor es ~ ........ Height ...................................... ~ ............ ' ..................................... Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ............ ,~.._. ..................... N- rDljer 9irl,Stories .................................... 8. Dimensions ofz~re.~ne~construction: Frdnt ~'~ · t 3f.,/~ .'r .... Height ................................................. Number of Stones ......................................................................................... 9. Size of lot: Front ....~.~- ............... Rear ...................................... .~h~ ...... ~ .................. , ...... .Name of Form ncr --' . ....... 10. Date of Purchase, .......... ~.....,~... ........... 1 1. Zone or use district in which premises are situated ........... ..r..( ............................ ~..p ....................... , 12. Does proposed constructio,n~ola, te any zoning law, ordinance or regulation: .... ...........................' · ................................ 13. Will lot be regraded~,~=~.~.;.....,e... Will ex.cess~ll be[p,,movedfrom premises: [ ] Yes ~J, No .... . ~ ..,x..¢.~ ..~.~,~. M... In, ~../x~.~ . . , .... 14. I~lame o! uwner o~' promises ..................................................................................... ~ (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 set-back dimensions from property lines. Give street and block number or description according to deed, and show street name., and indicate wheth- er interior or corner lot. S~A~ O" ,~W VO"~, "COU,WO, ....... ~..~..~.,.~.~< ................. i.I .;S~. \ ................... ..~.~,~,~....C_.~.~.',.<,.. ........................ (Name of individual signing, Contract) being duly 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 t9 perform or have performed the said work and to make and file this application; that all statements conta ned n th s appl cat on are true'~'o the best of~l~s kno~vte~e an~ bel ef and tha~ the work will be ~rformed in the ~nner set forth in the application ~ed therew;th. . ~ ~ ~ ' :~ ' ~TERRI ~E E~K ' ~ ~ ~ ~ ~,. ~Y~BLIC. 3ta~'~New ~o~h ~ ............ ~L...~ .......... day of ............ ~.~.~.~ ............. ~o,,5}~i~ .... ~ ~ ~ ~ ,~ ~ ........... .......................................... ............... (Si~amre of applicant) , ~