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Home My WebLink About6601-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. ~1~+~. ..... Date ............ Se. Dr...1~ ...... , 19.73, THIS CERTIFIES ,that the building located at . Old' Cove. B.I.v5 ........... Street Map No.. ttass ...... Block No...xX ..... Lot No... XX .... S0~.th0ld...l~y.. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... May...21~ .... , 19.7-~. pursuant to which Building Permit N~O.1Z .... dated .......... May...21~ ..... , 19.7.~, 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~.ivat~. ~ .£~ly. dw~ll~.n~..(.~tl~ &dd~_tion~..storage ) ......... The certificate is issued to ...J.o..h~.. &..H.e..~en..F~..n.~.~. .... .o~..e.r.s. ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval '.N.o.R, ............................. UNDERWRITERS CERTIFICATE No.. ~.~. ........................................... HOUSE NUMBER.. "160 ....... Street ......0~].. C, OYe. ~'l.~rd ............................ 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) No. 6601 Z grant : ot,,re,-i.-,,o,:oted o,.....~'", fl~.~.=.~').~.~.-.,...~.~.~..'.>.. ....... ~.p...u....r~ ............................... .................................... ~ ........ ~~ .......... ~..~; .............................................. pursuant to application doted ........ . ...................... , ]9. , end approved by the Building Inspector. Fee $.../..~. ................. C I NO. I TOWN OF SOUTHOLD 'TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disopproved a/c ........................................................................................... APPLICATION FOR BUILDING PER~IT .~·~/'~ o~-.~ ~ INSTRUCTIONS ~ a. This application must lie completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3sets of illm~l, accurate plot plan to scale. Fee according to schedule, I1' .b. PI0t. ~ .I.~i.ng .,l~cati~o? of lot, and of buildings on prom,sss, .relationship .t.o adjoining premises or public streetl or ames, and ivlng_a, aediles aescrlgtlOn O.T Im/.o~t OT pr.operty must be drawn on dl.agr, am which il pert of this application. ~ c. rrm work covered I~f this apghcation may not be commenced before iuuarme of Building I~r'mit, d. 4Jpon apl~qval of* thi~ atN31ication, the Building Inspector will issue a Building Permit to the al~licant. Such permit,shall be kept o the gmmiml available for inspection throughout the work. grant~d,by'e' No buildingthe ~ulld~l~'~!l be,~eupledlnsl~ctor. ~r used in whole or in pert for any 13urPose whatever until a Certificate. of Occupen~/shell have beel~'ri7 O~iLICA~T~I~T~H~RE~B.Y.M..AD_E to the Building D~pe.~n~n.t ,.or,tbe~i~uan~ o~fa Building Permit purman, to the Build," Zone L..~? ~__m~. ~s ~m~ ? ~mo~l~ ~ Coun'e/, New Yom, eno otl~er applicable I. aw~, Ordinances or R~ulatlom, for the ~tru~tlen ef nanca~, ~uflotng ~, ~usmg coae0 eno r~ulation~, end to admit authorized inspector~ on pmmbe~ and in bulldln~ for ne~e~esy inspections. ...'g ............ (Signature ef M3plicant, or name, if a corporation) ....... ......................................... ?t' (Addm# of applicant) ~.~lat~.whether eppxJj~cant il. owner, lellee, agent, architect, engineer, general contractor, electrlclen, plumber or builder. ........ ,.....: ............ .................................................................................................................... of o ,r o, ................................................................... allN311cent Is &'~orporate, g gnature of duly authorized officer. (Name and.title of corDorate officer) Builder's License No ......................................................... Plumber's License No ............ /. ........................................... Electrician's License No .................................................... Other Trade's License No .................................................. 1. Location of land on which pr,oposed work will be done. Map No ............... ~Lot No...~ ................. Municil~ality 2. State exi~ing use and occupancy 0' ~l~.m.i.~s. ~)and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~ ....... ~....~. .... .~....~.....;:;.~. ...................................... b ntended use and occu nc ..... .-..~, 3~ure of....rk (check which appliceble): New Building ....................... Addition ........ ~ ....... A(teration......~.......~. ~ Repair ......................... Removal ......................... Demolition ......., ................ Other Work (Description) 4. fi~timated Cost ............................................... ~-ee ................................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwel(ing 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 use ..................................... 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 ........................................ 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 For~er~Ov~er...l ....................................................................... · 11. Zone or use d~strlct in Which premises are situated ..... ~ ...... ~.'. ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ ~ ......................................... 13. Will lot be regraded ..... ..~....,...~ ............ ~l/illla, xce. ss fill be removed fr,om premises: [ ] Yes [ ] No 14. Name of Owner of premises ....d.l~d~,.......~....~,.....~~ ............................................................... (Address) (Phone No.) Name of Architect ..........~__ ...... .~. ...................................... i~.~i;~.;;i..~H~.~.~ ......... ii~.~-~.~.~:i ......... , ..... Name of Contractor ...... .:.~.......L.~..~ ................................... ~.~...~. .......................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. G've street and block number o.r ~es~'iption aCco[dij~g tq deed, and show street names and indicate wheth- er interior or corner lot. ~ ~ ~1t, STATE OF NEW YOR ,1~ ~L/,~(~ ) .................... ~~~ ......................... being duly sworn, deposes and says t~at he is the applicant above named. (Name o£',£~' divi~gcon~racdivi ' in con ~ct] Heisthe ~L~~ -- . .............................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work end 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. ............................ day O~OtAR~.~SLic -Yme ....... 19 ........... · ~ uali ' t,0 ........... ~ .................. "~ ~ - ~{,Signa'T;~ra of applicant}