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Home My WebLink About6379-zFORM NO. 4 TOWN OF SOUTHOLD BU-ffDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificnte Of Occupnncy No. ~576 "' Date ........... 0e.tober..181 .... ,19~. THIS CERTIFIES that the building located at . t~tlt~ .27! ........... Street Map No.. 'X]E ....... Block No .... X~ ..... Lot No....~X .... l~tt~tu~ ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... Fllbl't~l~ .~.g., 19.. 73 pursuant to which Building Permit No. 6~7~g · dated ........ ~..~t 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 l~,ued is ... l~ivate 'acoessol'y. (£~.). ~h~ certificate is issued to . .. John. 8~dorj..SI,, ................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .$,.1~,. .............................. UNDERWRITERS CERTIFICATE No. N,R, HOUSE NUMBER .... 7~7~ .....Street .. Coun.t 27 .................... 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? 6379 Z Permission is hereby gronted to: ............. .~.£.~/....~ ........ ~..I..~.C.~.~ .......................... · ..t.~.J.£ ......... .~. ~-.. r..~ .~ ..t~ ...,~.h; ........ ~.....~.~.£.~.~.~'. ....... Z ~..~ J......C.l~.~..,r.~ ...... C.~.t!.~.;:!.~....~ at premises located at ...... ~.~...L~..~...~..~.[....~.(~.~L~.....~..~ ............................................................................ pursuont to opplicotion doted ............................. ,,~.3.......~..(,'-..~..., 19~.,~.., ond opproved by the Building Inspector. Fee $...,L ..~. .............. Building Inspector FOBM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Appraved ........................................ , I9. DisaPProved a/c ............................................................. Pemit No ..................................... Application No. ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUC'I'IONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witl~- -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, anql. 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 shell be occupied or used in whole or in pert 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 County, New York, and other applicable Laws, Ordihancas 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, a.nd regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. .- ~' 'applicant, or na~:'i~; '~'"'"[orat.on) .......... z2',~,.'zz.~,~,~,..z2z~.~,../.,.,_~,./~,~...z/..?~..~.. (Address of applicant) State whether applicant is own e, agent, architect, entlineer, general contractor, electrician, plumber or builder. .*~.~.~.~ ............................................................................................................................................................................. N.me of ownar of prami.s ............................................................................................................ If appli~nt 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 ................................................... 1, Loc~tion of land on which proposed work will he done, Map No .............................................. Lot No ......................... Strut and Numher. ~..~L~...2 2,..~ .~.,.5.. ..~,,.~,.:.X.~.~ & ........................................... Municipality 2. State existing use and occupancy of premise,s and intended use and occupancy of proposed construction: a. Existing use and occupanCy~'~.~.~..~..-:..-~.-~;~..~r~c~.-- .................................................................... i ........................ b. Intancleduse occupancy~'~.c~''''(''L~-~''~ ........................ i'~'-' and .-~.~::L -_ .. ,,. 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ................ Removal .............. Demolition ..... ;~ ................. Other Wo .................... (De~iption) 4. Estimated Cost .~.:~.o. .............................. Fee ......................................................... ; ....................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .~,t~. ..........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 ~/pe of use ..~,~.~.~.~e,~.~Q.~,~. 7. Dimensions of exiSting Structures, if any: Front ....~.~..~5 ........ Rear ..... l.~..~.~t..~.., ....... Depth .~,~..~.~..; ................... Ho~h~ ~,~ t~. . ......... Number of Stor es~c~.,/~- ....................................... Dimensions of same structure with~alterations or additions: Front ..... [.~,.~'..~. ........... Rear ...... L.~.......~.. ...................... Depth ...~'~.~..~ ........................... Height .................... .,~:-.'; .............. ; Number of Stories .~:~.~ ....................... 8. Dimensions of entire new conStruction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ............................................. 9. Size of lot: Front ......'~...~r~e.e.....F.~.~z~...... Rear .......................................... Depth .................................................. 10. Date of Purchase .~:).~,..~.~,..L~.~..=k- ....... Name of Former Own~.~.~....[~.~z.~.~.'r~ .................. ~,~.;.~ .................. 11. Zone or use diStrict in which premises are situated ..................................................................................................... 12. Does proposed construction vioi'ate any zoning law, ordinance or regulation: ~ ....................................................... 13. Will )ot be re~'aded -~, ............................ Will excess fill be removed from premises: [ ] Yes [~] No 14. Name of Owner of premises ~-~..~.~,~[n.(..~..v.~-k~.~..~Q~-.-~-~-~J~.~--,..~:-~. ........ ~..~.:.~."~'.~' ........... (Address) (Phone No.) Name of Architect ..~..~'~- ...................................................................................................................................... (Address) (Phone No.) Name of Cdntractor ..~.~c,~ ....................................................................................................... ;= ....... :.?.~ ............... (Address) [~hone ~oJ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exiSting or p[,oposed, an~.Jndicate all set-back dimensions from property lines. Give Street and block number or.description according to deed, and ~ow street names'and indicate wbeth- er interior 6r corner lot.' STATEOF NEW YORK. [ ) COUNTY OF .....~-.~.[~-~ .............................. ) ...~.~-~.~'~.....~L~R.~.....~-.['..; ............................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual s~gning contract) He is the .(~.~.~....: ...................................................................................................................................... ~: .................................................. {Contractor. a~ent, corpo~te oj~cer, etc.} of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this aPl~llcation; 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 there~th. ............... ......./I.day of Notary ............ ......... ....... ........... , ....