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Home My WebLink About6393-zFOR3{ ND. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~1+73 ...... Date ...... 8ep~.ember..20) ..... , 19 73. THIS CERTIFIES that the building located at . Pr;IV. ate. Driv~ ........... Street Fisherman's Beach Map No. Peconic. BayBtock No.. XX ...... Lot No.. 15.~..16 ..... Cu~;.chogLle ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated . Mar. eh. 8.~ ........... , 19.73. pursuant to which Building Permit No. 638~.. dated .... March .St ......... , 19.23., 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 .. Private..one. f.azail , .dwelLing ...................................... The certificate is issued to ...Jo~:t. 0 ~,~.e.l-; ........................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ).~.,~., ............................. UNDERWRITERS CERTIFICATE No.P.e.n.d Y}g ......................................... H 0 U S ~; N U M B ~; R.. !0.~. ...... S t ~e e t...F.$ ~ .h.e.r~gt.t. '. $.. ~9.a. Ct~. ~tg.a.~' .................... ........................................... eu~;ehogue ......................... Building Inspector FORM NO. 2 TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6393 Z Dote ......... .~ .~ ........... Building Inspector. Fee $/....~...~ FOB, M NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Pemit No ..................................... Applicotion No. ~' ~,F ,~ APPLICATION. FOR BUILDING PERMIT O Date ............................ .(~... .............. , , 9..~..........~kl~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. r~ b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and~~i~ giving a detailed description of layout of property must be drawn on diagram which is I:Jar~ 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~j~ 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 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 Zonel~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations for the constrUction o~l~J buildings, additions or alterations, or for removal or demolition, as'herein described. The applicant agrees to comply with all applicable law~ ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ,~. .S~ate whether applicant is owner, .lessee, agent, architect, engine ....................................................... .................... (Addre~f applicant) general contractor, electnman, plumber or broider. 'Name of owner of premises ,-~...~ J6 lm ........ ..~..! [~ ,?, ['/~ ~{ If applicant is a corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) 1. L~ation of 18nd on ~iah propo~d work will ~ done· ~p No.: ..................................................... Lo~ No./~.~ ....... ....... ~ [~ n' i h 2. S~a~ exi~ing uM and o~upancy of premiss and in~ended u~ 3nd ~aupancy of pro~ con.mellon: ' a Ex,ngu~and~cu anc . ~S,J~ ~/~ p y ........................ ..................... .................................... b. Intended um and ~upancy ............. ~.~.~.X.~.~.~ ......................................... ~ ........................................ ~ 3. Nature of work (check which applicable): New Building ....................... Addition ....~ .......... Alteration ............... Repair ......................... Removal Demolition ........................ Other Work .................................... .................. i Description) 4. Estimated Cost .....~. (to be paid on filing this application) r.~.~..¢;~ ....................... ...'~ Fee .....; ....... '.,.' ....... ' ....................................................................... 5. If dwelling, number of dwelling units .................Number of dWelling units on each floor ......................................... If garage, number of cars ............................................................................................................................................ 6. If business, commercial 0r' mixed occupancy, specify nature and extent of each type of usa ..................................... I / ' ............ Depth ...._7. .......................... 7. Dimensions of e.xis[[Dg/~tructures, if any: Front ....... ~...~.. Rear Height ...................................../~') ,,., ...... , ......... Number of Stories ...~ ............................................................... Dimensions of same structure ~ter~ or additions: Front ..... ~..,~. .......... Rear ....~...~.. .......................... '9 ,~ ~ /,~ / / Depth .......... ~.~...,.c~.. ....................... HeJ~l~,. .... ~. ........................... Number of Stories ~(.. ............................ ........ ~ ................ Depth 8. Dimensions of entire new construCtion: Front ...... ./ ........... ,,. Rear / /'~/ / .... Height ........... ~., .............................. Number of Stories ........../...~ ................................................ .~ ............. 9. Sizoofl;[ Front. Z~..O'..! ...:. Rear. ./..~.....~'. ..... , ....... Depth .... /....~..C) 5. ............ 10. Date of Purchase ......... l.....?....~....Z ....... ,Name of Former Owner ............... ..///...o,.YT. ........ ~'"q"/¢~"~"/'~/7 ........... 11. Zone or use district in which Premises are situated ........... ~..~..~.~...c~..~.~t.~..~./.- ................................................... 12. Does proposed construction violate any zoning law, ordinance or regulatiOn: ...... ~.~/..4~ ............................................ 13. Will lot be regraded .......... '...~.....O=, .......... ;. Will exces.s fill be removed from premisas: [ ] Yes [ ] No ..... f e Isas ....~...~..~q~l .... .~[~-1.~, ......... C.~..~'..~.~ff ..~,..~ .7.~..~."-~'.'.'~.. · ,o, r~ameo, uwnsrO pr m' . ......... r.w,~ ................ : .-~. ............... . ...v~-'~"~''' · ' (Addressl -- (Pnon~'.) ... , ~. Name of Architect ..................................................... .. ................................................................ ~J~n~"l~' ....... " Name of COntractor..~..~.F..T E ''~''' ' '~'''~' ...../~..-~.4.v/~ ..~.(~d~.&..°....~.'":~C.~-.:~(Address) / ...~.j.~.....~.r%.g.)....~.~...(Ph~e No. PLOT DIAGRAM I'ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from pr.(~Rerty'iines, Give street and block number or description according to deed, and show street names and indicate wheth- :~rJ.~ior Or corner lot. ~ o~ ~ · ~ X ~ ' W STATE OF NEW YORK,~ . ~ ) ~ COUNTY OF ............ ~.....) ~' ........... ........... ~......~ ............ being duly sworn, deposes and says that he is the applicant above named. (N~ oJ'in ~il~:~ll~gnin~ contract) (Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to perform Or ha~s psrformed the said work and to make and file this aplffiCatloo; thai all statements contained in thi~ application are true to the best of his knowledge and belief: and that the work will be performsd in the manner sat forth in the application filed therewith.