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Home My WebLink About6495-zFORM NO. 4 TOWN OF SOUTHOLD BUr~.DING DEPARTMRNT Town Clerk's Southold, N. Y. Certificate Of Occup;,ncy THIS CERTIFIES that the building located at .....C.]..e...a~v..l.?..A.V.?? ....... Street Map No..~. ~.~..~A... Block No .... ~ .... Lot No..8.! .......... .~?.~..l~...~d,' .N.: .~? .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........A.I~.Z~..1..~..8~.., 19.7~. pursuant to which Building Permit No...~. ?.~.Z.. dated .......... .Ap.l~..1..1. gj...' 19. ?~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to . .,~...t~...l~r..J.,...A.b.a.t..~ .................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER .... .1.0~0. ..... Street . .C.I.q.~.F~..i..~...A.~.$s ........................ Sou .t,h.o. ld~ Building Inspector FOR3~[ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISE: COMPLETIOIx OF THE WORK AUTHORIZED) UNTIL FULL N? 6~95 Z Permission is hereby granted to: ..... /~.~..~ ~... ~I~.~..¢.e.~ ........................ : ................ ........... .C...Z..e..~e..v.....~ .v..e.. ................................. ............... ~**~.~,~1¢~ .............................................. to ....... .~e.c.C...az~d..z~e-in.~5~.. a~...a~ce~ so~.F.. ~ ~e...b.~l~ i~g ................................. at premises located at ~O,t 8 ......~.~...~,~.~:~,e.~.¢...?.a,;E~. ..................... ............................... OT, d~J[*~J~,~r...~.v.e .............. So:u~ho2kt.....[~'.,JY., ..................................................... ,~r~,ont to application doted ................... ~.~. .......... !.~.....,..., 1~...~3., and approved ~y t~e Building Inspector. Application No. (..~....~..~.~' ..................... Approved ........................................ , 19... Pemit No .... .~....~..~.~ ....... .~PPLI~.ATION FOR BUILDING PERMI'~: , Date ................................ ( .... ,19 ..... INSTRUCTIONS a. This eg~lication must be completely rifled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi 3 sets of plans, ~ccurete plot plan to scale. Fee according to schedule. . b. Plot pl~ showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving 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. UlXm approval of' this application, the Building Inspector will issue a Building Permit to the applicant. Such permit,shell be kept o the premises available for inspection throughout the work. e. No building shell 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 Zone Ordinance of the Town of Southold, SuffoJk County, New York, and other applicable Law~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply wi~h all ~ppllcable law~, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necal~ry in~pactiona. ........ ........ .... (Signature, of 8~plica~t: o~/teme,/i~, corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ............................. .......................................... ........................................................................................ Name of owner of premises .............~'~....~.. ..~......~.~...../~,Jl~7~.,/.~ .~.....'~... ........................................................................... If applicant 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 ................................................... ~ ,~o ~ f i ,-~,, t f k II ne Ma No ~-~Pl/T;1 ! //:/. ~) .~'..,.~. 1. Locat'on o land on which proposed wor wi be d° . p ................... : ......................... Lot No ...... ~.. .............. v/ v L / Street and Number ........ L .~.......~.. ...................... ..~.......~. ............. .~...:~. .............. ...~.~...:....~....~...~..~ ............................ MunicipaliW 2. State existing use and occupancy II?~pre~intended use and occupancy of proposed construction: Existing use and occu n .......... J~ ~/~'..~.....~.O./~...~...~......~...,~ ~ · ........................................." · · · '"'"'""'""'"'""'""""'"'"'"'"" b. Intended use and occ .................................... ~`~~~~ 3. Nature of work (check which applicable): New Building ............... Addition ..................... Alterat'on:....t......,.., Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ............................................... Fuu ..... ~v .......................................................................................... (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 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 ......... · t I 8. Dimensions of ept,m new construction: Front ...... :~.~ ............. Rear ...... ,L..0. ................ Depth ...~. ........................... Height ......... .~ .......... ' ............... ~ ...... ",. Number of Stories .............~ ........................................................................... -~ Size of lot: Front ........ 'll,.,~lt~"l~": ................... Rear .......... ~..O...~../. ................... Depth ....... ~_ --r~).~r~'c'z~ .............................. 9. 10. Date of Purchase ......... ,P,~.~..r/[t~, ......... Name of Former Owner ................ ~'~ ..~....~.........~.~.t~.~..L.y., ..... .~,~. .......... 11. Zone or use district in which premises are situated ................ ~ ........ ~. ....... .['. ........... ~'Z ......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ ~..w. .......................................... 13. Will lot be regraded ................................... Will excess fil. l.,__, --,be removed from premises: [ ] Yes [I~;~o 14. Name of Owner of promises ....... ..~......~T~.. ~. ....... .~,~ ....... ..~.~../:l.f~.-4~./... .............................. 7.(e,,['..;./.~.~.~.3 .......... (Address) (Phone No.) ~ Name of Architect ............................................................................................ (Address) (Phone No.) Name of Contractor ....... ....'~. ~~ .............................. :.:.:.:....., ....... ; ............................ m: ....... :'"'~ ............... 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 names and indicate wheth- er interior or corner lot. STATE OF NEW YO~',/~,~.~ _ ) ~ .......................................................................................................... being duly sworn, d~po.~s and says that he is the applicant a~oYe named. {Name of individual signing contract} {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 true to the best..of his kno~edgeand belief; and that the work will be performed in the manner JUDITH T. BOKEN set forth in the application filed therewith. Notary Public, Stole of New York .................. ./.z ....... .....da. yo ........ Notary Publi~...~'..~.....~...... County .............. ~...'...~. ........ ~ ................ ~' {$tgr/ature~g applicant}