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Home My WebLink About6770-zFON,M NO. 4 TOWi~ OF $OUTHOLD BI~.BINC, DEPARTlt~NT Town Clerk's Office Southold, N. Y. Certificete Of Occupancy THIS CERTIFIES that the building located at Ce~ate~. ~oad ............ Street Map No .... XT~ ....... Block No... XX ..... Lot No..2 ...E~t .,v,~,ol~ ............ conforn~ substantially to the Application for Building Permit heretofore filed in this office dated .......... ~tt].y. 31~t.., 19..~.3 pursuant to Which Building permit No. 6~.~.0Z.. dated .......... Au~,. ~r .... , 19..?~ was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P~.v~te. aoeeB~ory. ~a~ldS~$ ....................................... The certificate is issued to . Deea~. ~],],;~a~m ................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...l~O~. ~q~$~ ................... UNDERWRITERS CERTIFICATE No...~o..t. ,.e.q.~. ?..~. ............................ HOUSE NUMBER .. 23~ ........ Street .... Ce~nef.~.y. l~ad ...................... .......................................... F~t. l~lon ........................ Building Inspector IPOB~[ NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING I~ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6770 Z Permission is hereby granted to: · ..Dee e,'C~. ·, .Wil,Z.,1,&&~ .................................... .......... r,,am~..~?..a. ........................................... at premises located at .......~~..i~l~ .......................................................................................... ....................................................... h~t;../tt,~.t, oz~ .............................................................................. pursuant to application dated ............................. ~g,~r......~) ....... , 19.~,~..., and approved by the Building Inspector. Fee $.l~iJ~O ........... FOB~ NO. 1 TOWN OE SO~THOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .... ~....~. ...... ~ ......... , 19.?.....~... - A~proved ........................................ ~ 19 ...... P~rmit No ..................................... Application No. ~ ~7 0 Disapproved a/c .....-.,-,...,-,.,,-,-,-...,._,_,,,,,, ,,,.,,.,, .,: ................ (Bu~ drag nspactor) APPLIGATION FOR BUILDING PERMIT Date ..... ~-~ ....~..~ ..................... , ] 9.?..~ ...... INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and bf buildings on p~emises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the 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 s¥11 be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy~ shall have been granted by the Building Inspector. B ~PiPnLaICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the/ u' d' g 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, ordinances, building code, housing code, and regulations, and to admit authorized inspec, tors on premises and in buildl~gs~for necessary inspections. (Signature of applicaiqt, or name, if a corporatimq) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~lf..,~.~..~. ....... ~..., .~...~ ................................................................... 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 ............................................... 1. Location of land on which proposed work will b~e ti.one. Map No.: ...................................... ~ Lot No ......................... Street and Number ..... '.....(.,~..~l.~......../~J~ .................................... ~.d~:..~.....~'. ~'~_/..~.e~.' ............................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .......... ~..~..~ ......... . .~.~i ............................................................................. b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building Addition ~" Alteration Repair .................. Removal .................. Demolition .................... Other Work ................................................ _.~1[ 0 ~ (Description) ! .............................................................................. 4. Estimated Cost ............................................................ Fee ............ (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 occupancy, specify nature and extent of each type of use ............................ '~ ~1.~.4~ 7. D mens one of existing structures, if any: Front ...... d~ .......... Rear ....~....O.~..~..~. ................ Depth ./.~.~ ...... Height ~r Number of Stories I Dimensions of same structure with alterations or additions: Front ....-~ ............................ Rear ............................ Depth ........ .}..O...t.~..~ ............ Height .......... ~ .............. Number of Stories ......... /. ..................... 8. Dimensions of entire new construction: Front ........ .~. ......................... Rear ..}....2.....~ ................ ~ Depth ...~..~.~.~....~. ........ Height .....~... ............ Number of Stories ....... ./. .................................................................................... 9. Size of lot: Front .......... ~f.~.~. .................................... Rear ....... ff....~;Z~....~ ........................ Depth ......~_.?.o...~ .............. 10. Date of Purchase .......... f, ............................................ Name of Former Owner 11. Zone or use district in which premises are situated ................................................ ..~, ............... ; ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~.~ .............................................. 13. Will lot be;regraded ....... .~....o.. .............. Will excess fill be removed from premises: ( ) Yes (~) No 14. Name of Owner of premises ....~....~.~T..... Address ..~'..~..~.....~.....~./.~.~..~.. ..... Pl~e No..~.~.../~..~... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM - Locate clearly rand distinctly all ~ildings, whether existing or proposed, and indicate all set-bac;.k dimensions fram property lines. Give street and blocl number or description according to deed, and show street names and indicate whether interior or corner lot. OF COUNTY 0,~..~ ~i'" ............. ~...~...i.~.Z.4~.~...~.. be ng du y sworn, deposes and says that he is the applicant (Nome of individual signing contracf) above named. He is the ................................................ ~./~ ................................................... '! ............................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed fhe said work and to rr~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith· Swom,~b.~ me this ~, ~ ......... · -'" ...... JUDITH Z. aO~EN (Signature of applicant) Natae/ Public, Slate o~ New yolk Ne. ,52-0344963 Suffolk Count)' Cemml~ion IL~plm~ k/m~,J~ 30, 19.~