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Home My WebLink About6817-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . .SSem.fQl~a]~ .l~ ........ Street Map No. ~ ......... Block No... ~ ..... Lot No. ~ .... ~at~t~l.~....l~. ~.Y.,. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... &~ ...~...., 19.72 pursuant to which Building Permit No.~5¶~'S~ .. dated ......... ~..23 ...... , 197:~., 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 .....i~.~t..~.. &.e..~..~.~.o..~..b..~_~..1.5..J4~ .~$.~..a,.a.~...~.t.o..) ...................... The certificate is issued to . Y~..&. 1~.8. lea,~ima,~k, f~,lo,~... ~x*a .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .].*.~.? .............................. UNDERWRITERS CERTIFICATE No ..... .~.*.Bt.~. ........................................ ttOUSE NUMBER .... .~4'..'].~ .... Street....~'.~. $.~..1~...]..~. ~ ............................ Building Inspector FOBM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6817 Z Date ................. ~ .............. 19. Permission is hereby granted to: ..... ~..~..~,~s...~.s,~.e.r. Lc.~..~,~r..~.o.~ .............. ............ .Xu~q2tm2tA..J[~ee4 ............................... ................. ~.~$.~..ug....k. ..................................... i... ro ..... ~.~9~.~r..~.~.~~.'.~.?~.~`~.~..~.*.?.?.~?~.~.~?.~ ........................... at premises located at .~../..~ ldes.~.~...ha....]:.~ ]~.Q..a.d 14at~uck N.Y. pursuant to application dated AU~ ~ 19....~?., and approved by the Building Ir~l~:tor. Fee $ ....... 10.~0.0. ..... ~ Bulldm~ FOI~M NO. 1 TOWN OF SOuTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE WUT,OLD. N. Y. ........ /~ ~ Application No ................. .~.. .......... 19~~ ermit No . Disapproved a/c .~.......~ ...... ~.....~ ...................... ............. APPLICATION FOR BUILDING P/~IT Date INSTRUCTIONS ~ · This application must completely filled in by typewriter o~ in ink and submitted in triplicate to the Building~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ' b. Plot plan showing Io~. a. tion of lot and of buildings on premises, relat onsh p to adjo ning premises or public streets or areas, ana giving a aetaima aescription of layout ofproperty must be drawn on the diagram which is part of this applicat on 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 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 issuence of a Building Perm t pursuant to the Building 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 inspectors on premises and in buildings for necessary inspections. · {$jgna~tur.e ~f appli?o~or r~_me, if a'~"rl~ti;~i ........ ................... ............................... State whether applicant is owner, lessee, agent, architect, engineer,, general contractor, electrician, plumber or builder. Nameof owner of premises .~....~f~...~'~J~r~ ....~~..~ ~ ...... ' ' 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 be done. Map No.: ........................................ Lot 1~o ............. i ........... Street and Number~~~.~.~.....~~ ....... ................ ~.. /'~'/' ! ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use ond occupancy ..~ ...... * ........................................... b. Intended use and occupancy .~......~~,~,...~2.~...D'.... 3. Nature of work (check which applicable): New Building ...~ ..... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... ~. ,- 4~ .OO (Description) 4. Esti mated Cost 4~Q~'~.....~.~.~. ....... ~...~..~......Fe, ........ ./..P .............. ~ ....................... (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 ............................ 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 ....... ~ ............ . ......... Size of lot: Front '"~'/'~'"'~'~,V~--~ ................... '~ ................ Rear ..... ~...~.~:~..~. .................... Depth ..~..~..~....~'~,,~'~' Date of Purchase ~ ...... /..~.~'~ .................. Name of Former Owner~~.~../~_,~, Zone or use district in which premises are situated ..,4~-~-~.. . Does proposed construction violate any zoning law, ordinance or regulation: ~ ............................................. Will lot be regraded .,,~!~. .............. Will excess fill be removed from premises: ( ) Yes ( Name of Owner of premises .'~'-~',~..~.~..¢.'~f-~kddress ~ Phone No. Name of Architect ..............................................................// Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM distinctly 9J~ buildings, whether existing or proposed, and indicate all set-back dimensions from ;t and I~lock number or descriot on according to deed, al~ show street names and indicate 10. 11. 12. 13. 14. Locate clearl, property lines. Give whether interior STATE OF NEW~ I~e ,~ · /~ &L. · ,. COUN'I~ OF .,...~'~..~-~..f...Z....J'~'~ '~-/~,~7-~ /, ~ u~ ~ ...... ~*'~-~f~.-~--....L.~=~-~K4~...~. ........................... being duly sworn, deposes and says that he is the applicant'' (Name of individual ~ning contract0 · above named. He is the .....~ · ' (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 knowledge and belief; and that the work will be performed in 'the-manner set'~orth in the application filed therewith. Sworn to before me this ............. Of ....... ..................... , "'"- (Signature c~pplicant)