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Home My WebLink About6625-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificste Of Occupency No. Zg9~.~9 ... Date ........ ,7%m~. 7- ..... , 19.~+. THIS CERTIFIES that the building located at . 'Soln~d ¥1'e%r 'Av~ '&' Ho~%o~treet Map No. ~... Block No.~ . .. Lot No. -~ · --S~tBo~ ........... conforms substantially to the Application for Bulldog Permit heretofore fried ~ t~ office dated ....... j~s..] ., 19 73' p~suant to which Building Permit No. '6625Z dated ...... J~e ~, 19 g~, was issued, and conforms to all of the req~e- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P~iva~ swiping poo.t .wi~h ~eessorys ~ e~los~r~s ......... The certificate is issued to . Leo' ~ch ..... ~er ...................... (o~ner, lessee or ten~t) of the aforesaid build~g. Suffolk County Department of Health ApprovM · N-,R · ........... UNDERWRITERS CERTIFICA~ ~' '~'~6~3 ..... ~" ~" ~9~ .............. HOUSE N~ER 12~ . Street · - 'So~d' Vi~w- ~vs ..................... ..................... ................. ......................... B~d~g Inspector FORII~ NO. 2 TOWN O~ $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N:. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6625 Z Permission is hereby granted to: Leo..~t~sc~....~/~ ............................................. .......... ~o~t~ol~ ............ N-.~.~ ........................ to ..... J~;~at ..and-..~J~teJ~.~.".a~o.v.e...t~m~t ."... ~.rl~ata..m~ ~m~_~ ~..l~o3L .......... ar premises located at .......... ~01JZ3~L...~[;~L~..~k.~..~..~Zo~.tOJ~..~ .............................................. ............................................................. ~Ao...~ ................................................................................ pursuont to ~pplicotion dated ........................... ~T.~1~....~....~ ......... , 19.~.., ond opproved by the Building Inspector. ]~0~$ 7ool %o have self ¢los:L~g l~ate~t &J pO:Ll~t o~ ao~elle Fee $..t5~{~. .......... THE NEW YORK BOARD OF FIRE UNDERWRITERS SW BUREAU OF ELECTRICITY i' : I-- 85 JOHN STREET. NEW YORK NEW YoRK 10038 A, ril 24..7, ..p,,.,,o. No.o.,,,. N 1 55623 THIS CEI~rlFIES THAT only th~ ~l~tr~t~d ~q~n~t as described b~lo~ and lnt~ by t~ ~t ~ o~ t~ a~ ~ ~um~r in t~ p~ o] in the followlng location; [] Basement [] 1st FI. [] 2nd Fl. OUt S ~.de Section Block Lot wo~ exarn~n~d on ~ ~ ri l 2 ~') R 1~ 7 ~ and found to be in Compliance with the requirements of thls Board. RANGES iPEOAL RIC'PT I¢OOKING DC-CKS OVENS DISH WASlIIRS TIMICLOCICs BELL UNITHEATHS MULTI.oURET ..v,~ DLS~,,,.E:T I~;T~" OTHER AF~ARATUS: R V I C E EXHAUST FANS DIMMERS (Swimming Pool) Th18 certificate covers compliance at the date of inspection only. Because of uriusual environments it ls advisable to have frequent test and/or repairs made by a qualified person. ~o.uZate ~leetrie co. ~.'I'~:'GALO G 827 Middle Country Rd. ~mu~lw~~ ~[ Selden, New York 1178~ mNIOZM~ ~1 COPY FOR BUILDING DEPARTMENT. TH~ cOpy OF CERTIFICA~ MUST NOT BE ALTE~ ~ ~ ~NE~ Examined ..... ~,~./.~...~ ............... Approved ........................................ , TOWN OF SOUTHOLD BUILDING DEI)AKTMINT '~,L.~.,c, . "~ TOWN CLmK'S M'F,CE SOUTHOLD, N. Y. ... App ~ ............................... ..~ , ,rm,t (Building In-~)ector) / ,,~ %- APPLICATION FOR BUILDING PERMIT ,,~ ~ a. This a~licati~ must be completely fill~ in by ~ewriter ~ in ink and S~mi~ in tripl~ate ~ ~e Bui~l~l Ink,tar, with 3 ~ of pl~, accurate pl~ plan ~ ~le. Fee acco~ing to ~h~ule. b. PJot plan shying t~ation of tot and of buildi~s ~ premises, relafion~iP to ~j01nJng premiss or public str~ o; ar~s, and givi~ a detail~ d~ripti~ of I~ ofpr~ must be drown on the diagram which is ~ of this ~plic~. c~ ~e work c~ered by this a~lication may n~ ~ commeKed before i~uance of Building Permit. ~' d. Upon approval of this a~licati~, ~e Buildi~ Ins~tor will issue a Building Permit to the a~licant. Such permit shall be k~t on the ptemi~ ~ailable ~r in~i~ th~h~ the work. ' e. No building shall be ~cupJ~ or u~ in whole or in pa rt for any pu~e whatever ~til a ~ific~ of ~cu~n~ shall have been granted ~ the Building In~or. APPLICATION IS HEREBY MADE to the Building Department fo~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, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for~ removal or demolition, as herein de~ribed. ~T~e .a. ppl!,cont ag. rees to comply with all appli.cable laws, ordinances, building _code, housing cede, and regulations, and to mir auTnorizea inspectors on premises and In buildings for necessary insl~ions. / ~-~ · ........... ,~, .............. ~....~..~-~....~ ..................... .; ........ (Signature of ~pplicant, or name, ,f a corporation) ............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general cohtract0r, electrician, plumber er builder. If applicant is a corporate, signature of duly authorize~ officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No.~....~:..;...~' Other Trade's License No ............................................... ,~,//x~q ~ ~/ 1. Location of land on whicJ~proposed wor~k will be~done. Map No.: ..~ ........ , ................ ,~ ........ Lc~t3No..................~...... Street and Number~....~.~..~ ......... ~.~......~...~.......~...~. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ........................................................ ~ . ....... ;. .................................................... b. Intended use and occupancy ......... ~......~~:~...¥....~ N~ture of work (check which applicable): New Building ................. Addition .....~/ ......... .Alteration 'Repair .................. Removal .................. Demolition .................... Other WorkC~,/~......~...~.....-- -- 4. Estimated Cost ............................................................ Fee ..................................... ~....~ (to be paid on filing this applicoti~) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each. floon~.~. .......................... 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 od~iitions:~ Front .................................... Rear ............................ Depth ................................ Height .....; ...................... Number of Stories ................................ 8. Dimensions of entire new construction: 'Front ....................~ ............... Rear Depth ........................ Height .................... Number of Stories ............................................................................................ 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ......................................................... Nome of Former Owner ........................................................ ! 1. Zone or use district in which premises ore situated ................................................................... 12. Does proposed construction violate any zoning tow, ordinance or regulation: ........................................................ 13. Will lot oe regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises .................................................... Address ................................ Phone No ....................... Nome of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proPosed, and 3ndicate all set-bock dimensions fram according to deed, ahd 'show street names and indicate property lines. Give street and block number or descr pt on whether interior or corner lot. I~., ~ STATE OF NEW' COUNTY Of~) .................. ~ ........................................................................... being duly sworn, deposes and says that he is the applicon, (Nome of individual signing contract~ 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 fo make and file this application; that all statements contained in this application are true,J~,the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the Opplication f)lecl,)therewitJa~ Sworn to be.f~'e me this .......... Nota ........................ ............................ (S~'gnoture of applicant)