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Home My WebLink About6640-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate THIS CERTIFIES that the building located at Map No. ~' ..... Block No .... ..~. .... Lot No. Of Occupancy · ~. ~ ."':'"' /.II.. ., zg..2..Y conforms substantially to the Application for Building Permit heretofore filed in this office dated . .'~.....'-'..., 19.~. pursuant to which Building Permit No. ~- ~.7.f-- ~ c dated .... k,./ ~, ~ , 19.~.., was issued, and conforms to all of the require- l:aents of the applicable provision~of the law. The occupancy for which this certificate is Thecertlficateisissuedt°(~~'~''''y:-'''' (~'/'~ / '~"(owner, lessee ' ']]ortenant) ] '" .... of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No ...... '.. ~ .................. HOUSE NUMBER ..~ ! /~ ~.... Street ...~.-~ . A.'e'..'"A~.. ...................... Building Inspector FOR~ NO. 9. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6640 Z Date ........................ '~ze ..... ~ .............. , ]9?3-" Permission is hereby granted to: ........ · T~ s..-I~t~ ........................................... .................... ~u~h~gae .................................... ~o .g~.~.~.l~..~,C.~_~ta~1.~.~...g~oua~...s.~.~ ..... ~',~--~,f,~-.-X.-.2~.-~.-.~e- .................... ~t premises located at ....... ]~/~,.C~x...La~e,: ...................................................................................... ............................................... :. ........... ~..~____ ............................................................................... pursuant to application dated ..; ........................... e~.i.1.~e ........ ~' ....... , '10'~..~ .... and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. ~. ~ ~ ~( Examined ...... ~ ...... ~ .........19..~...~.. ~ C-"~ ! ~ Applicat,on No ....... f:.~..L..~..~.~ ............ Approved i 19-.~...'~ Permit No. (. (.r C~ O ;;L.~ ~ ,~2~.~... ..................................................................................... "'t.2' '7 D,sappro,,ed o/c . / (Building Inspector) Date ....... ......... JZ.. ............. , ,9.zz.... INSTRUCTION$ a. This apphcahon must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin Inspector, w~th 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adlommg premises or public streets c areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which ~s part of this applicatior c. The work covered by th~s application may not be commenced before issuance of Building Permit· d Upon approval of this apphcat~on, the Building Inspector wdl ~ssue a Building Permit to the applicant. Such permi 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 untd a Certificate of Occupanc 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 th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or afterabons, or for removal or demolition, as herein describer The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in buildings for necessaw inspections. ............. .................................... (Str~hature of applicant, or name, if a corporation) .......... ...... z,z., ................. (Address of ap~plicant) State whelher opphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde: If apphcant is a co~orate, s~gnature 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/,,,/f~,.j_jL_~Work wdl be done. ~ap .No 'i ................................... Lot No ....................... Street and Number .......... .%r. Oc~(..../._/~../L4e...i...~.u./. C¢.16,!¢_/..¢&~.. .................................................................. ~ ~ Municipality 2 State existing use and occupancy of premises and m.~ended use and occupancy of proposed construction' a. Ex,siting use and occupancy ....... .~.'~(..~./~..(~..~... ~.~/~[/.~.,.C..,~ ............................................................... q b Intended use and occupancy ...... ...~--0~..G~..~.~.~ ... 6.tt SJ ~.C~ ................ ~d.~/$/..~ ~l~ .. ~.~..0..~.~-~...~..~. t~.~ 3. Nature of work (check which apphcable): New Building .................. Addttion .~ ........ Alteration ..... Repair .................. Removal .................. Demolition .................. Other Work ......................................... ;~~ /"~ , ~,,~.,,. (Description) 4. Estimated Cost .....7.,~.C.~. ......................................... Fee ...... ..~..'./.~.~ ............................................................... '/ (to be pard on filing this application) 5. If dwelling, number of dwelling units ............... .~.. ....... Number of dwelhng umts 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 ....... .]1/..~. .............. Rear ...~..~ ........................ Depth .~... .......... Height .....-"/.¢ .............. Number of Stories ................... /. ...................................................................................... Dimensions of same structure with alterations or addmons. Front .................................... Rear ........... Depth ................................ Height ........................... Number of Stones ............................. 8. Dimensions of entire new construchon: Front ............................... Rear ........................... Depth .............. Height .................... Number of Stories ......................................................................... 9 S,ze of lot. Front ...... /..~..~,~.~. ............................ Rear ..../..~..~.,~.~. ................. Depth .~.~. ................... 10. Date of Purchase ............................................. Name of Former Owner ..... ~./~..~...~....~'..-~..~j?.~,c'-~,~ 11 Zone or use district in which premises are situated .... ..~.'.Z].. ......................................................................... 12. Does proposed construchon violate any zomng law, ordinance or regulation ................................ ~ ................... 13. Wdl Jot be regraded ....... .~f.~,--,~ ............ Wdl excess, fill be removed from premises' (,,~) Yes 14. Name of Owner of premises'. ~J~q~-~..../~.~..~.~.~...~.. ......... Address i~;y.&.¢...~.o~..,-~.~. Phone No.2,~.".t~.~.... Name of Architect .................................................. Address ................................ Phone. No ....................... Name of Contractor ........................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and dtstinctly all buildings, whether ex~ting or proposed, and red,cate o~1 set-bock dimensions from property lines Give street and block number or descnpt,on according to deed, and show street names and indicate whether interior or corner lot STATE OF NEW YORK, t.c c COUNTY O F- .'.?-~..'-A.'. · .~Z~.?..~..~ .......... ~' ~"~ ............. ~.~-~.~5..~x...~...~.....~..~.....~-~..~,..'~ ............................ being duly sworn, deposes and says that he ts the apphcant (Name of mdiwdual s~gnmg contracf) above named He ~s the ..................... ~D..q~..~.q.q-~ ............................................................................................................................ (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and file this application, that all statements contained ~n this appl~cahon are true to the best of his knowledge and belief; and that the work wtll be performed in the manner set forth m the applicahon filed therewith Sworn to before me this ........... · ~..~.... day of .."~. :.~.:.b.~.~ ..... ~ ~c~ .............. , ,~,~\\¢,'--""~L9'--/~..~ .~..~. p~ Notary Public, ..-,5,,.~.~~ ........ County ........ ~ ............................ (Signature of applicant) TERRI LEE ELAK I~TARY PUBLIC, $~&~e el New Yor~ No 52 6168295 [~olI'~1~$1on Exp*res March 30, 1~ ~ ~