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Home My WebLink About6651-zF~-'~ NO. 4 TOWN OF $OUTHOLD BUW,1~ING DEPARTMENT Town Clerk's O~ice Southokl, BI. Y. Certificate Of Occupency THIS CERTIFIES that the building located at . ...P~.e..N.~]c..]~..~. ........ Street conforms substantially to the Application for Building Permit heretofore filed in th~ office dated ........... J..~..e..~.1..., 19.?~. pursuant to which Building Permit No...6.6...~.. dated ........... J..~..?..~.t..., 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 (owner, lessee or tenant) of the nforesald building. Suffolk County Depsrtment of Health Approval .................................... HOUSE NUMBER 2100 Street P~e l[eek Road ....... ~. Building t~.~pector / TOWN OF SOUTHOLD,~,~ /~ //f .,~ TOWN CL~K S OFFi~ ~ ~ ~ ~ --_ ~TH~D,N.Y./_ ~--~, APPLICATI~ FOR BUILDING PE~IT Det .................... ................. , ..... INSTR~IONS a. Thi~ ~pplic~ti~ mu~t be compl~tel~ {ill~ in b~ ~ewrit~r o~ in ink ~nd ~mi~ed in triplic~ to In~tor, with ~ ~t, o{ plan,, ~ccurat~ pl~ plan to ~al~. F~ acco~ing to ~h~ul~. b. Plot plan sh~in~ I~ation of lot and o{ buildin~ ~ pr~mise~, relationship to ~djoining premise~ or public ~tr~ o~ ~r*~s, ~nd Oivi~ a detoiled de~ription o{ I~out ofp~ must b~ drawn on th~ die, mm which i~ c. ~ ~ork covered by ~ o~licotion m~ n~ ~ comme~ b~fore i~uonc~ o{ Building ~it. . d. Upon ~pprov~l o{ thi* ~pplic~ti~, the ~uilding Ink, tot will issu~ ~ Building ~ermit ~o th~ *pplic~nt. Such parm~t~ sh~ll b* ~pt on th~ pr~mise~ ~v~il~bl~ {or inaction thr~ th~ work. ~. ~o building ~h~ll b* ~cupi~ or used in whol* or in part for ony pa~ose whatever until ~ ~ifie~ of ~h~ll h~v* ~*n ~mnt~ by th~ Building In~tor. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os 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. S g t.re of ppp,,cont, or n0me. ,f o corporation) /..~.~..0.....~..~. ~ .~...~v..~..~......~..~,.~.... 5..~..u..~...~...~ .~. ............... (Address of ol~plicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electr!cian, plumber or builder. ....................................... A...~.~.~. ....................................................................................................................................... Name of owner of premises ..... .~9. t~.~..3~..~......~......?...~/...~./...~. ...... .~.....~../...~.. .......................... ~ ......................................... 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 ............................................... Location of land on wh~h,p~osed work will be done. Map No.: ~.~..~.~.e?~.......~...~....~.:. Lot No ......................... Street and Number .~.~./...~....~.....~...~.-...~........~...~..~.....?......~.~.~..~..~....~.~.~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy .......... ~...~..!....b.~.~ ........................................................................................ b. Intended use and occupancy ...... /~..~..~...~......'~.~./....~...~../..~1.~......~...o.~..~.......~../..'/~......C'-'-'-'-'-'-'-'-'-~-......~........~....~.~.~... 3. Naturt o.f.w?k (check which applicable): New Building ........ ~ Addition .................. Alteration ..~ .......... ;..~ Repair .................. Removal ..................Demolition .................... Other Work ...................................................... ~, /~.....c~...._~.. (Description) 4. Estimated Cost ..........~,...-9:~....°.. .................................... 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 ............................ 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 ............. ..~...G.. ................ Rear .......... 4t.~ ........... Depth ....../..~.. .............. Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ............... ./...o...o. ................................ Rear .......... /..g..~ ....................... Depth ........ ...~....o...o.. ............. 10. Date of Purchase ........................................................ 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: .............. /~.0. .................................... 13. Will lot be regradedl ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises(d~..~.~/..~.,~.......c~./..~... Address ./.~.,~...~.~....e~....~...,~...~..~phone No....?..~...'~..T....3..~..*~ Name of Arch tact .~.....~...~..~D...~.~.~;..~.. ................................... Address .~.~.....~.~-~..~.----'~. Phone No....~..IE./...T.,~..~/.~' Name of Contractor..~...~...%...~..9.q..~..~ ....... 4..~..c...r ................. Address .~.9.~../~.¥.~.s...../~J~one No. ~T~."~.7..~..~...~..~ 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 t° deed, and show street names and indicate whether interior or corner lot. k STATE OF NEW YORK. I. SS COUNTY OF ....~..u...~...~...~. ........ ~ · ................................................................................................. being duly sworn, deposes and says that he is the applicanf (Name 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 to make 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. Sworn to//. ~"xbe~-'~ me this ~' ............ day ............. , , o . Notary Public, ~~ounty ..... ~..~.,...~ .................................. (Signature of applicant) RICHARD A. ZORN NOTARY PUBLIC, State of New York No. 5[-9811243, Suffolk County_ Term Expires March 3~, THE NEW YORK BOARD OF FIRE.UNDERWRITERS BUREAU OF ELECTRICI'~Y, * * 85 JOHN STREET, NEW YORK, NEW YoRK 10038 : THIS CE~IFIES THAT a~te~ ~a!n, P~neneck Rd. ~19~0, SouthOld, L.Ig in thef~ing location; ~ B~ement ~ ist ri. ~ ~.d ri. Out s ide ~tio. ~ ~ w~ exami~ on ~ ~ E~B ~ 2 s ~ ~ 7 ~ and found to be in complia~e with the requirements of this ~rd. ~KTm=~ [ ~RNACE ~TORS ~TURE A~A~E mE~ ~IALR~'PT TIME~ B~ ~UNITH~ M~T~ D~ERS OTHER A~ARATUS: ~otor/s: 1-3/~hp 1-30 amp. iisc. switch (Swimming Pool) This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have frequent test and/or repairs made by a qualified person. Patricia A. Cain' 1980 Pine Neck Rd. Southold, L.I. 11971 COPY FOR BUILDING DEPARTMENT. THIS COPY OF L~kii~iCATE MUST NOT BE ALTERED IN:ANY MANNER. PINE. 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