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Home My WebLink About7675-zFOR~ I~0. t TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6~O~ ..... Date ........... ~ala...i.~...;i .,! .., 19.~.~. THIS CERTIFIES that the building located at . {lard.~na!...Dx, ............ Street Map No.. 14a.t.t ,. ~st Block No ........... Lot No..~6 ..... lgiat~;ituok .~. I~Y, ....... conforms substantially to the Application for Building Permit heretofore filed !n this office dated ............ Dee. '30., 19.~1~. pursuant to which Building Permit No..F67.SZ. dated ....... Dee · · 3.1 ........, 197L~.., 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 .. Private · one-family, d. wel.l.lng .with .ata. addi.~ion .... ' ............. The certificate is issued to .Dom~.lale..P~$e.i~.et.l.l ....... 0wll®.l~ .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . N.,It, .............................. UNDERWRITERS CERTIFICATE No. p®nd. iug .................................... HOUSE NUMBER . .1+00 ......... Street . {)ard~mal. DI~ ............. ~ .............. c~961 '11 '93(3 ,0~ =,,I : 39~0S ',X,'N "09 'J--IDS ~'aJ.N~'~vn9 ggJ. I.L 3H.L aq0HlnOS =10 NN~OJ. ,oJ. o:~J.~vavne >13 NJ. IliVI41 ,,'ON I 'S31~//93 9; 'ON /Oq I-Iq3.LlO$1d OI NI~OC] ~10-1,L3A~JNS ;0 o~0 GG tO'l Frl m O- 0,. ,, 0~08 ,gB'Z9g ~ .LNgranNOifl = · 3J. ON ;9c3 ,~o-I : 3 ,,OS N :1 ~/IAI ogg '$ 'N ........................................ , Application No. 7; Approved ............. ~..! ........................ , Permit No ..................................... Disapproved APPLICATION FOR BUILDING PERMIT Date . ..~)..~.~....~...~. ............ 19..~....~.~,. INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildin ~g~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises relationship to adjo n ng prem ses or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this appllcation.~ 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for 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 described. The applicant agrees to comply with all applicable laws, ordinances, build ng code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary ir~spectlons. (Signature of applicant, or name, if a corporation) ..... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applic~t is a corporate, signa~r~ d~ ~uthotized officer. ...... J(Name and title o~o~t~ffl~r) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: .......... .~...~.....~..~.. Lot No Street and N umber ............... .,~.,~'..~'~.~t~..~...:~.~7..J~'.Z~..'C ...........! ................. :i...:ii~ '.~ Mum~cipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .......... ..~.....z~tf'~.z,~Z~.~.....,~...~.~..~:.....~. ..................................................... b. Intended use and occupancy ....................................... ~..: ..... : ................................................................. 3. Nature of work (check which applicable): New Building,. ................. Addition..............f ..... Alteration ............... Repair .................. Removal .................. Demolitior ..................... Other Work ................................................ . .... ~,~....~.. ~...4~. ~. o~0 (Description) 4. Estimated Cost .......................... ,~,~. ....................... Fee ../....~.].~.. ............................................................................ (to be paid on filing this application~/ 5. If dwelling, number of dwelling units ............ J~....... ....... Number of dwelling units on each floor ..... ~', ...................... r garage, hum er or cars ......................... , .................................................................................................................. 6. If business, commercial or mixed occupancy, specify.~nature and extent of~ecich type of use ..~-..'~....~..~-- ....... 7. Dimensions of existing structures, if any: Front ...........~.~.. .......... Rear .......... ~.~... .............. Depth ~... Height ........ /....'~.. ........ Number of Stories ......................... Z. ................................................................................. Dimensions of same structure with alterations or additions: Front ........... .~..~.. ............... Rear ... ~,/.~... ................ Depth ...,~ ./.~.~... .........Height ........... ,Z.~.. ......... Number of Stories ...... ~ ....... .,.......~ ...... 8. Dimension{~of~ntire new construction: Front ../. ........ /.~.,..../. ........... Rear ...... /....~.........~..... Depth ..,/.~.....~. ......... Height ....x~.. .......... Number of Stories ................/.. ................................................................................. '7~ ............ 9. Size of lot: Front ..................~..i.~....~.r...~ ....................... Rear ...... ./.~,~.r....O.. ................... Depth ....¢~.....~.~./...c~_.~....7.... / 10. Dote of Purchase ............./...~..~.....~. ............................ Nom~f~f Former Owner ........................ 11. Zone or use district in which premises are situated ........ "/~'/"~'~-' '~/'~'~~'/~'- ............... ~;~'" .............................. i ...... 12. Does proposed construction vio~te any zoning law, ordinance or regulation: ........ .'..z...~/ ........................ .~-~....i ...... 13. Will lot be regraded . ....... .../~.....O. ......... Will e~cess fill be removed from premises: ( ) Yes 14. Name of Owner of premises~,~'r~'~.'.~..~.~..~.C'?T..~.~K,;./. ............. Address/~.~Z.,~..~<~(,.~..... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor~.~..<~..~...~.~_.:~'.~.....~;: ..... Address ~.'.~.-.~.7/.~..~..~.,.:.... Phone No ....................... 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 to deed, and show street names and indicate ~vhether interior or corner lot. STATE OE NEk'~MO~ iS S couNTy OF '~::':~~'~i~~~/- ................ being duly sworn, deposes and soys thor he is the opplicanl He is the ................................. ~5..~C~.~ ............................................................................................................. (Contractor, agen?, corporate officer, etc,) / '"~ of said owner or owners, and is duly authorized to perform or have performed the said work and t~make and this application; that all statements contained in this application are true to the best of his knowle~e and belief; ~nd tha~ the work will be performed in the manner set fo~h in the application filed therewith. ~ Sworn to 5rTe d~; ,~ ~ ~ -- ]9 ~ -' '/ " ..................... , ............................. , ...7