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Home My WebLink About7574-zTOWN OF SOUTHOLD BU~.FtlNG DEPAIlT~T Town Clerk's Office Southold, lq. Y. CertifiCate Of Occupancy THIS CERTIFIES that the buiI~i-g located at . t~y' Ho~- Rd .&. ?~,O,w'.¢ · · Street Map No..x:cx ....... Block No...mc~ .... Lot No.. :c~.. ltoutl~Qld.. ~,tr, ......... conforms substantially to the Application for Building Permit heretofore filed in tht~ office dated ............0¢t; .... {+.., 19;75. pursuant to which Building Permit No.?.~71+Z... dated .............0c.~ · .l+..., 19.7~:, was issued, and conforms to all of the require- ments of the applicable provisions o! the law. The occupancy for which tirol, certificate is issued is .Priv. a~e. acceasory..b~ll~lag .v~h. atiltl.~, fp~., ~l.e.e.~i .~. 1I. The certificate is issued to . .MaCao.. ~ett~aioh ..... Ownez (owner, lessee or tensn~) of the aforesaid building. Suffolk County Depa~-Lment of Health Approval .N,R, .............................. UNDERWRITERS CERTIFICATE No. peudin{ .................................... HOUSE NUMBER ..... 1.~55 .... Street ....J{a~. Some. ,Roa& ..................... ....... .... ' ' Bull&ins Inspector i~OB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OI~FICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UI'4TIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7574 Z Permission is hereby granted to: ....~..~ ......... ~..~ ...... ~ ......... i ........... ,....,...i ................. ~...~... ~ ~ ~' , 'r c ~ ~:- N u ~ , .T~ . , ..... ~ ............................ at premJses located at .................................... .~.~....~ ...... ~...~.~.~./...~.~. ........ .~...~.~....~. ...................... ....................................... ~ ................................................... ~...~.~...~..~...~.~......,., .......................... Building Inspector. Fee $./,~..~. ..... BUilding Inspector' TOWN OF SOUTHOI~ .~ ,~"~ ~/ ~UILDING DEPA~'rMENT'~ ~ TOWN Ci.E~K'$ OFFICE Examined ......................... ,?...,,d...~..x, 19.,.,.? ~-~.~ L/~.]~_ Approved ........................................ , 19 ........ Permit No ..................................... Disapproved a/c ..................................\ --- ~'- ,~,~,,,.,~:,;z::;,,, ~, .......... Application No. ................................ PJ (Building Inspector) APPLICATION FOR BUILDING PERMIT ///T/ // Date ................................................ ,19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or. 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, location of lot and of buildings on premises, re at onsh p to adjoining premises or public streets areas, and giving a detaded description of layout ofproperty must be drawn on the diagram which is part of this application. 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 ~ailable 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. .AP. PLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~lucl;:tgio~Zs,C~orCl~hd~nca~r~:tr~t~hoen oT~ui~d~ Southo. l,d..,. Suffolk Cou.n. ty, New York, and other applicable La~, Ord ng,St a.a.alf~ons or a.!terahon~, or for removal' or demolition, as herein described. The Q---ii . . I~p ¥~..~ ag. tees re comp;y w~rn o;~ opp~;caole laws, ora~nances,/bullding code, ho~sing~ode, and regulatior~, and to aam~t authorized inspectors on premises and in buildings for necessary inspections. ($ignatare af opplicont, or ~me, it ~ ¢o~ti~) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......................................... .. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .................. ~j...~ P umber's Lcense No ......... .~.~...:..L~J:.~,~,~-,.,,,,,,L~--- --'----"-'"' Electrician's License No .... ...~........~. .......................... Other Trade's License No ................................................. ~. Location of land on which proposed work ~,ll}" be done.,/~op~.: ........................................ l.ot No. '"-~"e, .............. Street and Number .............. ; ..................... Municipality State existing use and occupancy of premises and intended use and occupanc/y of rp.rapose~d,constl~uc/tion[ ~- b. Intend~ use and occu~ncy ............................................................. 3. Nature of work (check which applicable): New Building.. ................. A~ddition................../-""~'~ Alteration ...~ .............. Repair .................. Removal Demolition .................... Other Work ..................................................... / / / '/ -Jr / / (Description) 4. Estimated Cost ............................... 4 ........................... 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, specif'/nature and eXtent of each type of use ............................ 7. Dimensions of/e~sting structures, if any: Front ................ '/"'../ .......... Rear ................................ '/ < Depth .......;..../.. ..... Height ............ [ ........... Number of Stories Dimensions of sq,r)n~, structure with alterations/0~ additions: Front ..................'....~: ........... Rear ............ ~ ............ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear .................... ~ ....... Depth ........................ / Height .................... Number of Stories ...................................................................................................................... · >:~'~ /~ , / ' ~ ' r , 9. Size of lot: Front ............. ' ........................................... Rear ............... . ........................... Depth ........ ; ....................... 10. Dote of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... ./.! .......... ~.~. ....... 1. ....................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ~Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect ........ ?.....: ........... ~'""7~ ........ ~.' ............... Address ................................ .Phone No ....................... Name of ContraCtor Address ................... : ............ 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 whether interior or corner lot. STATE OF NEW YORK, --" lc c COUNTY OF ........ : ....................... [~'~ ................................ .................................... ; ............................ being duly sworn, deposes and soys !hat he is the applicanl (Name of individual signing contractO 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 forth in the application fil~l~l therewith. Swam to before me this /" i i 1, ;.' · / day of ............................................ , 19 ...... Notary Public,. ................................................... County '~'..,,~... tt ..~....-~..../....~. '.~.~ (Signa;mre of applicant) · ,,, ~ T I, ,~rt' P~bhc, State of N~ NI) 52,.0344963 Suffolk Coufii~ ,