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Home My WebLink About7577-zTO~q OF SOUTHOLD BU~,I~INC, DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy ...... THIS CERTIFIES that the building located at ................. Street Map ~o ............. Block No...~. ......Lot No...~ ..... .~. ........ conforms substantially to the Application for Building Permit heretofore filed in thi~ office ............ ·-(~..../.., lg.~..~, pursuant to which Building Permit No. dated dated ......... ~ .... /..., 19//., was issued, and conforms to all of the require. ments of the applicable provisions of the law. The occ, ppancy for which this certificate is ~ssued ~s..._?~..d~p~L.,,.. ~. A0.~.~ ....................... The certificate is issued to~ .~.~~...Q. ~' ............... ~/ ~/(owne~ lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval ....~/. ( .[..~-.. ........................ UNDERWRITERS CERTIFICATE No. ~J' ~-~ ..... ~. ...... ',~' ' '~x ........ ~:-' ' ' ' ~'e',~'~ HOUSE NUMBER ..... ~ ..~..~ .~'[.. Street.. ~..~.. '~.. ~...~...(~...~...~L~. FORM NO. ~ TOWN OF $OUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 50UTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7577 Z Date ...................................... ...~.....~.....~...., 19...~.~.. Permission is hereby granted to: .... ~.~ .... - u'~.~ at p~mi~s I~et~ et ............................................................................................................................ ............... ~ ~, ~.~.~.~ ..... pursuont to GpplicQtion ~ote~ .................................................. ~.., Building Inspector. Fee $.../...~...~. ....... Building Inspector Examined · - ...................................... , 19 ..... No. Disapproved o/c ................ ::.:::: ...7: .................................................. · . ..................................... ................................ .. .........................................., ..... '.: ... :....:'. ..... ..... i~;',i'~i;~ 'l.~'gr) ................. APPLICATION FOR BUILDING PERMIT Date "~ INSTRUCTIONS . --~. ~,~ a. This application must be completely filled in by typewriter o~ in ink and subm tted in triplicateto the Budd- .~_~' · Inspector, with 3 sets of p aris, accurate plot plan to scale. Fee according to schedule. b. Plot plan show,Jig location of !at and of buildings on prem ses, re at onship to adjoining premises or public street: areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is I~t of this appltcat~ c,. The work cove. re~, ~ this .a. pplication may not be commenced before issuance of Bl~ilding Permit. ~a;, ,u,pon?pp..mva~ or mis app~i.ca.t!on; the Building Inspector will issue a Building Permit to the applicant. Such sna. oe Kept on me premises availaDle ?or nspection throughout the work '-'"'T ~ e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of ~_ shall have been granted by the Building Inspector. APPLICATION 15 HEREBY MADE to the Bu ding Department for the issuance of'a Building Permit purlu0nt Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al.heelin T~e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and re~ -~, admit authorized inspectors on premises and in buildings for necessary inspections.~.~.~ /- ~ !.'...;,;~.~,,...~ ................. ; .~ ..J'~. - ............. .~.' . } :?':, :.:'¥..,...:i... State whether applicant is owner, lesseeJgeat, architect, engineer, general contractor, electrician, plumber or bUil Name of owner of premises ....>./../..':L.. 7 ' ~ [ .... /.L~ If applicant is a corporate, signature of duly outhorized 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 work will be done. Map No.: ................ ..~: .................... Lot No.......~-. ............... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed censtruction: a. Exisiting use and occupancy .................. ./. ........ ; ........ :..: ...... b. Intended use and occupancy , 3. Nature of work (check which applicable): New Building.' ......... ~. ........ Addition Alteration * ' ~ - Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ' ~ ~ (Description) 4. Estimated Cost .................... ~ ............. /...~.....~...~...~.. ....... 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 c~ rs ............................................................................................................................................. 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 ............... .....,&/.....O. ......... Rear ........ ...~.....~.. .......... Depth ...... .?......~... ...... L~es proposed construction violate any zomng law, ordinance or regulation: ............... ~ .......................... Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No Name of Owner of premises ................................................... ~ddress ......... ~ .,. ~ No ....................... Name of Architect .............................................................. Address ............................ Phone No. ...................... Name of Contractor ........ ~ ..... Address (.V'...~...~..U...~.. ..... Phone N . · 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 descriotion according to deed, and show street names and indicate corner lot. 12. 13. 14. whether interior or 0~.~ STATE OF NEW YORK, COUNTY OF ................................ ~ '"'"' ~[NCE'~I~ .~.~(~' H ~' ~ be ng duly sworn, deposes and says that he is the oppliconl (Name of individual signing contrecf) 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 sai~ woKk 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 filed therewith. Swam to before me this ......... . ..... ............... F" .... ........................ Commleeie# Exeire* March 30. 19,,.~ i~lo~d nb~ro~erfi~$ b~o fOrm CO. corP'