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Home My WebLink About7596-zI~O~M NO. 4 ~0WN OF $OUTHOLD BUH.nING DEPARTMENT Town Clerk'~ Office Southold, N. Y. Certificnte Of Occul:~ncy ~ , No.Z.6..~)..2 ....... Date 1/.o~. 18 / ., 19..~.. ~s CERT~mS that ~e b-~a~,g ~?t ~. Pr.~* ................. S~ ~ap ~*~.~. ~.. Block ~o..~ ........ Lot,~o. ~.., ~0~...~.*. .... co~o~ ~bs~y W ~e App~ca~on for B~g Pe~t hereWfore ffl~ ~ thi~ office da~ ............. ~.~.. J~, 19.~. p~t ~ wM~ B~di~g P~t No..7~. ~t~ ............ 0eg..~..., 19.~, was msu~, ~d eo~oms ~ ~ of ~e ~ m~ of ~e app~eable pro,iota of ~e hw. ~ ~mp~ for w~ thi~ ee~fie~ ~ ~ ~ ..... ~o~ .bn~g .~$~. · ~.~,l~gX~ ............................. ~e e~ieate ~ ~u~ ~ .. ~. & ~. ~. ~ ....... ~ ............ (o~er, le~8~ or ~n~ ) of ~e ~ore~d b~g. Suffolk County Department of Health Approval ... ~( el/., ............................ UNDERWRITERS CERTIFICATE No. $.,..I~: ....................... ~ .............. 1~. Street oak HOUSE NUMBEB .................................................... Builams Inspector FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7596 Z Permission is hereby gronted to: A~..~.~.....~......~/..L.c..~.~.~.~ ........ ~..~.~.~ ~ ot premises Io~ot~cl ot ................... ~ ............. ~. .................................................................................... purs~nt to o~licetion doted / & ~C ~ 1~., ond opp~ed by the Building Inspector. F.. $./.~.~ .......... Building Inspector a. ?his ??fll. ication _m.ust be comp..~.y .fil.red, in by .typ~,~ oe in ink. and,.sqbmitted in triplicate to the Building inspector, with 3 set~ of Ptans, accurate pwz L~m~{g , ~1. Fee ~r~ing to schedule. b. Plot, plan showing Iocafien ~f IOl;~Jl~f~.~ 0~h prert~/r~btionship to odjoini ,r~. prem ses or public streets o, areas, a_~na givi ,nga detailed descripticm.6~.l~p ..~. rte..must be deawn on the diagram whmh is part of this application. c. , ne worn covered by this applic~ trot' ~be ~6mmer~ced I~fore issuance of Building Permit. d. Upon approval of~this applicatign,411e Buildi~lr~tot Will iS~ue a Building Permit to the app cant. Such permit shal! be kept on the premises availabl&~o~ ii~ctidn thre~o~ the work.. e. No building shall be dccupied o~,~t~e~'in ~hole or in P~'for any purpos~ .whate~,er until a Certificate of Occupancy shall have been gmnted~ b~ the Building In~,.ecto.r,..< ~ APPLICATION IS HEREBY MADE tO the Building Departr'nent for the issuance of a Building Permit pursuant to the Building Zooe 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. T~e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ bulldin~s' for necessary inspections. (Signature of applic.ant, or name, if a 'cori~oration) ( ss o applicant) " State whether applicant is owner, lessee, agent, amhit'ect, ~'~gineer, general cantmctor~ el~:trician, pluml:~r or builder. Name of owner of premises ~....~....~ ~ - . ~¢:::b~ .. If applicant is a ~rp°rate' signature °f duly auth°rjzed 0fl icer' ..... .............. Builder's Lic.se No ..................................................... Electrician's License No ................... .......................... ~her Tmde's Lic~ No ............................................... ]. L~eti~ of la~ en ~ich p~d work will be d~e Map No ~.. Street ona Num r . ............................................................. ................... 2. State existing use and ~cu~ncy of premises and intended use and ~cu~ ~cy of p~ c~ti~: a. ~isifing u~ a~ ~cupancy ................................................................................................................................ b. ~nten~ u~ ~ 3. Nature of work (check which applicable): New Building.. ................. Addition ........... Alteration ~" ' TM Repair .................. Removal .................. Demolition. .................... Other Work ..... d~ c~. ~ c~J ' (Description) 4. Estimated Cost 'i. ~- 0 ~ ~'' ........................ Feeri.....~......-~........i ............................................. ...., ................... (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 ...;I,..~. .......... Height .....L..O....r. .......... Number of Stories ..,.~?.) ...................................................................................................... I I Dimensions of same structure with alterations or additions: Front ..t..~. ............................. Rear ..L.."/. .................... Depth ......1..O4..! ................... Height .~.~....~2..t..r......,...Number of Stories ...(J..~ ...................... 8. Dimensions of entire new construction: Front ...... I.~...~. ..................... Rear ......... J..~. ............. Depth ....!..~ ................ Height .~..r....~...,.!.. Number of Stories '"'G~ ........................................................................................................... Size of lot: Front ......... q..~.../. ..................................... Rear ..... .~...~. .............................. Depth,.J..~.. ........................ Dote of Purchase ......... [...~J. ..................................... Name of Former Owner ...~,.AZ....~ U Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: .....~/~ ............................................. Will lot be regraded ..........~ ......... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises ~'~.,...~....~...~ ..... [.....~......~....~..~one No ................ .~.....'~ Name of Architect ........ ,..., ............................................... 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. 10~ 11. 12. 13. qq' qq' STATE OF NE~ Y,~).RK, I ¢ c°u NTYA F ....... ................................................................................................. being duly sworn, deposes and sa~ t~t he is the applicam (Nome of i~ividual signing cont~ above name. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of ~id owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; t~t all statements contoin~ in this application are true to the best of his kn~ledge and belief; and thor the wOrk will ~ performed in the manner set fo~h in the application fil~ t~rewith. Swam to~ore me this ................. : ...... day of ..~ .................................. ~ ....... 19 ........ Nota~ Public, . ..................................... ~ ......... C~n~~ ,.~. ........... ~. ..... ~ ........................ , ................... 1 ....................... (Signature of applicant) JUDITH T.