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Home My WebLink About7638-zTOWN OF SOIJTltOLD BU~ING DEPARTSmNT Town Clerk's O~iee Southold, N. Y. Certificate Of Occupancy No.Z.7.31).l ....... Date ................00.t...1 ~...., 19. ~.6 THIS CERTIFIES that the bufldi-g located at ...1//8. I/ew. SuffoLk; La... Street Map No..xx ........ Block No...z~c .....Lot No... xxac..gutcho&,~u~ ............. conforms substantially to the Application for Building Permit heretofore filed in this office ~ .... &ged ............ Nov...~.~.., 19.7~. pursuant to which Bug~ing Permit No.. dated .........l/or., a~ ..... , 19.?k, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi~ certificate is issued is . P~.ll¢. ~.~ 1~.~...-...Fll'.~ .~ou~e. :;.ltl .add~.tion ................... The certificate is issued to . .¢utahogu~ .Ft.r~ .Dlitri~t ...... 0~ms~ ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .1.{: lt.: ............................. UNDERWRITERS CERTIFICATE No...pen/kLnl .................................. HOUSE NUMBER ...... 260 ....Street ... liar. ,~u_CfoLk .I~na ................... ............ B~din~ Ins~qor FOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THLE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7638 Z Date ............................ ~: O.T. ......... ~,.~......, 19'~ .... Permission is hereby granted to: ~.~.~tg,~lL~....~..~,~::~..,~.~.s.t~lc ~ ........................ ....... C..~ 2,~.ho.§ue ................................................... to ..~..Z..c.~...~..~:...~.~.~;L .t,,L~...~;~...~ x~, ~.t,;L~g..£ ~-~ .. ha~e ............................................................ at premises located at ....:,~.~.....~Lel~...~L~£~...~,ne. ..................................................................... .......................... g..u..t...c, ho ~...e ~,~., .............. pursuant to application dated ...........................~..°..T. ......... .~.~. ....... , 19~.~...., and approved by the Building Inspector. Fee $.zJ.c.~..n..e.. .............. BUILDING I)iP&R19~tNT,,~.~. Examined .......................... 19... ,, .i No.. Approved ........................ , Disapproved o/c ................................................................. [Duilalflg mspactor; APPLICATION FOR BUILDING PERMIT Dote ]fov ..... INSTRUCTIONS a. This application must be completely filled in by le.t~Fwriter o~ in ink and subrrdttod in triplicate to the Building Inspector, with 3 sete of plans, accurate plot pian to sca e. ee according to schedule. ' · b. Plot plan showing location of lot and of buildings on;'premises, relat onship to adjoining premises or public streets m areas, and giving o detailed description of layout ofproparty 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.. U.pon appro, val of this application, the Build!ng Inspector will issue a Building Permit to the applicant. SUch permit shall be Kept on the premises available for inspechon 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. APPLICATION IS HEREBY MADE to the Building Department for the iSSuance of a Bu lding Permit Pursuant to the i~?_lud;_n,g.._Z__or~z__C)~_nanc?, of .t. he T,o~, n.,o,f. Southo. l.d.:. Suffolk ..Cou.n. ty, New ,York, and other applicable Laws, Ordinances or ~, '~'h~ ~)~l~co'n'T°-r-T-n-e--c~-°~sTrucz?n o.~ Dujja,ng.s., ,~o, ,t~ons or o,?rot,ons, or Tar removal or demolition, os herein described~ , .?~ ~.~,,,. u~.,.~ .u comp,y WITh Oil app,come ~aws, ore, nonces, building code, hca-sing cede, and reaulations and to aamlt autnonzea inspectors on premises and in buildings for necessary inspections -' ' Cuteho~ue Fire Dist (Signature of applicant, or name, if a corporation) Cuteho~ NoY. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................................... Ou.t;..e..~o F re Dist 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 ..................................................... ~ Plumber's License No...(~.e~..e.~13,t~,l,,~. ................... Electrician's License No .... .~..I;~:,....~....~. ........................... ~ Other Trade's License No ............................................... Location of land on which proposed work will be done. AAap No.: ..... ,Z~ ............................. Lot No ........ ~ ........... Street and Number .~/~..~t~..~i~',~f),~...~l .......... ~l~ll~f~'13~. ....... ~.~.~..., ........ : ................... Municipali ,fy State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~,~LI~J...}IL~I~I.e ............................................. b. Intended use and occupancy ........ ~II31t..."~,'~,~I...IR,..tL~(L'L~QIK ................... ' .................................................. 3. Nature of work (check which applicable): New Building'. ....... ~ ......... Ad~lition .;I;3~1~ ...... Alteration ................ Repair .................. Removal .................. Demohtior. ............. , ...... Other Work .................................................... (Description) 4. Estimated Cost ................... ~ti~O0..~ ..................... Fee J~ (to be paid on filing this application) $. If dwelling, number of dwelling units ...0. ...................... Number of dW~elling 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 ..~l,t. ltt~)a~ .... 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 ...~(~....-.~ ..................... Rear ...... 3~.~ ............ Depth ....~1~../....8~6 Height .................... Number of Stories .~ll~ ............................................................................................................. 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ....... ~t...~J ....................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~ ........................................... 13. Will 10t be regr~ded ...~¢1~ ................. Will excess fill be removed from premises: ( ) Yes (~,) No 14. Name of Owner of premises ..,.(~ll.t~o~ilJL~;Ll~..,D.t.m~.. Azfdress ....... ~A~,aJti:;Xl;I~.... Pha~e 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. ~-- ~'--~, -- STATE OF NEW/YORK, ~ ¢ c COUNTY OF ...~-~l~J'~:l]~. ........... f~'~ .................... ...~......~g,.~..¢[l~.......,...., ...................................... being duly sworn, deposes and, says that he is the applicam (Name of individual signing contracf) above named. He is the ,..~..~ ........ ; ......... ~l.~l,$.~g.~...~,~f~,~t~,,l~ ............................................................................................................... (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 filed therewith. Sworn to before me this " ................. Z~.. day of ............... ]ilar. ..................... 19..~..~.. - /J/'J~_ / ~J,,l_/,_ //~ · ~L~tol~ '~ ~'~/-X-~ ,v~r i/I/,,~l~ /z~ / ' . .......... ,2. Notary Pubhc, . ................................................... County ........... y~.~ ~'.~ ~: ~.,., ..,+.~..~....~.. ................... (Signature of L Jl I, ----} l Office Of N. Y,, Sl~ie E~du~at}o~ Luw,