The URL can be used to link to this page

Home My WebLink About7645-zFORi~I[ NO. 4 TOW8 OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z~.~9 ..... Date ............ .AUg...~.~. ....... , 19..~.~ THIS CERTIFIES that the building located at . ~,C®r~t~a~, D.~,ve ........... Street Map No. 0al~.t; .l~cld. Block No ........... Lot No..1~9 .~..a.t.t.~.~ .u.e.k....E:.Y.: ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ .D.e.e... ~..., lff/.l~., pursuant to which Building Permit No. dated ........ D. ec.. ~ ....... , 19. ?.~., was issued, and' conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. PrlVa.~.e.. ~n.e..f~.~.ly..d?4e..~iBg ,W.~.~.h._~,~..~.d.d. ~o~1~ ................. The certificate is issued to ...G;~.~q~..&..I~. ~'.b.~l~$k .$.~l~i$.tZ.' ..... ,'.' .o~..e.~.s. ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval lq UNDERWRITERS CERTIFICATE No,. per~dlnl~ ........ . ....... .................... HOUSE NUMBER .... 9~ ...... Street .... C®n.t~l. ~,/~ ....................... ..... Building inspector <~ FORI~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7645 Z Date ............................ 'D~'""~ ............. , ]9~, . Permission is hereby gran{ed I,;. J...,~.~.].~l~.....~/.C...I[,,.r.b&~..t, ..~,..O.~.ae~il. ....... ,7. ~...W~ s 3~ran...D~. ...................................... ............ ~.~t..~l~ .~ .q~m......! J.7...8.7. ............................. to ~l~..~..~d~.t~o~...on..~x~s~in~L.~.w~...!.img ................................................................ at premises located at L~l:...].3.~.....Calmt....L.idtl...Lat ....................................................................... ............................................. .~.~.t.~':~-~,l..,i.~:%.v.e ......... ~,~.t.t J..~uck .................................................... pursuant to opplicotion doted ......................[~.e,.....~ ................... , 19.~.., and approved by the Building Inspector. Fee ~1, ~ :.~..0. ............. (Building Inspector) APPLICA'rION FOR BUII~BING PERMIT 2 iNSTRUCTIONS o. This ...a~plicotion must be completely filled in by typewriter or. in ink and subm tted in triplicate to the Buildlna Inspector, w,th 3 set~ of plans, ~accurate plot pian to scale. Fee according to schedule. ' --' b. Plot plan showing lecatian of lot and of buildings on premises, :relationship to adjoining premises or public streets at areas, and giving a detc~iled 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 laermit 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 have been granted by th· Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a BuildingPermit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable I.cn~, Ordinances or Le~eulati,.ons, .for the c.onstruct?n o..f. bu!!dtng?: _~ac~,_it~ns or a.!terations, or for removal' or demolition, al herein described.. je .?pp~?.an.t ag, r.ees to.comp,y wnn .a. app!~.cao, le.! ~a~s, o,ra,nances, bul.kling code, housing code, and regulotiom, and to aam~r aurnonzeo Inspectors on premises aha In IXllKIlngs tar necessary inspections. (S,gnature of aplt~i~ant, or name, if a corp°rotlon) Road S- Lthtmm 11787 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................... hJ,.t,l e ....................... . .... Name of owner of premises .G:F~,I~.I..~..~Z'~I~:~..J~I~t~; ..... . ...... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. ][*F. 0tl Ht Electrician's License No. ~ll~,..~..q ................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ...... ..C.~P..~.....~!'...~.~..E..~...~... Lot N~...1.~.~. ................ Street and Number ........ .(~1~11.~'~], .~1~1t ~lk~;.~,.~....~.~.~..*. .............................................. . l~,l. unicipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .................................................................................... b. Intended use and occupancy sale with a~ additioI 3. Nature of work (check which applicable): New Buildir~g.. ................. Addition ...;[~.. .......Alteration ................. Repair .................. Removal ................. :' Demolition .................... Other Work ..................................................... (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... O~¢1 ................ 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 ....... ............. 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 ............ 2~. .................. Renr ............. ~.8. .......... Depth ...!..6. ................ Height .................... Number of Stories ....O~l. el ...................................................................... ~ .................................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 I. Zone or usa district in which premises are situated ....".A~..~;I,~I.~ ............................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... I~ ........................................ 13. V~ill lot. be regraded ........ ~O ............... Will excess fill be removed from premises: ( ) Yes ( ) No Name of Architect .............................................................. 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 end indicate whether interior or corner lot. aee attae~e~ pla~ STATE OF NEW_YQI~,.. I ¢ c COUNTY OF ~..~..0...~... ............ ~ ~-~ ..................... ,~.li'titJ~l. ll~.~.'tl ;LO~......, ................................ being duly Sworn, deposes and says that he is the applicanl .(Name of individual signing contract0 above named. He is the ................................. .-]~...~]:..~..e..z'.. ........................................................................................................................ (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 applicatior); that all statements contain~ed 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 ................... da, of ................. ................... . Notary Public, . ........................... ~13~.,~J;~l;~lE ...... County ....... ..c~....~Z...~..~.....~ ........................................................... ~ .,~=~ JDlgnature of applicant) l~t. oc~¢ II ~y