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Home My WebLink About7670-zl~q~t~ NO. 4 TOWN OF SOUTHOLD BU~.~ING DEPARTM~ Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z(~ ..... Date .............. ~Y...29 ..... ,19. THIS CERTIFIES that the building located at . l~.S. Ba~rvie~/.Road ....... Street Map No .... xx ......Block No. ~x .......Lot No. v=~r... -~outhald~.//,Y, ......... conforms substantially to the Application for Building Permit heretofore ~ed in this office dated ............Dee...20.., 19.~!~. pursuant to which Building P~nit No.. dated ............l~o...26..., 19.~., 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 .PrSvate. ~ne. £amiLy..d~e~.llng.. ~ith an. a~tditlom ................. The certificate is issued to . .1/iL~ia~ .~a~iater. .... (hrns~. ........................ (owner, lessee or te~t) of the aforesaid bui/ding. Suffolk County Depa~-h~ent of Health Approval . .N,i~, ............................. UNDERWRITERS CERTIFICATE No. pending .................................... HOUSE NUMBER .... 107.7.~ .... Street ....~a~&e~. Road ....................... ........ .... Building InspCctor INSTRUCTIONS ~a ~' a. Thi palicotion must be~cornpletely filled in by typewriter oe in ink and submitted in triplicate to the Building Inspector, with 3 ~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan location of lot and of b~ildings on premises, relationship to adjoining pre. mises or public streets areas, and giving a detailed descripti°n of layout ofpraparty must be drawn on the diagram which is part of this application. c. The work cOVered by this application rna~ not be commenced before issuance of Building Permit. d..U,pan.app..mva! of ~is apal!.cat. !on: the Build!ng I.ns~.tor will issue a Building Permit to the applicant. Such permit ~ shall De Kept on rrm premises ovalloole mr i.l~l~?lon mroaghout the work. e. No building shall be occupied or used ~n w~ole or in part for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspecto~ APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Bu Id ng Permit purwont to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulnti..ons, for the construction of building?: additions or alterations, or for removal' or demolition, os herein described. The applicant agrees to comply with all aRohcable k~vs, ordinances, building code, housing code, and regulations, and to admit authorized inspe~-~au? on premises ~a?cl~, ,in buildings for necessary ir~oections. ~'s~T'~ ~-~.. A.U.- ~ ' - ,_ .........~ o~e.~.Z ..~.o.~.~'~ ~.~.t~o~ ...q.o.;~ ............................ k_~)_~-~ ~- ..~ ~ (Signature of applicant, or name, if a corporation) ~ ........ ~o~t~,~o:Lcl ...................................................................... (Address of applicant) State whether applicant is owner, levee, agent, or~hitect, engineer, gen~lral contractor, electrician, plumber or builder. ............................................. ~.~. ............ : ......................................... It, l ................... ............ l,' .......................................... II Name of owner of premises ,. ~LL E¥ .... ;d=..Vax ~I~ ~- ............................................................................................................ If applicant is a corporate, signature of duly authorized officer./:-~$-r Builder's License No .. Ce~'~e..'L.3. ............................ '~ ,, T I '""~ ~"21 ~ P~umber's Ucense No ...... -~:t...~.~& .................... Il ~ ~'~, L ~ s~ : d . / ~/'~ ~ Other Trade s L,cense No .......................... ~.-..':~.__ /1~1,- ~,~__'~ .. ~ 7X ,. ~ation of,and on wh,ch p.~.d work w,,, be don._. ?p_ ... ~o':': ....... ~.::~'' ,-- ~'ff'Y~...~..~....~..... Street and Number s ~.?.. ~ ~s 0 · ..:...~/& -L~e~e~-e~ .~oe6 ......... ~a,~a l~.,.~., .................... : ............. ..<, ................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .......c~.e'l];L~.g. ...................................................................................................... b. Intended use and occupancy ............ aa~ae..u~h..,a~,~.~.'0&er~..(,..Ga~.a~e..6...~¢&~L~Lt.~ ............. i ........... Nature of work (check which applicable)i New Building'. ............... Addition ......-3¢~3~. AlteratiOn ............ ., ..... P, epa~r .................. Removal .................. Demolition...' ................. Other Work ................................................... ... .... ~ription) Estimated Cost ...........1~)9~0~.~_~ .............................. Fee .-:~.~[eO~ ........................................................................ -~ (to be paid on filing this application) If dwelling, number of clwe~ling units ...Se. .................Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 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 ..l~). .............................. Rear ....~43 ................... Depth .2~9. .................. Height .................... Number of Stories .D..~.~ ............................................................................................................. 9. Size of lot: Front ........................................................ Rear ........................................ Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ t 1. Zone or use district in which ~)remises are situated ...ttA. lt..~.¢.~ ............................................................................... 12. Does prooosed construction violate any zoning law, ordinance or regulation: ........... ~¢) ........................................ 13. Will lot be regradecf .....~. ................. Will excess fill be removed from premises: ( ) Yes (Z) No 14. Name 0f Owner of premises .~m..~ZXl~a.t;ez'. ........................ Address .....qot3,t[3z;~J~, ........ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..(~DZ'JI,e~].]...(~.QZ~t,Z'. ........................ Address ....~Q~.t, ho~l::]. ........ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and ndicate all set-back dimens ons fram property lines. Give street and block number or description according to deed, and show street hames and indicate whether interior or corner lot. see attached pla~ STATE OF NEWQy, OI~If~,~. I c c COUNTY OF ...~...u~...~...u....~.. ............ f~.~ ........................ L.~..D.S...~,.~...~D.~-1'1 .................................... being duly sworn, deposes and says that he is the applicam (Name of individue signing contract') above named. He is the .................................... .~....'~...~.d....e.?. ............................................................................................................................ (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 qf his knowledge and belief; and thor the work will_be performed in the manner set forth in the application filed therewith. Sworn to before me this .............. ..... day .............. ...................... , ..... ,x? Natal?ab,c, ........ .................... ............ '1 . -4 /"-'--~" ~'~/ ,/~, _.~ /- / /..(Signature of applicantt