The URL can be used to link to this page

Home My WebLink About7400-z FOItM NO. 4 TOWN OF $OUTHOLD{ BUILDING DEPAHTMEN'T Town Clerk's Office Southold, N. Y. Certificnte Of Occupnhcy No.Z.??73 ....... Date ...... ...... ~P:~..Y .... ~.3 ....., 19.17 THIS CERTIFIES that the building located at . 8o~Ud.view. Ave ........... Street Map No.. X~ ........ Block No..:~X ........ Lot No, ~c .!.. S.outhold.. 1~.~¥, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. $~!~...~ 119 .?.1~. pursuant to whi%h Building Permit No.~.~.01Z... dated ............. July...1.1, 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 . Privo. te..one. £amiiy..~t¥;.~s.i[~i~zg. ~.~ ~g. ~4~x:Lt.J/~o ...................... The certificate is issued tof~oo L, Penny 1V O~m~:~ of the aforesaid building. Suffolk County Department of Health Approval (o~vner, lessee or tenant) UNDERWRITERS CERTIFICATE No..loend-~,ng ................................... HOUSE NUMBER ..... 9~0~ .... Street .... ~ouncl .VJie~..Aw~ ..... S.~thold ....... Building Inspector FO~.M NO. ~ TOWN OF ~OUTHOLD 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) 7400 Z Permission is hereby granted to: ........ ....... ....................................... ,~,,'/ ~m~.,. //~' . ... ,o ......................... ~ .......... ~ ......... .)~ · .~,. ......... ~ e ............................... at premises located at ............................. .~.~ ....... ~..~........t ................................................... pursuant to application dated ................................... .~...~.~..., 1~..~...., and approved by the Building Inspector. Fee $.../....~......~.~.... ....... Building Inspector · rowNm, muT.m.e / Examined ............................. ~........~.., 19 ........ Approved ................ .... ~. ........ :t ........ ' , 19 ........ / '/ Permit No.:'~.."./.../...'....~. ................ Disapproved a/c ~ ~ ~OUTHOLD, N.Y. ~ ApRlication No...~..."~'..../.i .................... (Building Inspector) APPLICATION FOR BUILDING PE~41T INSTRUCTIONS a. This application must be complete y fi led in by typewriter o~ in ink and submitted in triplicate to the Building InsRector, with 3 set~ of plans, accurate MM plan to scale. Fee according to schedule, tad bl Plot plan showing location of lot and of buildings on prem ses, relationsh p o joining premises or public streets o! areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this application. ~ .c. .'l~.~e work covered by this al>PI!cation may not be commeqCed before issuance, of ~uilding Permit '~ dl Upon approval of this application/the Building InspectOr Will issue a Bt~ilding' Permit to the applicant. Such permit shall be kept on the premises available fer 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 Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~iludi~tgioZn_on~e__O.r~inance' oft. he T,o?n.,o,f..__S~t'_ho, l,d.: Suffolk .Cou.n. ty, New York,,and other applicable Laws, Ordinances or y n~, Tvr ~ne construction at ouualngs, ac::l¢~mons or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary ir",,pections. (Signature of applicant, or name, '~' ~)'~'i~ ........ (Address of apphcant) ' '~,7"" Plumber's License No ................................................. Electrician's License No ..................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... .~...~............~.~......~....~.......................`........................................... / - If applicant is a corporate, signature of duly authorized officer ~ .................. ......... Builder's License No ..................................................... ~ Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .................................................................................................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Wa r k ~..~1,/-~ ..~.~ ~ -' 0 d ~ C) / ~-c~' (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 cars ..........~ .................. .~,: ............................................................................. ..~ ....................... 6. If business, commercipl~.or mixed occupancy, specify nature and extent of each type of use ~ 7. Dimensions of existin~ any: Front ...... ~ .............. Rear ..... ~ ..................Depth .....~ ........... Height .....~..~..~...~: ....... Number of Stories ........... /..~ .............................. ~ .................................................................... Dimensions of s~me structure with alterations or additions: Front....................................'~'°~ / Rear ...~...~ ............... Depth ....... ~...~.~..... Height ...... ~...~.....~...'. ......... Number of Stories ....... ~ ..................... 8. Dimensions of entire new construction: Front ...... / ..~.....i..., ................ Rear ....~..~ ............. Depth ..../..~.../. .......... Height ......~..?....?..~ Number of Stories ......~ ............................................................................................. ~,9.~Size of lot: Front ...... ,...~ ........ '~--v .............................. Rear .......................................... Depth ................................ ~I0. Date of Purchase ..~ ........... )..~......~. ...... Nome of Fo.r. me~ .Own~,.,:..~ .............................................. 11. Zone or use d~strict ir~which premises ore situated ......... ~,~,,~.~C,.~ ............................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~ ..................................... 13. Will lot be regraded ~(/~fi.~ Will excess fill be removed from premises: ( ) Yes ( ~ 14. Name of Owner of premise~.......'..'~....~ ..... Address'~'-...~~~ No....~....5.:...~..6...~...--.~. Name of Architect .............................................................. Address .......... 7~...~..~ ......Phone No ....................... Name of Contractor ....~.....~ ...... Address No. PLOT DIAGRAM Q4v~~ 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. . /9" ~TATE OF NEW YORK. -- ~ c ¢ · COUNTY OF ...... ..~.,~.;.'.,..-.~: .......... ......... ,~..~s..-e.~.~..~..~........~.......~,c~ ................................. :being duly sworn, deposes and says that he .is the applicanl (Name of individual signing contracf) above named. He is the ......... c~..~...:..>~......C~-.: ................................................................................................................................. ~ . . (Contractor, agent, comorate officer, etc.) of said ow~e~' or owners, end is dul~; aut~holized to perform or h6ve performed the said work and to make and file this application; that all ~ta.te~peD~J~contain§~ in t,his~ .al?p~icotiop.ore tree to the best of his knowledge and belief; and that the work will be perfo~med'ir~'thb r~,,~'r set'fc~rth ~fi the apl~lication filed therewith. Sworn to bef. f~re me this .......... /../ ......... day of ....... Notary Public,. ................................................... County /.....~..~ ......... L..:......~ ............... ~ ~ (Signature of applicant) / GEORGE C STA~¢KE¥1CH NOTARY pUt, lC, State of New Y01~ No, 30 380?858