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Home My WebLink About7401-zTOWN' OF SOUTHOLD BUI~.DI~G DEPARTM~NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . ~d,view. &ye ........... Street Map No..!l~.. ........ Block No,~ ........ Lot No. ~.v... ROu~,hol~.. I~Y, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. .J.~ll~...} 119.~t~. pursuant to which Building Permit No.~%)¶ dated .............J~l~...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 . Private..one. £ami~. ~twmlilag. ~ith. adcli.tJ.Qn ...................... The certificate is issued to .~..O..L.,...P.~.n..1~..IV. ..... .0~t...e~ ............................ (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department o! Health Approval .I~.,R.,. .............................. UNDERWRITERS CERTIFICATE No..p~ztd,t,lls ................................... HOUSE NUMBER ..... 9~0~ ....Street... l~ottl~ .¥ie~ .Ave ..... B~tttho].d ....... Building lmpe~r FORM NO. :B TOWN OF S04JTHOLD BUILDING DEPARTMENT TOWN CLERKS OFFICE SOUTHOLD, N~ Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7401 Z Permission is hereby granted to: , .?..e...o......~ ......~.e..~Z ...z...v. ....................................... ......... .~o~o~l ................................................... to ~'~cl.. ~z~.~ ~t ~c~..~,..~e..&~te~e~..o~ ..ea~t~s..~l~e .~f ..................... at premises located at ..{~.~{...~il3.U..n_.d....Y~L.~.SFfa ............................................................................... .................................................. ~.~%~th~.3.~ ...... ~,.~.o ........................................................................... pursuant to appl{cat{on dated ............................. ~.13~. ....... .1.~. ...... 19...~..br., and approved by the Build{rig {nspector. Fee $.t ~,Oi3 ........... ..... ...... ~..~ ~ ......... ~..... ',.2. ~ ~ . ~.~..~ t~ . ............ ......... ~.. ~. ' In~, ~ 3 ~ ~ p~, ~u~o~ ~ ~ ~ ~ F~ ~1~ ~ ~le. b. PI~ plan ~ing I~ati~ of lot a~ of ~i~i~ ~ ~im, mlatlonship to ~ioinina Dremim shalld' ~t~l~ ~e ~mi~°f ~is ~li~i~,~il~le ~r ~i~Bui~i~ ~,illhi,~a Building ~rmit to the ~lic~. e. No ~ildi~ s~ll ~ ~c~i~ ~ ~ in ~le or ~ ~ ~r any pu~ ~r until a ~ific~ S~all ~ve ~en granted ~ ~e Buildl~ I~r. APPLI~TI~ IS HEREBY ~DEto the Buil~ ~ .~e ~nee~f ~ Buildi~ Pe~it puget ~ ~e~ Buildi~ Z~e ~e of ~ T~ of ~, ~k ~, ~ ~, a~ ~er ~ R~ulati~s, for ~=on~i~ ~ ~ildi~,~itl~ or ~s, m ~ ~1' m ~iti~, ~ ~min ~n~. ~e ~plicant ~s ~ c~ly wl~ all a~llc~le , ~, ~1~ c~, h~t~ c~, a~l~, admit au~ofiz~ I~ ~ pmml~ ~ in ~1~1~ ~~ ~.~~ i~. ...Z~..~....~......~.~..~...~..,. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. L'~'"'_' ................. ~... ~. ................................ '~ .......... :'""~"; .............................................. Name of owner of premises ........... ~ ~::~I ' ~ ........... .................: ............... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....................... Plumber's License No ............................... Electrician's License No ........................... Other Trode's License No ............................ 1. Location of land on which p_rapaeed _work will be done. Map Np.: ........................................ Lot No ......................... Street and Number ....... ~....~..~........~......~.?.~,.~...J..~i~......~...~.,..~T...: ................. ~.~.~.~.~.~.~.~.~..~,~.~.. : Munlcipofi~ 2. State existing use and occupancy of premises qnd intended use and occupancy of proposed cOnStruction: o. Exisi.ng use°nd occ~ncy....~.C....~;.....~:,~::~'"'C-~' b. Intended use and occupancy .~....~,.,~...C~..~' 3. Nature of work (check which applicable): New Building.. ................. AxJdition .................. . Alteration ................ Repair .................. Removal .................. Demolition. .................... Other Work ..................................................... ~.-- (Description) 4. Estimated Cost ................... .~ ....'....:......~.i ..................... Fee .~..~....~ .................................................................... (to be paid on filing this application) I 5. If dwelling, number of dwelling units ........................... Number of dwell ng ~nits 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. Dimensior~ Height ...... :~ ............ Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ I'~ame of Former Owner ........................................................ 11. Zone or use d~stnct m which prem~s~ are s~tuated ................................................ ~ .......... ~- ............................... 12. Does proposed construction violate ony zoning law, ordina e o 13. Will lot be regraded ...?....~ ................ Will excess fill be removed from premises: ( ) Yes (~) No Name of Architect ........................................................... Address ................................ Phone No ...................... Name of Contractor ............................................................ Address ................................ Phone No. ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings whether existing or pr.~osed, ,ancO, indi.cat, e all set .-~ack dimens! .o?,fro~ property lines. Give street and block number or description according to aeea. aha snow stree~ names aha Jnaicare whether interior or corner lot. i I I I t COUNTY OF ~-~...~/,,,~x~z..~..;<~ ' ~ /-- (/--~_,~__'- -; ...~,..?. ....... be n~ du v sworn = says that he s the applicant · ' (Name of md,v,dual s,gmng contract~ above named ~M'~. He is the ............................ ~'~~ ..................................... ;' ............... ] ............ ~'l ....................................... !" (Contractor, agent, corporate orricer, etcj / // L of said owner or owners, and is duly authorized to perform, or have performed the sai~l/work and to make and fife this application; that a statements contained in this application are true to the~best of his knowledge and belief; arid that the work will be performed in the manner set forth in the application filed the~/ewit~n. Sworn to befpre/l,,/~l.~me this /'~ /') ..?: ? ......... .............. ................... JIJDITH- BOKEN ~. £L-0344963 Suffolk Count'/ Commission Expire= March 30~