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Home My WebLink About7427-z~'0~' NO. 4 TOWN OF $OUTHOLD BU~.nING DEPART~T Town Clerk'~ Office $outhold, N. Y. Certificate Of Occupancy THIS CF~TIFmS that the building located at....~..~...lq.:..R.o~..~...~...2, a...~S..~treet Map No.. jlSg ........ Block No .... ~ .....Lot No...~.....~..o~..th..o..~. .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........J~I~Y...1.7..., 19..~ pursuant to which Building Permit No .... .~...'~. dated ...........J.u.~y...l{~.., 19..?~ was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which ~.hls certificate is issued is ...~.v.e..~.e...~..e.~.~. ~..o.~., ~..~.~..~.~. ~? .~...t~...x.~..~..~ .......................... The certificate is issued to .... Robert. ~4cOe~.~ .................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~.,~.. ............................... UNDERWRITES CERTIFICAT~ No...$.~1~.* ...................................... HOUSE NUMBER ...~.~0. ....... Street .......................................... ...... Building Inspector (THIS PERMIT MUST BE KEPT ON THE I:~,EMISES UNTIL FULL COMPLETION OF TIlE ~AUTHORIZED) N? ?~127 Z Permissic~]l~'hemby gronted to: ~....~,;ct.. ~ge,tt~. .......................................... N. ~ Road . . .Sutld~ng Impector. 10.00 Fee $ ........................ Building Inspector TOWN Of ~ou'rHOLD IUILOlI~ I)il)AIn'MINT Examined .............. 1 Approved.. '~' 1,.~.. ~.. Permit No. ~/'-/~ '7 z'-'--- DisapptcF4ed a/c .................. !..~ .'.'.. ...................... ' ............... ............. :": ........................... ........................... .£ AI~FLICATIOH ~ lUlLDIN~ INSTRUCTIONS a. This ..a~l, ica.fian,rn.~t be completely_fil.l~ in ~ .~wH~ ~ in i~ a~ ~ in triplic~ ~ ~ Bui~i~ *'. b~' P~ ~l~n ~,~. I~la ~of ~l~ings ~ pam~a~s~i~t~ ~ni~ pr~Ms or ~blic st[~ al or~s, a~ gwl~ a ~.~ ~np,~ at i~ ~ m~t ~ the d~agmm which is ~ of this ~h~ti~. c. ~e ~ c~e~ ~ ~is a~licati~ ~ ~ ~ c~me~ ~fom issuance of Buildi~ Pe~it. d. U~n a~al of ~is a~lic~i~, ~e ~ildi~ I~tor will )~ a Buildi~ Pe~it to the a~licant. Such ~it shall be ~t ~ ~ ~i~ ~i ~ · for in~i~ ~h~ ~ '~r~ e. No ~ildi~ ~all ~ ~cupi~ or u~ in ~ole or in ~ for any pu~ whirr until a ~ifica~ of ~cu~n~ shall h~e ~en gmnt~ ~ the Building In~r. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for~ the construction of buildings, additions or o!terations, oj~for remqva,. Lor. demolition, os herein described. The applicant ~mes tq comply w th all applicable laws, · o,rdmances, b~.d~ng c,.(~ ;IY~smg code, and regulations, and to admit auth~ ri~ed :inspect?s orl premises and in buildings mr ~~ ,~]~m~f~- . ..... (~tpr ~-m~, if(a ~c~rporatlon) (Address of applicant) State whether applicant is owner, lesse~ agent, architect, engineer, general contractor, ~leC'tri~ian, plumber or builder. Name of ow 'o ' remises ............ If applicant is a corporate, signature of duly authorized'officer. (Name qnd title of coq3~rote officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... . :.:: :,.: ,: l. Location of land on which proposed work will be done. N~ap No.: ..... ~ ......... .,~,.T~.,..,~...,,..;..~, I-~.t No, ........................ Street and Number ......... ~[O~'.~;b..~.~,~l~,aa&de..~O~.~l~o'lel, e...][~.~'~.' . .'.: ...... :.:.:.:'.,: ................ Municipality 2. State existing use and occupancy of premises and_ intended use and occup~nC'y of proposed construction: a. Exisiting use and occupancy ........... J[ea~[aa~.t,:[a~.,...-...]:lize~l.:L~ ............ , .................................................. b. Intended use and occupancy SELllIO vt~;b, ale~a.~, ft~;o~e si:tod. 3. Nature of work (check which applicable): New Buiiding. '"]E~ ......... Addition .................. Alteration ................. Repair .................. Removal .................. Demolltio~. .................... Other Work .................................................... 4. Estimated Cost ...... ~(~1~)e ....................... ~ .............. ~."Fee ~.~....-~........ .................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units qn 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 ...3~.I .......... Height ........................ Number of Stories ..... :~1~.....; ...................................... : .......................................... .*. ............. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... 1 tt.I. .................. Rear ....'10.!. ................. Depth .].0.!. ................ Height ...~.1..~.?. ........ Number of Stories ....... ~, ........ ~ ....... ~ ...................................... ~ ................................... .'. ................ 9. Size of Iot:'Frbnt ..................~.~,.I. ............................ Rear .......... J~2.1 ....................... Depth ................................ ~1~: Date of Purcb~ .~,,-'~.J~,9.~-~ ....... : ............................ Name of Former Owner ~D..~...~e..~g:J;.12o~.~...1a'~,~., ! 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~ .............................................. 13. Will lot be regraded .....~...O. ................... Will excess fill be removed from premises; ( } Yes (~) No 14. Name of Owner of premises~,l)~'G..Z:.~..le~.l~e ......... Address ..~e~t~l~e.l~.]ll/-... Phone No......~(l~-q~ Name of Architect .......................... ~.a~l~.~. ................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, ~, COUNTY OF .... ~.t~.~jlj: ........... ~b.~ .................... ,~O]a~'t~;..~...~.(~ .BI31~, ................................. being d~ly sworn, d~oses and soys t~t he is the applicant (Name of individual sigDin~;c~tr~c~:;~ ' above name. He is the ................................... ~.~ .................................................................................................................................. (Contractor, ag~t, co~rote officer, ~c.) of said owner or owners, and is duly a~rl~ to ~ffo~ :o~:~ h~e :~performed the said work and to ~ke and file this application; t~t all states,ts con~d in th~.appli~etion :ar~ tree to' the best of his kn~ledge and belief; and tha~ the work will ~ performed in t~e man,er set fO~h in thee appli~o~i~il~ t~ith. Sworn to before me this . ....... ...... Nota~ Public, ~..~~.~.~T~~n~ ........ ~.~..~..~.T~.~.~...~........~ ~.T~ ...................... ~OT~RY pUBLIC. Sta~ of New Y~