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Home My WebLink About7176-zI'OB,M NO. ,S TOWN OF SOUTHOLD BU~.nING DEPAR~ Town Clerk's O~ice $outhold, N. Y. Certificate Of Occupancy No. Z6~ ...... Date ........... Apl'~ .... ~J..., 19.?~[. THIS CERTIFIES that the bui]di,~g located at . .]~j~lhol, e .Rol~ .......... Street conforms substantially to the AppUcation for Building Permit heretofore fried in Sh~ office dated ............ April..~219. ~ pursuant to which Building Permit No.. ?.~.~Z. dated ..........Ai~/1- · .~g.., 19.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thl, certificate is issued is P~lvaf~ .aoo~or3r. (ator&g~). ]~ullA/ng ............................. The certificate is issued to .. Lou/a & .Ul/no~. ,I&gel .... .Ochers .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval )1,]t, ............................... UNDERWRITERS CERTIFICATE No.. ~eRe ...................................... HOUSE NUMBER ... ~1.8.~0 ...... Street...~71~ho.]f$..1~$~1. ........................ Buil&in~ FOB,M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PJ~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7176 Permission is hereby granted to: Building Inspector. Fee ~.....~....~ ...... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Disapproved a/c .......................................... ~9 ........................................ ....................................... :: ........... ................... ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o¢. in ink. and submitted in triplicate to the Buildin~ Inspector, with 3 set~ of plans, accurate plot p an to sca e. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets of areas, and giving a detailed description of leyout 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 Permit 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 ar~y purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the I~uilding Department for the issuance of a BuiEling 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, adclJtions 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 inspections. ............ .......... .............................. (S'gnot~e of applica;';i';'6,"~t' na~e, if a corporation) " State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.,~ 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 Trade's License No ............................................... ~. Location of land on whicl~.g,roposecl work will be done. ~ap No.: ........................................ Lot No ......................... Street and Number ..... ~.~...~......~3~....~......(~..*. ........... ~~....; ......................................... Municipality 2. State existing use and occupancy of premises end intended u~.e. and occupancy of proposed construction: a Ex s t ng use and occupancy . ~. ~'~ ~:~"~C~ .. b. Intended use and occupancy ........... ~ ............ ~...~.... ~. ...... ~ .~. ~....~/ ....................................... 3. Nature of work (check which applicable): New Building:~.~, ............ Addition .................. Alteration .................. ~ ~ r ' : ~' (Description) (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, commercial or mixec~ 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 ............................,~lumber of Stories .............. ~,. ............. 8. Dimensio~scs of entire new construction: Front ............ iD ..................... Rear ........... ~ ............. Depth ....'~... ................. Height ...~. ............ Number of Stories ..................................................................................................................... Size of lot: Front ........................................................ Rear .......................................... Pept~ .............. ,~ ................ Date of Purchase ............t.~.~..J .................................. Na[ne of-~ormer Owner ..'~.. ..........~......~.~ ....... Zone o~_u~: d. istrict, in .w. hich premises are situated ....... ..~........\.~J.. ........................................................................... ~...~ Does prupusea construction violate any zoning law, ordinance or regulation: ............ I~'.....~. .................................. Will lot be regraded ......................... :.. Will excess fill be removed from pre~. ises: ( ) ,,v~i i ( (/~ No Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Pbe~e 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 nterior or comer lot. / ~ ~ )C9. 10. 11. 12. 13, STATE OF ND6/ YJ~K,//.//.~'_ ~ r r COUNTY Of~°'° ................................................................................................. being duly Sworn, deposes and says that he is the applicam (Name of i~ivid~l signing c~troc~ above name. He is the ................................................................................................................................................................................. (~nt~ctor, agar, comorete officer, etc.) of said owner or ~ners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all ~atements cont~ned in this application are t~e to the best of his ~owledge and belief; and that the work will be pe~ormed in the manner set fo~h in the applicati~ filed therewith. Swam to bef~ me this ......... o, ..... ........... , ~ I (Signature o~a~plic~t) JUDITH T, BOKEN Notaw Public, State ~ N~ Yo~ No. 52-03~963 Suffolk Count/ Commi~ion ~pire~ Ma~h ~0~ Jg~