The URL can be used to link to this page

Home My WebLink About7210-zTOWN OF SOUTHOLD BUILI~ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificale Of Occupancy No..Z?3..06. ..... Date ............ . .0~.l; .... 18 ...... , 19..7.6 THIS CERTIFIES that the building located at . .~.a..ah.i.n.g.tg.n..~..v.~ .......... Street Map No. Id&sll. ttt;.s.. Block No ........... Lot No..~.~. .... .~.r..e.e.nl~.q.r.t .... .}I:.Y.: ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Apr...23..., 19.?.~. pursuant to which Building Permit No...7..2.1..0~. dated ............ Apr....30..., 19..7.1+., 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 . .P.r.i.v.a..t.~..~.e..ee.s.~9.ry .(..s.tg.r.a.g.e .)..b.u.l. 1..d!.n.g ............................ The certificate is issued to .L.~.s...E r..~.r..i.l.l.t. .... .0f~...e? ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N: ~.° ............................... UNDERWRITERS CERTIFICATE No..~: .R.. ....................................... HOUSE NUMBER ...9.30 ........ Street .. W~shi~g~on. ATe ..... G..r~.e.n. pg.r.t. ....... 110 Washington Ave (Post office #) Building Insp~ FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7210 Z Dote ....................... JLp,~:J,1 ......~0 ........... , 19..~..~. Permission is hereby granted to: ~u~..~....G~,T&~ ............................................ to ..~u~,id,..~ev..4e, o~s~e~..(etez,&l~)..bJ:l,14~,~i .............................................................. at premises located at L{~t..lec).....Wesl~}_wgten..Z~e{.g{~ ............................................................. ................................. J~/. $ ..V/& sl~n~t ~n...Ave ......... G~e eljpel,4} ....J{, .~., ...................................... pursuant to application doted ...................... A~F ....... ~.~ .............. , 19.~J~..., and approved by the Building Inspector. Approved ............t..(. ......................... , FOILM NO. ! TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 19...~...~Permit No...?....~...../.....~.....~ ..... APPLICATION FOR BUILDING~PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout 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 any purpose whatever until a Certificate of Occupancy 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 '~ 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 alterations, or for removal or demolition, as herein described. ~' The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and to hi admit authorized inspectors on premises and ir~ buildings for necessary inspections. ....................... (Signature of applicant, or name, if a corporation) (,~ldress of applicant) / ' 7' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... clu ........................................................................................................... Name of owner of premises ........... L.O....~...i..~ ....... ~-......~.~..I.i..~..L.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 Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: .............. ~ .................. Lot No ....................... Street and Number 11~ .~...fit~.~. tO '..'~ ..~.~,3 .~ ~._ .~ z.~.~ O..,t;.72T..~... , .................. .................. ........... ......... ................................. / Municipality 2. State existing use and occupancy of prem~es and in:ended use and occupancy of proposed construction: o. Exisiting use and occupancy ........ ...~..~..../~.....~..~/ ........................................................ b. Intended use and occupancy ..~..~..I ........ .~..~/....~..~. ~.~'1~....~..~ ........................... 3. Nature of work (check which applicable): New Bu,ldmg/~.~.'.'~'... Addition .................. Alterotion Repair .................. Removal .................. Demolition .................... Other Work .................................................. :. (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, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ........./.~,..' ............. Rear ...... !...2../. .................. Depth ...~.D.~../. ....... Height ....... .~...! ........... Number of Stories ....... {. ........... ~q.~.,~i..L..C....~-~...x~-..-.~. ....................................................... Dimensions of same structure with alterations or additions: Front ...... ...~)..~..~,...~... .............. Rear ..../~..~.~...~. .......... Depth .......... ......~.~..o...~.....~..... Height .......... ..~..o....~ ..Number,, of Stories .......... ~.o....~.r ............. /' ~ 8. Dimensions of entire new construction: Front ......... /.O..t...nd. ............... Rear ....]..~......~ ........... Depth ........................ Height ....... .,~...~ ...... Number of Stories .......... 1 ............................................................................................................ 9. Size of lot: Front ...................... ~..~....t. ........................ Rear ............ ..~...6...! ..................... Depth .../..~..~....x. ................. 10: Date of Purchase .............t..~..~1~. ............................... Name of Former Owner Z~'..~.~f~--~....C~./.~-~4~-'x..;..-~ ............ 1 1. Zone or use district in which premises are situated .................................................................................................... .~../.. 12. Does proposed construction violate any zoning law, ordinance or regulation: .... /~'..O.. ............................................. 13. Wilt lot be regraded . ...... .~..?. ............... Will excess fill be removed from premises: ~ Yes ( ) No 14. Name of Owner of premises ......~...O...~/.i..~....~-......~.'2~'~':~-,~:.. Address ..... Phone No. Name of Architect .............................................................. 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. ' lO! '1" STATE ~F' NEW YORK, cou . OF .................. ~~ ..~.~,._........__ ~_~.____~ ................................ being duly sworn, deposes end says that he is the applicanl .... ........ contrac'~) above named./9~t~.~_a.~ He is the ...... ~ ...................................................... ~'f ';'~";;; ................................................................. (Contractor, agent, corporate o 'c , .) 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 of his knowledge and belief; and tha~ the work will be perf~n~ed in the manner set forth in the application filed therewith. Sword to before me this/ ....................... ' ~lo~.ry -Pub ~-~ .................... County ¢~71~..~,~¢,¢,,~.....:.....;;.. ................ ;. ....... ; ...................................... ~'~--- ~,~_ ~_~,'~' 7 '~' ~:~ignature o~ appdcant)