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Home My WebLink About7216-zNO. 4 TOWN OF SOUTHOLD BUITI)ING DEPARTMF.~T Town ~lerk's Office Southold, N, Y. Certificate Of Occupancy THIS CERTIFIES that the buildi~ located at ~..~.~....O.A...~..., ~..~..~. ...... Street Map~e°6~'' ~f~V .... ~_loek No......"-~. .... Lot No.. !.~..~. 7..1.~./. .................... conforms substantially to the Application for Building Permit heretofore filed in thin office dated ............... !..~.~.~..~, 19.~.?. pursuant to which Building Permit No. 7.~./..~..~- ............... ments of the applicable provisions of the law. The occupancy for which tb~s certificate is The certificate is issued to (owner, of the aforesaid building. Suffolk County Department of Health Approval . ...~.:...~... ......................... UNDERWRITERS CERTIFICATE No. ttOU~E I~UMBER .............. ~treet .......................................... 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) N? 7216 z Permission is hereby granted to: ............. .V....E.....'g...,,,A:,. ........... ~..o....~..~..-c...~ ..... ~o ...~...D.. ........ ~ ...~..A....,.-S..A ~..g.. ...T..o ~ ....O..~.l~.~ {'~-~ /3~p, LY ~:>~d /~ kLlt--I C~ .................... at premises locoted ot .......................................... .~. ............................................................................... ...................................................................................... E...~ ....... .P.. .......... ~ ............................................ ....................................................... ~ ' ' ................................................ 'i ................. L ...... pur.uo.* ~o o,,,co,on ~ted .................................. ! ......... Nh.i. l~.y..., ond o,,ro~ed by the Building Inspector. ......... PERMIT INCLUDES APPi~DVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADING LOT ~-- DRIVEWAY CONSTRUCTION CESSPOOL CONS fRUCTtON CELLAR C~oNSTRUCTION '"'"'"'-- OTHER Building Inspector FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ................... ^pproved .................... I'.?Z Perm,t No. .......... Disopproved o/c ........... *~ ............ ~ .............................................. ......... ............................... (Buil~inO Inspector) Application No. '"~'~ / ~ APPLICATION FOR BUILDING PERMIT Dote ....................... ....... ,,,Z..Y..... 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 o~ 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 cpplicant agrees to comply with all applicable laws, ordinances, bu ding code, housing code and regulations, and to admit authorized inspectors on premises and in buildings for necessar~4~l~ections. -~ (Signature of applicant, or name, if a corporation) (Address of applicant) i I '~"7/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................... ............................................................................................................................................ Name of owner of premises VIZ T~ ~ C~OE J~ ~- L.~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. -~. I~'~. Plumber's License No ...................... ...~...;..~.. ............. Electrician's License No ............................................. Other Zrode's License No ............................................... Location of land on which proposed work will be done. Mop No.: ..................................... Lot No ................... Street and Number 3 ~5 ~A~ ~ K~- ~}~ 0 c~ ...... Municipali¢ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and ~cupancy / ~ ~ ~ LY ~ ~-L L / ~ ~ b. Intended use and ~cupancy ~ ~ ~1 ~ ~ I TN ~ ~ ~ C [,l ~ ~ ~ ~ ~ ~ &-- 3. Nature of work (check which applicable): New Building ~: ................ Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... c~, (~ O O /_~ ~ (Description) 4. Estimated Cast ............................................................ 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 ................................Depth ................... /.~...~ ....... Number of Stories ............. ~. ......................................................................... ../-../. ............ Height Dimensions of same structure with alterati°ns or additions: Front ............... ............ Rear ...........~ ............ / (~ Number of Stories / ........... Depth .............. .-.~./.. .......... Height ................................................. 8. Dimensionsof, e~ptirenewconstruction: Front ................. ~. ................ Rear ............................ Depth ...... /... ............. Height J/~ . Number of Stories .................................................................................................... / ....... : ........... /~O t /~-~ 9. Size of lot: Front ........................................................ Rear .......................................... Dep h ................................ 10. Date of Purchase .............................. (....?.....¥....~.....~....Name of Former Owner ........ ..~....L.-.~...~....?~...~..~.. .................. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ......~..v.....~.. .............................. 13. Will lot be regraded . ........................... Will excess fiji be removed from premises: ( ) Yes 14. Name of Owner of premises ...... ..Y...Ez....~...../~.. ....... ..~'T.~...~.....~..~.,,L.. Address ~'/~ ~*! ~ Phone I~o 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 oil 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, ~S S COUNTY OF ...... , ......................... f ' ........................ . .~.... ......... ..~..?.0~- ~....~...~ ...........................be ng duly sworn, deposes and soys that he is the applicon (Name of individual signing contracf) above named. He is the ............................................. ~ontractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to ~ke and file this application; that oil statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the oppli~ed therewith. ~ Sworn to before me this ,. ~ L '/ ~ ,, ~2 JUDITH T. BOKEN