The URL can be used to link to this page

Home My WebLink About7264-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . P.~..N.~..~...&..0.ak..l~..w_$. .... Street Map No... U ....... Block No. ;K~ ....... Lot No.. U .... .~o~.t~o.~,~ ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..............~la)~...~.~, 19..~.. pursuant to which Building Permit No. F.~.(~..~.. dated ............!~, .... 20.., 19.7~., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pl*llr&~..0~..~ami~Y.. ~I~.~.~.~L~g..~.l~l~..~d.d..~.t.~.o..~ ..................... The certificate is issued to .~.~;h.~.~ .~rSgo..~!~. . .~.fi~..,.l* ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval I,R~ ................................ UNDERWRITERS CERTIFICATE No..M.*R., ....................................... HOUSE NUMBER ...... 3.62~... Street ...0~kl&l~a .SYn..1[~ ...................... FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 726~ Z Date ....................... J~ .......... ~ ............ 19."~' Permission is hereby granted to: ~.~.e.L...,.~J,~e~a ................... .: .......................... 8e~t~ol~ build an &Sd~t:ton o~ ez,l..t,~a d~l at premises located at ....~,J,11~..~.qUIJL~I~,..I~....O.J~l~II~..AlI'i8...~,~;.....i ................................. i ........ 8out,~ol~ pu,~nt ;o a~lication dat~ ........... :.; ............ ~Z .......1~ .......... , 19~..., and approv~ by the Building In~tor. Fee $ ........ , .............. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIC:E SOUTHOLD, N. Y. ?'Approved ........................................ , 19... Permit No. ...'~... .... Disapproved o/c ..................................................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter oe 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 t° the Building Department for the issuance of o 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 all applicable laws, ordinances, bj~'ng code, housing code, and regulations, and to admit autho ri zed inspectors on Premises and in buildings for neces~d~ry h~spections. "' :;' 'i~i'~'~'~ ~':l~'l'i~ n t, or'"' -"~r~'~"i~"~"~'~i~i ........ Pine Neck Road, SoutholdA New .~.~ llgT1 ~ (Address of applicant) ~, 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 Lic~se No. ]~£. 7~ . Plumber's License No....~..o..~..e.~...~.?.?.~.fi;.~Z. ................ Electrician's License No ....... .~.~,11~L,.,,t~a~T'~l .................. Other Trade's License No ........... ..~....:.~ ....................... 1. Location of la~ on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ................................................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and ~x:cupancy 1! .~.~ ],lT. ~ ................................................... b. Intended use and occupancy .....................s....aJ~......~.~..~'~....~..~.+~.9,~. ........................................................................ 3. ~lature of work (check which appl!cgb[e);, New Building .................. Addition .............. .!~ Alteration .......... ~ ....... ~ Repair .................. Removal .................. Demolition .................... Other Work /,,, ~ (Description) 4. Estimated Cost ~ ~ / ~ -- ~ ......:. ................................ tee (to be paid on filing this ap~licatio;;) ............ 5. If dwelling, number of dwelling units ............ .1 ............... Number of dwelling units on each floor ............................ If garage, number of cars ....i...1 .................. . ............ 6. If business, commercial or mixed occupancy, specify nature and extent of e0ch 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 ................ i ........... Number of Stories ................................ 8. Dimensions of entire new construction: Front.........................~ ...... ..... Rear ............................ Depth ....... '. ................ Height Number of Stories 1 9. Size of lot: Front ........................................................ Rear ' Depth ................................ 10., Date of Purchase ........... ~9,5~. ...... ; ............................. Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ....~,q~-.~'~-.~3~L....-..~q::L.e...u~..~.e. ........................ 12.. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of prem ses ................................. '. .................. Address ......... ; ...................... Phone No ....................... Name of Architect ............................ : ................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locote cleorl¥ and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description occording to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ! S S COUNTY OF ...~.~,:L~.~.~.:],tf, ............... [ · ~%~e~ ~, G~go~s ha -~ duly sworn, deposes and says t~ he is the applicant (Name of i~ividuol signing controc~ above name. He is the .............................................................................................................. ~ ................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have~ performed the said work and to ~ke 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 performed in:the manner set fo~h in the application fi/ed therewith. Swam to before me this ~ ~ ' ........................ of ............. , / . Nota~ Public~~~C~n~ . .~.~;~ .................. ............................. JUDITH T. BOKEN / N~a~ Public, State of New York No. 52-0S447C,3 Suffolk Caun~ ~mmission Expires March 30,