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Home My WebLink About7274-zFO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ...~;.!.l.~..~.t.~.l-...A..V~. ......... Street co~orml lubstantially to the Application for Building Permit heretofore filed in this office d~ted . './ ........ 1,.~,$~..23 .... , 197!e.. pursuant to which Building Permit No... :.'dated -/i ......... ~.a~....23 .... , 19 ?.~.., was issued, and conforms to all of the require- ments o~[ the applicable provisions of the law. The occupancy for which this certificate is ~ (owner, lessee or tenant) of th~i~Moresaid building. Suff~]~ County Department of Health Approval . .~...R., .............................. uND~,RWRITERS CERTIFICATE NO. ti,R, ........................................ HOUSE NUMBER "; a' Building Inspector 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? 7274 Permission is hereby g tO re {se Iocat at pursuont to oppl{¢ot{on doted ........ ...~~..~--.~... ........... , Bu}{din9 {nspe~tor. .... and approved by the _.~~ Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~.~.~... ....... Approved ........................................, 1~ ........ P~rmit No .......... Disapproved o/c ........................... ............................................... APPLICATION FOR BUILDING 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 o~i areas, and giving a detailed description of layout ofpraperty 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 o 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 i shall have been granted by the Building Inspector. BR .A,P..PLI _CATIO~N .IS HEREB. Y NLADE to the Build ng Department for the issuance of a Building Permit pursuant to the% u.a!ng :on.e ~r.ainance at t. he Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances egulations, tar the constructmn of buildings, additions or alterations, or for removal or demolition, as here n descr bed The applicant agrees to comply with all applic, able laws, ordinances, building code, housing code, and regulations, and to~ admit authorized inspectors on premises and ~n buildings for necessary inspections. ..................................... ....................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................. ~..[. ~ ................................................................. 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 Trode's License No ............................................... l. Location of land on which__~roposed work will be done. Mop No..~....'~...'....~.~....#.../.~.1~ Lot No..~...~.....~...~....~.. .... Street and Nun~.~~ ~ ' ~ ~ ................................................... Mmaicipality 2. State existing use and occupancy of premises ~and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... ~ ....... ~...~ ................................................................... b. Intended use and occupancy ................. : ........................................................................... 3. Nature of work (check which applicable): NeW Bb'~ld~ng: ;~..£ ............ AdSition .................. Alteration .................. Repair .................. Removal .................. DemOlition........ ............ Other Work ................ .~....'~..~...~/. ........ ~. ~...~....~.... ~i~/u~- C~, aC) . Fee il~/./. O ~....~..' (Description) 4. Estimated Cost .............................................................................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ..~.....;.~. ....... Number of dwellipg 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 ...,~.~ .......... Height. ........................ Number of Stories ............./. ................................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ..................... .~ .......... 8. Dimensions of entire new construction: Front ........... /.~2. ................... Rear ........ j~.~....r. ......... Depth ...... ./...O....[ Height ..~...~2..~ ....... Number of Stc~'ies ...................................................................................................................... 9. Size of lot: Front ................. ./...~....O. .............................. Rear ....................................... ,.. Depth ......... ~....o..G...~. .......... 10. Date of Purchase ............ ../..~..~.....~:.. ............................. Nome of Former Owner ..~L4,..!3~.....~,~:t~r ...... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................ ../y~...O. .................................. 13. Will lot be regraded ....~.~.. ................ Will excess fill be removed from premises: ( ) Yes (~"~No 14. Name of Owner of premises ...~.~./~...~,.~....C..(.'~.~(..~,,~(~'4'..~{~'Acldress ~.~..'~. -~....~.(-~.~..~.. 'Phone N°. .~.,~..~.~....~..o....'~.. NNeme-af-R~ect ................ t~...¢..~...a~.. ............................... Addrer~ ...~U'~.~'~.~.g. ....... Phone No ....................... Name of Contractor ...................... ~'.R~...~... ....................... Address ................... ~, ........... Phone N° ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and india:ate all set-back dimensions from property lines. Give street and block number or description according to deed, anc~ show street names and indicate whether interior or corner lot. .,~, , 0 ~ ' ~" 2.----- 0 h ant ......................................................................... being duly sworn, deposes and says that h6~is the app 'c (Name of individual signing contracf) above named. 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 make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thru the work wiJ, I be performed in the manner set forth in the application filed therewith. Swam t,~e_,~,, ~ ~//~/~ this Nota .... ................................... 4/' ~' (Signdture of applicant) No. 52-0344963 Suffolk Commissien ~xpires March 30, I~.~