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Home My WebLink About7056-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z -~9(~ ...... Date ............. June~.. 20 ...... , 19 THIS CERTIFIES that the building located at .. W/$ -St.~ttwater. Ave .... Street Map No. xxx ........ Block No.. ~ ..... Lot No..xxxx .Cutchogua.. N,.Y, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated D.O 3~ ~ ?O~6Z ........... ~ ..... , 19. pursuant to which Building Permit No.. dated Ja~ 19 ~l~ 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 Acaes~o~,y. b-utld-ing. &..f. enc® ........................................ The certificate is issued to . R.f~chard .~achnowsl~$. J.~ ......... 0~msl, .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . N...R, .............................. UNDERWRITERS CERTIFICATE No.. H. R · ...................................... HOUSE NUMBER ...... 310 ..... Street ..... S.tillw. ater. Ave .................... Building Ins~i/ector SOUYI~LD, H~ Y. UG PER)ArT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7056 Z Permission is hereby granted to: ~.e.l~..l~m~J, ...................................... ...... ~l~.....~l~lJ~m~..Jkm ............................ m .l~x~IJ~4..m~..~a ~ e~er~.~az~L.b~ ~ .................................................................... at premises located at ...~.~,4).....~Lt,~i~lr&~..A~e ........................................................................... .~l~ll~l~ .~;~., ............................... pursuant to application dated ........................... ~)ee.'...:~.~ ........... , 19.r~.., and approved by the Building In~ector. Building--Inspector/ / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined proved ........................................ i Pe ,t ..... Disapproved a/c ,. .............................................................................. APPLICATION FOR BUILDING~pERMiT INSTRUCTIONS ~/~ a. This application must be completely filled in by typewriter or' in ink and submitted Jn triplicate to the BuildingS, Inspector, with 3 sate of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan ~hoWln~ location of lot and of buildings on premises, relationship to adjoining premises or public streets 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 opp~6val 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/v 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 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, building code, housing code, and regulations, and to "~ admit authorized inspectors on premises and in buildings for necessary inspections. (Signature ;" app icant, or na~;;"J~";';91'13oratJo~i ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................... ~....(~.....~...~...~ ..i ............................................................................................................................ Name of owner of premises .......... ..~.../..~..,C/..~.....~..~....../~..~...~.~'./...~...°....°~....-~...~...Zl....~.~.~ ..................................................... 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. o S z~ ~'..~. z~.~ c~-, ~ c u ~.C...~.~. ~ c., ~ Street and Number .........~.../. ............ .Z'../. ....... ..~.~ ........................ .! .......................................................... Municipality 2. State existing use and occupancy of premises and in.~ended use and occupancy of proposed construction: a. Exisiting use and occupancy ........... .~..~.....~......~.~.Z~./..~.7~......./2...~.....~.~.~.~..~....~.. ............................................ b. Intended use and occupancy ..... ..~..~..~.~.~..~.....~....`~..~....~..~.~..~...~../~..~..~.~.~..~....A~..~.~ .......... 3. Nature~f work (check which applicable): New Building ,.;..~.. ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ...................................................... (Description) 4. Estimated Co~t ...... ~..../..~....~......i .............................. Fee ............... ;~..~..~. ............................................................... (to be paid on filing this applicatiOn) 5. If dwelling, number of dwelling units .,.....~T, ............ ~.....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. Dirnensions of existing structures, ifony: Front ...... ~.../. ............... Rear ......... ~..~. ................ Depth ....~...~....x. .... 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 ........... ./.4~...~. ............... Rear ...... ./..~...~. ............ Depth /~" Height ..../....~.. ......... Number of Stories ................... ~.x~...~.~. ................................................................................... 9. Size of lot: Front ............ ./..~.~ .................................. Rear ............... .~....(. .................... Depth .....,~.....~....</(.. .............. 10. Date of Purchase ...... ~.....~....P...~..~.../...~...~...[ .................. Name of Former Owner ~..~...~..~..~../.~..Z...E~.....~'~....z-~.../~...~.~1. .... ................................ .~....U...'ZT..~ ~ ZL~. ............................................ 11. Zone or use district in which premises are situated u ~- 12. Does proposed construction violate any zoning law, ordinance or regulation: ..............................................~ ......... 13. Will lot be regraded ..... .~?....q ............... Will excess fill be removed from premises: ( ) yes (XJ No 14. Name of Owner of premisesl~.~.9~'.~gJ?.~...~..f]..¢.H.'....~..q...~*.~...s.../?..l~ ...... Address~/.~....~c'/..Z.z.z...~'.'~.~..... 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 properh/ lines. Give street and block number or description according to deed, and shaw street names and Indicate whether interior or comer lot. STATE OF NEW~K~_ ( e c COUN~ ..... .-~..~...~J~.. · ~.~.~ .... ~ ~'~ . ................ .~..~'~..~.-~.~.O.~...'~/~l:~.,~tc~-.G-'(,~n -:~'~..-~--~.~....k./~.:...being duly sworn, d~oses and says t~t he is t~ applicant (Name ~ i~ivid~l' ' ' ' - -~-~--~ 'signing contrac~ U ~ve nom~. ~ ~_ He ~s the ............................... ~~~ .............................................................................................................. of said owner or owne~, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that oil ~atements contoined in this ~pmicotion are tree to the best of his ~owl~ge and belief; and that t~ wo~k will bepe~for~d in the manner ~t fo~h in ~e Opplicati~ filed therein. NOTARY PUBic, S~of Ne~ York ~o. 6~1~, S~f~k ~t~