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Home My WebLink About7066-zTOWN OF ~ 80UTIIOLD BUILDING DEPARTM~qT Town Glezk's Oliee SouthoM, N. Y. Certificate Of Occupancy THIS CERTIFIES t~,t the building located at. B./$. ~.cp.o.t..%~.e. ......... Street Map No. x~ .........Block No..xx ....... Lot No. ~x.. 0~.%¢h~ue.. H,Y, .......... conforms substantially to the Application for B~ Permit heretofore ~ed in this office ments of the applicable provia~ns of the law. The oceu~ancy for which th~s cert~eate ~- ~sued ~ . Private..one. £amilM. dwelling..~ltk.an, a~dltion, &/~lY~e.' g~age The certificate is ~mue4 to .~.1.~.:1:.~..mi ~a..o.o~s. ..... . .Oj:~. ~ ............................ (owne~, levee or tenant) of the aforesaid butldin~. Suffolk County Deparlment of Health Approval .~ :.Pi.: .............................. UNDERWRITERS CERTIFICATE No..p.e.~...i-v-.g, ...................... : ........... HOUSE NUMBER ... %%~1 ....... Street. ilepo~. ~ane ............................. (THIS PERMIT MUST BE KEPT ON THE PI~,E~ISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7066 Z Permission is hereby granted to: ~..~.~,.~...~.~ ~.~.~......~ ........................................ ............. J~p~..~e .......................................... m ..~..~,~.~..~...~.~.t,L g~g~.....Lm~ m~-~.~ ................................................................ at prem!~e~ la~ated at ...... ~1~1~.,~J~13~ .............. ~ ........................................................... 0ur~uant to a~:plication dated .......................J~ ......... g ............. , 19..7~i,., and approved by ~,~. Building Insp~or. Fee ~g.~. ............ ~: ~ Approved TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN a. ERK'S OFFICE SOUTHOLD, N. Y. ,9.7...?.. ,,,., ............ Application No ................ ~. ............ Disapproved a/c ............................................................ APPLICATION FOR BUILDING PERMIT Date ..... ,..~,.,A~. .............................. , 19...?...~.... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buiklin~ Inspector, with 3. sets of plans, accurate plot plan to scale. Fee according to schedule. ~/ b. Plot plan showing location of lot end 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 app cant. Such perm t 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 Deportment for the issuance of a Bu Iding Permit pursu..ant to the Building Zone Ordinance of the Town of Southold, Suffo k 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 de~cribed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulation~ and admit authorized inspectors on premises and in buildings for necessary inspections. .~(Sign~ o~f a~j~.~o~m,, ifa corpora, tion) ,. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................ Name of owner of premises ~./.././/../.~ J..J/1~.~ .~..~ ...... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Liconse No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of landon whic~rk will be done. Map No.: .......... .~ ........................... Lot No ......................... Street and Number ~L_j..~_.~~ ....... .............................................. ~- ........................................... ~ ~- .~.~' ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy .................................................................... ' Intended use and occupancy ............................... ..~.... .......... ~..~.. ...................................................................... ,/ ~: "~ · D ''n hr r ' ~ ~'~ Repair ..................Removal .................. emohbo .................... Ot e Wok .............. '-~ ~~/~ ~_.x ~ (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 f~loor ~ ........................... 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 alteratJ0ns 6~ addition~.:_ Front .................................... Rear ............................ Depth ................................ Height ........... ~ ............. ...Number of Stories ................................ 8. Dimensions of entire new construction: Fror~t' .......~"......~... .................... Rear ....'~...~ .............. Depth ...~....~.. .............. Height ..L.~. .......... Number of Stories ....~. ....... 7. ..................... :~ ............................................................................... 9. Size of lot: Front .... .~...~... .......................................... Rear .....~..~.. ............................. Depth..~... ......................... 10~ Date of Purchase ..... ~: .................................... N~:~e, of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..... .~.(~1~..~.~~ ........ :"~ .......................................... 12. Does proposed construction violate any zoning law, ordinance or .regulation: ....... ...~.....~. ........................................ 13. Will lot be regraded' .............. Will excess fill be removed from premises: ( ) Yes (l~No 14. Name of Owner of premises ....~...'.~......~....:...~.P~:..'~.~.~,... Address~.AZ~....~l~!~.. Phone No Name of Architect ............................................................. Address ................................ Phone No ....................... Name of Contractor ..... ....~...?....~..~.....~'.~.~...~...~.. ........... Address C~,~.~...~.... Ph°~ No/.'~.....~....~....~...~.. PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all ~t-I~ck dimensions from property lines. Give st~et and block number or description according to de~cl, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, COUNTY../'~ ~'~ /1/~?.F/"~'~'; ................. f~'~ (Nome of indii/f~ib~/~'/~igning contract) 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 contoined in this application ore true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith, 'Swam to before me this ~_~.,~ . . .~ - .' ............ ............ Notary Public,~ ,.~....:.~?...~ounty ... K.f. ~.....~....."..~.."~f~Z~.....f:. .............................. ~' (.~lflatu~yof applicant) JUDITH T. BOKEN Notary Public, Stale of New York No. 52-0344963 Commission Expires March 3~17.~