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Home My WebLink About7477-zNO. 4 TOWN OF $OUTHOLD BIm,r)ING DEPARTMENT Town Clerk's Of[ice Southold, lq. Y. Certificate Of Occupancy No. Z6622 Date . - Aug 8 lg..7.~ THIS CERTIFIES that the bui]dlng located at l~ '.e0,~.~ .$/~..I[i~;L~. ]l.e.e,k ~treet Map NO...1~.. ........ Block No..x~c.. ....... Lot No. ~.. Peoontx~ · · ~.~ · ........... co~o~ su~t~y ~ ~e App~ea~ for B~g P~t here~fore ~ ~ th~s o~ dat~ ............ ~... ~.., 19..~ p~t ~ w~& B~ Pe~t No...~ da~ ............ A~..~..., 19.~., was ~su~, ~d ~o~ ~ ~ of ~e ~ men~ of ~e app~cable pro~o~ of ~e ~w. The ~p~ for w~& this c~ca~ ~ ~e c~ca~ ~ ~u~ ~..~ ~. ~q ~Z~be rg.~ O. J.~. ~S~ ..... ~.R ........... (o~er, le~ or ~n~t) of ~e ~o~d b~di,g. S~o~ Cowry Dependent of He&~ Apply& . .~ ~ ............................. ~~I~S C~T~ICA~ No...~ ..... ~.. ~.. ~ ............ HOUSE ~ .... 6~ ..... S~t ... l~le~ .~eOk .~ ................... FOBM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERJv~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WQRK AUTHORIZED) N? 7477 Z Permissiofl is hereby granted to: GZ'eG~Doz,t, to build an addition om ext~tl~K d~elltug at premises lacated at t~.O.W, off 8/8 Indti~ l~k R~4 pursuant to ~lication d~ted .............................. ~.....~. ................. , I~....~..., *nd ~ppro~ed by ~ Building Inspector. BUILDINe BtrPARTMINT ~OUTHOt.~, N. Y. DisapProved a/c .............................................................. APPUC, ATION IN~U~I~S b. ~plan ~ing of lot buildi~s ~ premix, ~lation~ip to ~joini~ premises or ~lic str~ ot~ sna, nave ~en g~ APPLI~TION IS HEREBY ~DE to the BuJldi~ ~a~nt f~ ~e i~uance of a Buildina Pe~it Pp , , I COrl:)orotion) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .../~.~R'.k~......~..Z ~ ~ ..~....Z:~...XL..:~.~.. ..................................................................... If applicant is a coq3orate, signature of duly authorized officer. .... .......... (Name 'and title Of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................. ........... .... . License .............................................. 1. Location of land on whi~h_p_rop~_o,~d ~ w~b_e_d~e: M~ap~No.: ...................... Lot No .................. Street and Number .P~..ZZ~-,-ef-,~4:~3 ,;~'~J~....~.../J~.~...~, .............. ~...~..~-,~?R~,~..C~ .............................. . Munlcipali~y 2. State existing use and occupancy of p~rnises and intended use and occupancy of p~ construction: a. I~islting use and occul:mnqt ........................................................................................ .... 3. Nature of~l~F~heck which applicable): New Building.. ................. Addition ..... ,~,.,,, ..... Alteratixon~ .;~.;, ........... Repair .................. Removal .................. Demolitior, .................... Other Work ..................................................... .//~j ~.. t C 0'~ (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 floor ............................ If garage, number of cars ............................................................................................................................................. 6. tf 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 ...... /'~e'. ............ Number of Stories ..... ../.~ ............................................................................... , ................. of~ s~ame structure with alteration_~or a/dditions: Front ....... .................. Rear .....'~.../.. .................. Dimensions Depth ........ ~.. ................ Height ....... ~..../~.. ....... Number of Stories ....... ~.. ..................... 8. Dimensions of entire new construction: Front ...~ ................ Rear ...~ .......... Depth .~ ...... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............... ............................. Rear ............. ................... Depth ...... ./..~.....J~....~.. .......... tO. Date of Purchase .................................. , ..................... Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... t2. Does proposed construction violate any zoning law, ordinance or regulation: .~..~. ............................................ 13. Wil lot be regraded ....... .~..~.~1 .......... Will excess fill be removed from premises: (/Yes ( ) No 14. Name of Owner of premises ................................................... Address ................................ Phone No. ..... v ................ Name of Architect .. Address ................................ Phone No ....................... Name of Contractor i.~.~ii~i~i".~iiiii Address..~...~.~..~....~'..--" ............... Phone No...~.,..~...~ PLOT D AGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fram 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 N .L~..~.~t,S.s COUNTY OF .................. i.l~..~..i~li~i~j~i..~.i~~~ng~~ duly. sworn, deposes and says that he is the applicant above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfomied the said work and to make and file this application; that all statements contained in this oppticetioh are true to the best of his knowledge and belief; and tha~ the work wdl be performe.d' m the monAer set forth m the apphcahon fded therewith. Sworn to before me this ' /~Ti x ~. _ ................... Notary Pub~.~~ty ........ ~...../../..;.../......[r~-~....~ ................. (Signature of applicant) JUDITH T. Notary Public, State of New York N,~ 52-0344963 SLr/TcJk Cou~r~. Comrrrssion Expires March 30, I~,~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual notura~ or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $.5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition ........ .X. ...... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....[~D.,~.,.....~/.$...~.D...Z.~..~..E.~...L...~.~.E.......P..E.~..[.~ ................................................ Owner Or Owners Of Property ....... ~.g..H.~.~.~..-~..~..D..E..~...~.~....(.~...F-.~.R.~.E...R~.~..~..:.....H.~.A...~..~...~.~.~.~..~ ........... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ......7..~2.7....Z... Date Of Permit ......~../..[.~./..?...~.Applicant ..R..~.~.H..T..E..~...~EI..~...E....[.~.P...R..D.~.E.~.~.B.T...~.~.... ..... Health Dept. Approval ............ .~.......~... .................... Labor Dept. Approval ................~......~... ..................... Underwriters Approval .... ..~..-'....?....'-~....?..~.?..-~.......7/~//~'anning Board Approval ................................. Request For Temporary Certificate ........................................ Final Certificate .......~ ........................ Fee Submitted $ ...~.,.flL~ ........................ Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Notary Public ~Co C .... _~¢Z / w