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Home My WebLink About7496-zFORM NO. 4 TOWN OF SOUTHOL] BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6221 Date Dee 2 ' ~ ........................................ , THIS CERTIFIES that the building located at .W./.S..B.~..1~..Hi..~.1..I.t~.'.~ ....... Street Map No.. XX ........ Block No... ~ ..... Lot No, XXx . .h~lzh~r,~. ;[.Slai~.d,..N...Y,,.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ J.tl],y...1.2, 19.7.be. pursuant to which Building Permit No.. ?.~.9.'~.Z.. dated ........... .A.ug.. 2.6 .... , 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 . rriva.t.a. (ac.cess.(~ry)..garage. build, lng .... (.. The certificate is issued to ...~m.;. i).,,..(}.till~l'i~, .,Tr..'..o.w!.~r. ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~;R.;; ............................. UNDERWRITERS CERTIFICATE No.. ~.:R.: ...................................... HOUSE NUMBER .... n.°.n.~. ..... Street ............ ~ ............................. Building Inspect~ FORM NO. 2 TOWN OF $OUTHOLD i BUILDING DEPARTMENT TOWN CLERK'S OFFICE~ SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMIS~ES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7~196 Z ~)ote ........... ................ ~....~,a...., ~'7~*'-' Permission is hereby granted to: Bout~n..~Se.vvt~...!.n~.:...a/¢..l,~t~ie~l..l~,...G'~illa~ Jr ........... F.,t~l~e.~a..~slant ............... : ................... ~o .~l~i 1.fl ..naw...pz'£~ate...garage...(gca;v*.) .................. ! ................. : ......................................... ............... .(ap.Br~v.e~l..hy..Bd...~pe~la) ....................................................................................... at premises located at .W/£..VtoZ1..~II.1.L,.Av$ ...................... i ........................................................... ................................................ ~.Ibshe~..iLsl~nd ....... I~,¥,~ ............................................................ pursuant to application doted .......................~LlZ~--..,..t~.......i ....... , 19.'~'.1i-.., and approved by the Building Inspector. Fee $1,Q.,.QO ............. ' I v Building Inspec~r TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFK~E SOUTHOLD, N. Y. Examined ........ , '9.2? App,cat,on ,o. ................ ...... .......................... ........ ¢ ....................... ........................... ~PPLIC~TIOM FOR ~ILDIMG PER~IT INSTRUCTIONS July 12 74 Date ................................................ , 19 ............ a. This application must be completely filled in by typewriter o~ ir~. 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 drawp 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 issu~ a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the w~rk. 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 Department for tk~e issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, Ne~v 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, bui!ding code, hous ng code, and regulations, and to admit author zed nspectors on premises and in buildings for necessary iinspections BOUTON SERVICES, INC. (Signature of applicant, or name, if a corporation) P.O. Box 506, Fishers Island, NY 06390 (Address of applicant) State whether applicant is owner, lessee, agent, architect, enDineer, general contractor, e~ectrician, plumber or builder. General Contractor Name of owner of premises Wm. D. Gaillard, Jr. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. 1142-E Electrician's License No ............................................. Other Trade's License No ............................................... x,~ \/ Location of land on which proposed work will be done. Mop No.: A, ........................ .: ....................................... Lot No. Street and Number Bell Hzll Ave. , Fishers Island ~ Municipality State existing use and occupancy of premises and intended use a~d occupancy of proposed construction: a. Exisiting use and occupancy ........................... .~ ................ ---,~,~'" ......... '"~- II 'J/~ ................................................................ r~ b· Intended use and occupancy ........ .~..~.~...'-~:.. ........ .U.~Z.C/.~ ,~L~F°-c~.,/~, ~-i~..~..~..:T.:: ............... 3. Nature of work (check which bpplicoble): New Building'. ....... .X. ........ Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost .... .$..6..:.0..0..0..:..0.9. ..................................... Fee ~ /. 0 ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Numbcr of dwelling units on each floor ............................ I 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 20 ' 6" Rear 30 ' 6" Depth 31 ' Height 22 Number of Stories 2 Dimensions of same structure with alterations or additions: Front same Rear Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..~..~...~. .............. Rear ....... ~..~...... Depth 26' Height ...... 1..2. ........... Number of Stories ..... .1 ............................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...,~......~j~..~ .~.. ..................... .~, ................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................................... 13. Will lot be regraded............................partiaily Will excess fill be removed from premises: (×) Yes ( ) No }gm. D. Galliard, Jr Bell Hill..A..v..e.:. Phone No. 788-7676 14. NomXe of Owner of premises .................................................... Address ............................................. Nome of Architect ....,n..q...n..e. ................................................ Address ................................ Phone No ....................... Name of Contractor ..~.o..u..t..o..n....S..e..r.y..i..c..e..s..,...I..n..c.:.: ................ Address ...C.T.e...s.9..e..n..t...A..v..e.~ ..... Phone No...7..8..8.7.7..2..6..8. ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn 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 NEW YORK, COUNTY OF ................................ Anthony J. Marshall ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. Contractor He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 thor the work will be performed irj the manner set forth in the application filed therewith. Sworn t~re me this No. 52-9509185 Qualified in Sulfolk Counrf~