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Home My WebLink About7515-zTOWN OF SOUTHOLD BUILrqNG DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at P,,0.W., .1~/$ -Pin, ·Neck -I~! Street Map No..XX ........ Block No..~ ..... Lot No. ~zx-. ~:mtho~.d·· ~1,¥~ .......... conforms substantially to the Application for Building Permit heretofore filed in thi.~ office dated ........Sapt...3 ..... , 19.71,. pursuant to which Building Permit No.. dated ......... .qept .... 3. .... , 19.7.1,., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thl. certificate is issued is .P..r.i.v.a. ~e..o.~e. ~.al~ily..dw~Xling..(appro.ved. ]my. Bd. Appeals ) ......... The certificate is issued to..John .M.. Jademar~ ..... Ow. el, ........................ of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) · .l~ ok. ............................. UlhrDERWRITEP~ CERTIFICATE No. pe,~din~ .................................... HOUSE NUMBER .. ~3[ ........ Street ... P. -tree. ~eok. ttoa~l ...................... IvOBM NO. ~ TOWN OP SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7515 Z Permission is hereby granted to: John~ Lademaz~n gutchogus pursuant to application dated .........................S..e..~.~. ......... 5. .......... , 19~.~....., and approved by the Building Inspector. APPLICATION FOR BUILDING FERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter at in ink and submitted in triplicate to the Building~ Inspector, with 3 sm of plans, accurate plat plan to scale. Fee according to schedule. b. Plat plan showing location of lot and of buildings on premises, ~elationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproparty must be drawn on the diagram which is part of this application, re, c. The work covered by this application may not be commenced before issuance of Building Permit. d. U.pan app..reval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit,~, shall be kept on me premises ava lable for nspect on throughout the work. e. No building shall he 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 the issuance of a Buildi Permit umuant ' th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applir~cal~le ~ Ordl~ntr~nc~es 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 regulatlans, and to admit authorized inspectors on premises and In buildings for necessmy ir'mpections. (Address of applicant) State whethe~ applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... C)...~....~.....~....~.. ....................................................................................................................................................... Name of owner of premises ......-'~..~.~.L....J~. ..... A,,~f~..O.~.,R~?.,e~.~'..~.. ........................................................................ If applicant is a co,rate, signature of duly aut~riz~ officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ....... :~L..~.C;L.~ .................... Other Tmde's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot. I}1o ......................... Street and Number ..~..~.....~..~.~..~.......~..A~.c~....~.~.~.O ......................... .~..o....O...~...~....~....~. ~aL.~.,:~'.~' " State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... ~.~.JJ~.~.~..~.~ ............................................... ' ......... b. Intended use and occupancy ~ ..~'.~..J ~).~ .~...C ~. ......... .'f...'~...~ ........................................ ) 3, ~Nature of work (check which applicable): New Building.. ................. Addition ....~ ....... Alteratlo~ ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (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. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...... m'~.~ ............. Rear ........ ~,..~:. .............. Depth ....~,P-'. ........ Height ........................ Number of Stories ............... J. ................................................................................................ Dimensions of same structure with alterations or additions: Front ......... .~..~ .................... Rear .....~..,/..'. ............... Depth ....... :~.x'~.~. ............... Height ............ ................ Number of Stories ...... ./. ........................ 8. Dimensions of entire new construction: Front .......... J.~.. ................... Rear ........ ./..~. .............. Depth ...... /...~. ............ Height .................... Number of Stories ........... ?. ......................................................................................................... 9. Size of lot: Front ....... /..~..~'. ...................................... Rear ......... /.¢3..~ ....................... Depth ..... .~...~..~.~ .............. 10~ Date of Purchase .....~.....~...~ ........ /. .~. /, . .7. ................... Name of Former Owner .~..D...~..~R.a...~,...~.~...~J..~.../~....~I~ 1 1. Zone or use district in which premises are situated ....~. ............................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............... ..~...O. .................................. 13. Will lot be regraded ....i.../..~..~ ............ Will excess fill be removed from premises: ( ) Yes (~/~ No 14. Name of Owner of premises.-~...~.~)~,C~2/9 .~.....~.. Address ...~.~).."~..C.~..O...~..?..~. Phone No..~..~...~.~../..~G Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .~.~..~ .~........./~..~....~.~.~).~.,,~7,,~ .~..~.. AddreSS ..C,...~...'~..~.~I.Q~...p.~. Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from properb/ lines. Give street and block=number, or description according to deed, and show street names and indicate whether interior or corner Iot~ ~s cJ(~y' C/~ STATE OF NEW' .~.Jl~,/~l,/( _ I¢ ¢ COUNTY OF~--~....... f~'~ ..................... ~..~. ............................................................ being duly sworn, deposes and says tl~t he is the applicom (Nom~ of individual signing contact) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate afficer, etc.) of said owner or owners, and is duly authori~d to per~orm or have per,armed the ~id work and to r~ke and file this application; tl~t oil statements c~n~:ainJd in ~his application are true to the best of his knowledge and belief; and thor the work will be performecJ/tn tl~m manor set fa~th in the application filed th~r~ith. Swam tobefor~ me this ~' __ , / .......... ........ , ....... .......................... /-~ ~ (Signature of applicant) JUDITH T. BOR~N Nola~ Public, State of New Yo~ No..52-0344963 Suffolk Ce~nrni==i~n Expire~ March 30, 19.~_.-~