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Home My WebLink About8766-z1~0~r MO. · TOWN OF SOUTHOLD Blff[,DING DEPARTME, NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z?.~'.~. ...... Date ............ A.~..~...~.? ....... , lg.7.7.. THIS CERTIFIES that the building located at . .~a$.k.e.~'..L.~.n.e. ............. Street Map No~a~t !n. ~1.. Block No ........... Lot No, 20 ..... O.~/e..e.n. gg.r.t' . .N..,.Y.: ....... conforms substantially to the Application for Building Permit heretofore filed in thi, office dated ........... ~T.u~y. ..... 2,8 19. ?.6. pursuant to which Building Permit No, . $?~.~Z. dated .......J. ul¥ .... 29 ..... , 19 76., 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 .... Priv. ate..o.~o..~.am. ~ly..c~ .w.e.!.l.i.n.§. ~.~.i..~...(.d.e.q .k./p.a.t..i9.)' . .a.~.d.i.t..i.o.n.... The certificate is issued to Hez~cy. ~.~ .HuLlo ....... ~ez .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ~ ,H... ........................... UNDERWRITERS CERTIFICATE No.l~.'~: ........................................ HOUSE NUMBER .... ~:~0 ...... Street ....T~.~.k.e..r..~.e ..... .G.r.e.e.n.p.o.r.t. .......... FO~I~ NO. 2 TOWN OF SOUTH/)LD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ~ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8766 Z Permission is hereby granted to: ..~.~.~.~..Y. ........ F. ....... .U...a...~.~. ..................... premises located 'T~Pt ~/~ E ~ K/~ 1,J ~ .......................... ~ ...................... : .............. :: ....... ~.~.,~.g..~.~..o.~ ....... ~...~:. ............................ .................................. ~, ......... t"'"- ............................................................. "~: .......................................... ~u~u~nt to ~pphc~hon d~ted ........................................................ , ] ......, end ~pproved by the ........ Fee $...t ..........C ' " ' Building i ~p~c~'n---Z~or TOWN OF SOUTHOLD ,/ -~/ ~ BUILDING DEPARTMENT .~ ~'l TOWN CLERK'S OFFICE ~,, $OUTHOLD, N. Y. -roved ~....~ 2-~. 19Z.~... Parrm. 4J~'7~'~ ~ AppiicationNo .............. (Building Inspector) APPLICATION FOR BUILDING PERMIT _ ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildlng',_~ Inspector, with 3 set~ of plc~ns, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of bui!dings on premises, ,relationship to adjoining premises or public streets at areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this appllcotion. 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 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 o Certificate of Occupancy shaft 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 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, building code, housing code, and regulatior~, and to~ admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ............ ,.., ...................................................................................................................................... Name of owner of ,rem ses ... ~...~.:.......~,.~~ ........................................................................ If appliccnt is o corpora, re, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. --/-/o - D-~-- /,,po - "4- ¥.,3... Location of land on which proposed wor~ will be done. Map No.: ...................... ~ .............. Lot No....~.~....O.. ............ Street and Number ...... ~**c.;! ........ ...'~.).j~r.~...~..CZ~......~...~./X</...~,. .................... ~'..~....~.~..~./~..~../2.,~..~.. ...................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed const~ction: ... a. Ex,stung use and ~cupan~ ...... ~.....~..~ .... , .... .G. ~ ................................... b. Intended use and ~cupancy ........ ~ ...................................................................................................... 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration .............. Repair ........ Removal ............... Derr olitio; ....................Other Work ....... .~..-.~r..../T. z. '.O. ......................... "~ ,--~ ~ (Description) 4. Estimated Cost .......... ~;.~-..,. ................................ e .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ~.~ ........ Number of dwelling units on each flor ........................... If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, speci~ nature and extent of each ~pe of use ............................ 7. Dimensions of existing structures, if any: Front ..... ~;...~ ............ Rear ...... -~f .....................Depth ~ ~ Height ..... ~.~ ............ Number of Stories ....... ~...~ .......................................................................................... Dimensions of same structure with alterations or additions: Front ~c~ ~ Rear ~ r Depth ....... ~.~ .................. Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ..................... Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front /~ ~ Rear ........ Z. ............................. Depth ........ J.~6t.[ ........... 10. Date of Purchase ~, ~ ~'~ Name of Former Owner ~--~Z~~ ..... ..................................... .--, ,t, --. - '"'"~A4 11. Zone or use district in which premises ore situated ..... ~ti~.¢~.~L~4 ..................................................... ~ .......... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~ ........................................ 13. Will lot be regroded ....... ~. ............. Will excess fill be remov~ from promises: ( ) Yes (~) No 14. Name of ~ner of premises~--.......~.~-..-.--------~ ~ ~fJ~(- Addre~..~..~ ..... PhoneNo. ~L~. Name of Architect .......... ~'"'".'~'~.-"'"'" Addre~ ..... ~ ............. ~one No ....................... k~h, ame of Contractor .~ -- ........................................... Address ................................ Pho~ No ....................... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or praised, and indicate all set~ck dimensions from prope~ lines. Give street and block number or de~ription according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW yORK, COUNTY OF .....'~.'.,--,x~,'z,~'.../~':z¢... ...... f'"'-' f~q ~ ~,¢ ~' ~-~, ~.~= ....................... being duly sworn, deposes and says that he is the opplicom ................ ('~"~¢"/~'i~uol signing contrace above named. He is the ...... z.:.:...: .......................................................................................................................................................... .... (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 ate true to the best of his kno~dge and belief; and , r t e anner set foffh ~n the a h t~on filed therewith that the work will be perfo reed in h m ' . PP Sworn to b~fore me this ..... .~..Z...., .....day of ..z..~¢..-(~ .................. Nota~ Public,. .......... ~..~..~:~ ................... Coun~ ~~.~--.~~ ................... ~ ' ~Signoture o~ applicant)