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Home My WebLink About8892-zNO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No, .ZS.0.!,~ ...... Date ............Ng.v ....2.1 ....... , lg.?.7. THIS CERTIFIES that the building located at .. $/.S . Main. Raacl ......... Street Map No. ~x ........ Block No. xx ..... Lot No, .. xx ...t~., .l.~ar£<m .............. conforms substantially to the Application for Building Permit heretofore filed in this office Crated ....... ~ept;. 29, 19 7.6, pursuant to which Building Pei, mit No. 88.9.2~.. dh-ted ....... qq~ . .!.., 19.7.6.., 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..P, ri.val;e Dlle. £am$1y..d'teA2.£rig.vl.~.t; ,?..~.~l~l..o. zl ..................... The certificate is issued to P, obez'.t 14,. iluiae ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N.,R, .......................... UNDERWRITERS CERTIFICATE No...~..e .n.d.i.n.~ .................................. 8~2o ~IOUSE NUMBER . ~5~0 ..... Street .~ain .Rd ..... ~....Ma~io~ ................. ....... :?. ..... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD 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) No. 8892 Z Permission is hereby granted3o.' /~ ~~ / .................................. -at pr raises [ocoted ..-. ............. ~ ............................ .. .................... .~....., ....................... :.~ .... ;:...~.;.........-..~....: ...................... pursuant to appJ,cahon dated .~. ....................... 19 and approved by the Bui!ding Inspe~tp_r~. "-~ ' Building Inspector lrO~,M* ~0. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. ApplicatiOn No.....r~.....~.~ ....... Approved ........./.~../...(. ................... , 19~/.~... Permit No ................................... Disapproved a/c ............................................................................................ '~'~'"'('~"'/<""'*""""'( Building~ Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Thru application must be completely filled in by typewnter or in mk and submitted in triplicate to the Buildinf 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, relat~on, sh~p to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which ~s part of this application c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl ~ssue a Budding Permit to the applicant. Such permi, 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 Occupanc~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to tine Building Department for the ~ssuance of a Building Permit pursuant to th~ Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, Regulations, for the construction of buildings, additions or olterahons, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t, 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 premises ..... .~...o..~...e..~...~.....~..~....H...~..1...~l..e. .................................................................................................. If applicant ~s a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) Plumber's License No ........ ~~ ....................... Electrician's License No .... ...~...~.~...Zr...~.. ....................... Other Trade's L~cense No ............................................... Location of land on which proposed work wdl be done. Map No .................................. Lot No ..................... Street and Number ..... .~..?.~.....~...t. ................................... .~...~..~..~,....~..~]~'.~.g..~.j....~.~..~..e .... ..]:.~-..~.~.~. .......................... Municipality Stale existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ........ ...~....e..~...~,~ ................................................................................................ Kitchen ~_~C~ ~ '~ . -~' b Intended use and occupancy ............................: .................... ~ .~ ..... ~...z.....~ ..... ~.~..L~..,,¢~ .............................. / 3. Nature of work (check which applicable) New Building ............. Addition ......~. ........ Alteration ....... Repair .................. Removal .............. Demolmor ........... Other Work ........................... (Description) 4 Estimated Cost ..~i~00.C)~ ..................................... Fee ... (to be pa~d on filing th~s apphcahon) 5 If dwelling, number of dwelling umts ....... ¢~ ............ Number of dwelling umts on each floor ........................ If garage, number of cars ................................................................................................................... 6 if business, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7 D~rnens~ons of existing structures, if any. Front '"'~4 ~'~', .......... Rear ....]~..,~.i .............. Depth .. ~6'":~;','" Height ......1.."[..-~'1~.i-.-. Number of Star,es ........ '~,14, ................................................................................................... D~mensions of same structure w~th alterations or addmons' Front ..... 4~-..~.t~.~ ................. Rear .-~6...~t~ ..... Depl'h ...... ~S:/,-.-~'t~ ........ Height ..... 1..'~...~'.~.~ .... Number of Stories .... .1.~ .................. 8 Dimensions of entire new construction: Front ...... ~.E ..~.~.~ .............. Rear ...~.~....~.-~., ........... Depth .....'1.8 .~.~ . Height ...9...:~t,, · .. Number of Stones ........ O;~ .............................................................................. 9 S,ze of lot' Front ..... ~,~'tO."~-1~.~ ............................. Rear ..... ~.p_~ ....................... Depth ....~6~.~7...~"t~ ... 10 Date of Purchase ...~'],I.~L~ ]-9~ ...................... Name of Former Owner '"~O~'~.-'~:L'*~¢~-.~-i ........ 11. Zone or use district ,n which premises are s,tuated .. ~&~.t,t.~]~ ............................................................ 12 Doe; proposed construct,on violate any zoning law, etd,nonce or regulation ...... ~ ............................................ t3 Will lot be regraded "'~tO .................. W, II excess fill be removed from premises: ( ) Yes (~) No ]4 Name of Owner of premises ']~:~t~ .~[,~[t...~.~e ............ Address .~8.~..~.t~.,... Phone No. Name of Arch,tact ......................................... Address ................................ Phone No ....................... Name of Contractor -.~.]..'1~. ~lZ~- ............... Address .0~¢~,~.~ ......... Phone No. '~.'~4-"-"/-'~'~.~... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~stmg or proposed, and indicate all set-back dimensions from property lines G,ve street and block number or descnpt~on according to deed, and show street names and indicate whether interior or corner lot Notary Pubhc, . ............................. ~ .g.:[.:~.9. ~,~ ...... County [LIZABETH ANN NEVILL[ ftOTARY PUBLI(], ~tale ol ~ev¢ York No 52 8125~50 Suffolk County ~ STATE OF NEW '~ORK, [ c S COUNTY ,OF .... ~ t,t.~,~ 0 ~,~ ......... .......................... .~'~ll'~l~'..~.~'~ ............................. being duly sworn, clef ~ses and soys that he :s the apphcam (Namelof individual signing contracf) above named He ~s the ............................................. .9.1~,f~¢. ............................................................................................................. (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the said work end to make and fdc th~s application; that all statements contained in th~s appllcat,on are true to the best of his knowledge and behef; one tho~ the work will be performed in the manner set forth in the apphcation filed therewith Sworn to before me th,s .......... ~f].t ....... day of ....Qc:.tzob~_~ ................, (Signature of applicant)