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Home My WebLink About8516-z~'ORM NO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's O~ice $outhold, N. Y. Certificate Of Occupancy No. Z?~+~3 ...... Date ............... ]~a~ .tla.t~y. · b~ 19..76 THIS CERTIFIES that the building located at .l~lat~ .lloai~ ................ Street Map No.. ~,X ........ Block No .... :XX ....Lot No...~X..Orient...NoIL, ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Alz~ll...£0, 197~,. pursuant to which Building Permit No, ~.~:l~l~.. dated ........... /~lllt.. ail..., 19.~.6., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Aeo~s.$ory..garage .wi.th. ar~ l~clitio,n ............................... The certificate is issued to . I;~.aa0. & .]~1~.. ]~(i~'ar.~z. ....... 0wlt~.~ ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Appr0val .. ~, ............................. UNDERWRITERS CERTIFICATE No~,R, ........................................ HOUSE NUMBER .... 2007~.... Street . l~Iail~. ~Oad ........ 0rl~nt ............... FOI%M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE~ SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8516 Z Date ........................ ~,~).~. ;:t,~, ....... 2Q ........ , 19..~..~.. Permission is hereby granted to: ~.~:..~.~ LUll.... '~/.O...I~a~c..~d~:ar~ s...~ ~:ife ................... ~.£e~t .............................................. to ..~L~,£1d...~e~...a¢~ee 6e~,~..(ee~...~b~a~e ............................................................................ at premises located at ..~/~.;:Ln..,~£O~..cL..P.~:IL..F,o~c~ .......................................................................... ............................................... .OrJ. e~t ....... ~:,~. ................................................................................. pursuant to application dated ........................... ~PIt,~,I-..~O. ......... , 19.~.6..., and approved by the Building Inspector. Fee $4~.0~ ........... a ' Bu,lding Inspector I I FOI~M NO. 1 T~WN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 .......Permit No ..................... ^pp cot on No. APPLICATION FOR BUILDING PERMIT Dote ...................... , 19 ..... INSTRUCTIONS o. This application must be completely filled in by typewriter or~ in ink and submitted in triplicate to the Bu'lding,: Inspector, with 3 set~ 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 areas, and giving a detailed description of layout ofproperty must be drawn 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 applicatic~n, the' Building Inspector will issue a Building Permit to the applicant. Such permLL shall be kept on the premises available for inspection throughout the work. e. No building shell 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 the Building Department for the issuance of a Building Permit pursuant to the-~ Building Zone Ordinance'of the Town of Southold, .Suffolk Count~, New York, and other applicable LaWs, Ordinances or~ Regulations, for the construction of buildings, additibns 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 regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. (Sigr~re of applicant, or name, if a c'orporation) ....................... ........ .................... (Address of applicant) (,,v (Name and title of corporate officer) Builder's License No ....... ..~...(~ ...................................... State whether app!icant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~....~.~.......~...~..,~~ ............................................................. If applicant is a corporate, signature of duly authorized officer. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~ /~ Location of land on which proposed work will b~ done. Mop No.: ................... ~ .......... Lot No..:.t. ................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use end occupancy ....~..~>..: ............. .~ ............................................................................................ b. Intended use and occupancy ..... ~..~..../....~~...~..Z. .................................................. 3. Nature of work (check which applicable): New Building ', ................. Addition .....,~,. .......... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ...~.~,~..:.....~...~..~.........~ , .... j~ ~ (Description) 4. Est mated 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 ....~.~..~ .................. Rear ...~..~......~. ................ Depth ~...~,.....?.. ...... Height :~- / Number of Stories .. ~ ............................................... Dimensions of same structure with alterations or additions: Front ........ ~....'~...~..,ff....:; .......... Rear ..~'....~....~..'~...~i( ....... .... .~,...~.. ............... Number of Stories Depth ....~...~....~ .............. Height ................................ (~/ ..... .~....~'. ................ Depth ../..~. ?..( ............. 8. Dimensions of entire new construction: Front .................................... Rear Height ....../~..! ........ Number of Stories ...... /. ........................................................................................................... 9. Size of lot: Front ...]...~.~.~...'..~....~./. ............................ Rear ..../..~....~...:..~. ..................... Depth .../...~..--..~.,....~:. ............ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated ..~.~: ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ....~ ............. Will excess fill be removed from premises: ( ) Yes (~f) No 14. Name of Owner of premises .4:.~....~.~-.~'..~.~..~. .............. Address ......~.....<~.~ ...... Phone No. ~..,,~.,~.T..~'....~..~.~..~ Name of Architect .............................................................. ~-~' __ ~',,~ Address ................ ,. ............... Phone No ....................... Controctor-~/. ..~¢C~.....~.......~...~.~...~....~.... ........... Address ...~.~..,...'Z~....'F~..~.~.... ...... Phone No.~.ff...3..TL.~.....~..~./. Nome L.oco~'e cleaJy and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propelffy fines. I~ive street and block number or description according to deed, and show street names and indicate whether i arOr corner lot. i teri, . / d~ ,~ f' /a o STATE OF NEW~: YOR~,, I, ¢ c~ ~CrO~tT~ ~rF --:.,~:'~t~..:::...::ff~ - ........................ · ~...~..~..~.. ...... ~..~.~/~../-..&.~.. ............................. being duly sworn, deposes and says that he is the opplicanl (Name ,of individual signing contract) above named. He is the ...................................... /?.?../.d...~..?....~. ...................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have 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 thax the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this : ....... of .................... , ,? Notory Pub,,o,. ........... County ................................. ,~ (Signature of applicant) F~'~d(~ F. KING, JR. (./ ' ' Notary Public State of New York No. 52-7267800 SufFolk County Term Expires March 30, 197~