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Home My WebLink About8549-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~iee Southold, N. Y. Certificate Of Occupancy j No!-th l~l(vie~z I~oafl THIS CERTIFIES that the building located at . ~V~, ~ad. ~ .21. ~ ...... Street conforms substantially to the Application for Building'Permit heretofore fiIpd in this office dated .............. A~rll.., ~.. ~6 pursuant to which Building Permit No..8~9~. ments of the applicable provisions of the law. The occupancy for which, this certificate is issued is .. P~iva~e. olta .family. &wellin$ .... ~ ................................. The certificate is issued to . .K~..l~.~.t.h..W..o.k.o.~k..j~...~,$...Ot~..e.~. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . JULY....1.~. ~ 9~...by. .I~. :..~%.1..15 .... UND~,RWR~TERS CERTIFICATE No...~agk'33~ .... .~:a.l~....~3..~.97.6. ............... HOUSE NUMBER ..... .~50 ..... Street .... P. ri~ate. P, oalt, ~ .at ..... ~outho~l... Building Insp~fr N? TOW" TOWN (THIS PERMIT MUST BE KEPT 85~9 Z Permission is hereby granted to: at Premises located at ....... ,> } iW:YORK BOARD OF FIRE UNDERWRITERS - ~i! ,' n 85 .JOHN STREET, NEW YORK. NEW YORK 10038 , , onl~ ?~.~r{~,~ffipm'~~ ~ ~c~ib;d bel~ and introduc~ b~:~h~ appli~n¢'nam~ On ¢~ pbove application number in the premiz~s of '-~=~ ~h'JG~uh'i' ~ames~'iw/s de R.0.iW.~,350, 2 7':iD[/O, NO. Bayv ew Rd. OU~L~S ~ ':'Lic,4 "' --,, ~- , 21E ' '' ', ...... , ' ' 7, '/,' ," ' D This cedificate mu~t not be altered'in any mariner;r return to lh~ office of 'the Board if incorrect. Inspectors may be identified by the TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE AI~PLICATION FOB, BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in 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 p an showing acatJon of at and of buildings on premises, relationship to adjoining premises or public streets at areas, and giving o detailed description of layout ofproperty must be drawn on the d agram wh ch s part of th s opp cat on. c. The work covered by this application may not be commenced before issuance of Building Permit. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ....... g...~?.....~. ................ Electrician's License No ....... ?t,..<,~,...~ ......................... Other Trade's License No ............................................... 1. d. Upon approval of this application, the Building inspector will issue q 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 a Certificate of Occgpancy~ shall have been granted by the Building Inspector. APPI'ICATION 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 Lows, 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 regulations, and to admit authorized inspectors on premises and in buildings for necessary inspection~s, (Si nt, or name, if a corporation) ............................. ........ / ..... State whether appJicant is owner, lessee, agent, architect, engineeri genera contractor,) eJectrician, plumber or builder. ................................................. .,.;;, ............... , ~ '.';¥, ............ , '; ...... ,', ........... ~....... ......... ,, .. .................................................................... Name of owner of premises ~.~L;~/...;J~..U~..L.'.,.~. ~A.</~;.; ..~I ~. '[?.~ '~./.. ......................................................... Jf applicant is a corporate, signature of duly authorized officer. Location of and on which proposed work wil be done. Mop No.: ..,....~ ....... i ............. , ........... ,Lot No ......................... Street and Number ~C..,...~.....:~z ........ g~ ...... ~.~,..6,~-~v.~,~.~.~,~:,..../.....-.~.....~,~.,..,~,.~..-~:'.z.--.~./. .......... >~f! ........... : ............ '7 ~Municipali~ S~ate existing use and occupancy of premises and in~ended use and occupancy of proposed construction: o. Exisiting use and occupancy ................................................................................................................................ / ~ · / ,~ b. intended use and occupancy ...... : .................................................................................... 3. Natare~of work (cheek which applicable): New Building.. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior ..................... Other Work ................................................... 4. Estimated Cost ........... ...... .* ................................ rea ..z...¢ ..................................................................... · (to~ie'~poid on filing this application) / 5. If dwelling, number of dwelling ~Jnits ............................ 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 .':,..:..:h..:..~..::': ...... Rear ..... ~,~ ...................... Depth .............. ,.~.... Height .... -:'-- Number of Stories ........ Dimensions of same structure with alterations or additions: Front ........ ]~ ............. Rear ....-..-r...;~..J....'.:', ....... Depth ......... r:a...L~Z ......... Height ..~~.N~mber~~. of Stories ....... 8. Dimensions 9L~tire new construction: Front .? ................................. Rear ............................ Depth .......... i .............. Height .................... Nu~l~er .of~ Stones .................................... .'r"'~....~ ...................................... ,~.x...~...~ .............. 9. Size of lot: Front .......... ~...~..~..,.~,-~ .............................. Rear ................................. .~:~.4'd,' D~th '"~'....m.'~.,~'~l ....... 30. Dote of Purchase ........................................................ Name of Former Owner ............................. ,~..,,..L../ ............... ] ]. Zone or use district in which premises ore situated ....................... ~ ....... ~'..~,4~/~L~) ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..........................................~ .......... 13. Will lot be regraded . ........ ~...,,...~f ........ W. iJJ~xcess/filJ~be rel~gv, ed from premises: ( ) Yes ( ).No 14. Name of Owner of premises ..... .~ .............................................. Address ................................ Phone No.,~t: ................... · " ',~"t- ,~.,,.~'Y'/'S Phone,,,~ No, Name of Architect ,.Z~'~ ...... ~.-.-..Z~ ./C/..,...~,~/~../~ ....... , ................ Address '"/'2)'~v ( ,za~.~,'/'" Phone No....': .................. Nome of Contractor ........................................ t .................. Address '"~")'l't'~. : PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate oll set-back dimensions from 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, ~ ¢ c COUNTY OF ....S~tff. alk ........... f~'~ ................ .l/f.,...~cl. zqiO~ ....................................................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) abow~ named. He is the '......~.~.,.~.9.~ ........ ~9~.~9~ ...................................................................................................................... (Contractor, ~gent, corporate officer, etc.) of said owner or owners, and is duly authorized to per~orm or hove per~ormed the said work and to make and file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h Jn the applico~on filed therewith. . Sworn to before me this / Nato Public, ~ ..............................: ............. ~.~.....~.: .............. y ....... ;: .................................... 7~' '"~~ ~~ t~gnature o* app,,cont) ELI~gETH ANN NFVILI,E LAND SURVeYOr'S INKE6 SEAL O ~BOSSED SEAL SHALL NOT BE CONSIDEr; AND ON H~S BLHAL6 fQ THE ~'~/~,~c~ ~,~4~ SUFFOLK · ,mL~ ~'~/e l~.t'l~ ..... ~. D. R~- The sewage disposal and water supply facilities for this loe~t:Lon hg~we ~ ~*ma by this depar~m~m~ Chief of ~eneral t I I-- i.__ __ ~r ii_ I I h ~1 I pERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL ABOVE pREMISES FROM ~,EGRADING LOT CELLAR CONSTI)'UCTION APPROVED, AS NOTED DATE' -- NOTIFY BUILDING DEPARTMENT AT 765-~660 9AM TO 4PM FOR REQUIR- ED iNSPECTIONS: 1, BEFORE BACKFILLING FOUNDA- TION OR ETART FRAMING 2. BEFORE COVERING pIPELINE ]. FINAL WHEN JOB COMPLETED RA~ C u ~00%~ ~O~ GITUHILL CO~%T, CG. I~C. ¢--,&~ C ~, t-tCbu%?... ~O'?-.. G%UtJ, tLL. C..G',.;%"F. co. I--A