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Home My WebLink About8569-zTOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Certificate Of Occupancy No. ZTJD9 ...... Date .............. July,... 6 ..... , 19.7.6. THIS CERTIFIES that the building located at .West..Creek .Ave ........... Street Map No. z:x ......... Block No. ~. X~ ..... Lot No.x~x .... gu%ehogue. · .N,.~:, ........ conforms substantially to the Application for Building Permit heretofore flied in this office dated ............ May...~..., 19. ?~ pursuant to which Building Permit No..8~6.9Z · dated ............ May.. -7 · · -, 19 .~6., was issued, and conforms to all of the require- ments of the applicable previsions of the law. The occupancy for which thxs certificate s issued is . P.~.iva.te. one .fam&iy. d~elting-.with.-ar~, ad.dit~.on .................. The certificate is issued to . Ninnie..S., Todebumh ..... ~w~qe:r ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N ~R.' UNDERWRITERS CERTIFICATE No.. ~].,.R.: ...................................... HOUSE NUMBER ..... .1.29% .... Street .... West..Creek .Ave ..... Catcha§ue ...... Building Inspector FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Nb Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8569 Z Permission is hereby granted to: _ pursuant to application dated 7 19.../...~'. end approved by the Building Inspector. F. $....(...o. ............... Building Inspector FOIR, I~ NO. It TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Permit No ................................. Application No. (~'.~... ,~... (Building Inspector) ( APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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 scheduleJ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or 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 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 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 Building Permit pursuant to the/~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appllcable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with oil applicable laws, ordinances, b6ifding code, housing code, and regulations, 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 premises If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate p~fficer) Builder's License No ......................................... -.;,~,,..,, Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ....... ~ ....~.... Location of land on which proposed work will be done. Map No.: ...................... ~. ......... Lot No .................. Street and Number ............................................................................................................. ~(qE.~'7 (¢.-I~EE"/~ AVE'~) ~..¢...~.,~...H_...O...~...U...~-Municipality ....... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .................... .V.../~. · ..~.-. ·..~. ·, ,~,..'~. .................................................................................... b. Intended use and occupancy ................ .~...C:~.~..¥....'7.. ............ ~...~..~..I...~ ............................................................... 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteratioo .............. Repair .................. Removal .................. Demolitior ..................... Other Work ................................................... (Description) 4. Estimated Cost '/. Fee / (to be paid on filing this application) 5. If dweUing, 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 ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .................................... ,~.... Depth ................................ Dote of Purchase ........................................................ Name of Former Owner ............. : ............. :.: ........ '....' ............. 11. Zone or uae dislrict in which premises ore situated ....................................................................... /... .......................... i2. Does proposed construction violate any zoning law, ordinance or regulation: ....................... ~ ............................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes 14. F~!arne of Owner of premises ....../~.......~..~...L-.~...~...U...~....~.. .......... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No Nome of Contractor ....L~..r'..?._..~'.~...'~..~ .......................... Address ...~...u. Zc...H...°...~..?...~.~... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all 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 ~CTATE OF NEW YORK_ COUNTY OF .............. ......................... ~.~ ............. ~.~.'~ ............................. being duly sworn, deposes and says that he is ti applicon~ (Name of individual signing contract) abow~ named. He is the ............................... ~.~.~.~.~.~..~ ................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to mace and file this application; that all statements contained in this application are true to the best of I~is knowledge and belief; and thor the work will be performed in the manner set foffh in the application filed therewith. Sworn to before me this .................... 7. ................................................... ............................ ~gnoTure or oppIICOBT) ~ARY PUBL C Stge of New Yor~ No. 52.8125850,'Suflolk Count~ T~rm Expires M~rc~ &, U /\ MAP OF LAND AT Z