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Home My WebLink About8371-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .8./.S..1~..L~...R.o.a.~. ~...14.~.1.1...C~treet Map No. X~ ....... Block No..~ ...... Lot No. ~..~sha~o~que~..(}reenpor~; conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 14~y....~[., 19.7.~[ pursuant to which Building Permit No.. dated ...... ~'.e~ .. 9..., 19 ~.~.., 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 . ~eeszory...radio .to, er.. (. &ppro.v~d. b~..Rd. Appea~s) ............ The certificate is issued to ...l~.o.~..d.sm~.$.h .~..0~.$..~.h..Op .~.II.e. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N.;R., ........................... UNDERWRITERS CERTIFICATE No.. ~.,.1~; ...................................... HOUSE NUMBER ... 6~ 50 .... Street. ~ J~oad~...R~ .2~ .................... Building Inspector FOE~ NO.~ 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI-HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8371 Z Date .......................... WO~ ......... 9 .......... , 19..~/~. Permission is hereby granted to: ; ............ ~..at .............. ~1~o~ ........ FO]~M ~0, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Permit No. ~ ~ 7 ! ~ Application No.....(.(~..:.~...7..,! ................. Disapproved a/~ __ APPLICATION FOR BUILDING PERMIT , ate ............ .................. .......... I NSTR. UCTION$ a Th,s applicahon must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Buiidin,. Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing locahon of lot and of buildings on premises, relationship to adlom[ng premises or public streets o areas, and gwing a detailed description of layout ofproperty must be drawn on the diagram which is part of this application c. The work covered by this apphcahon may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will ~ssue a Budding Permit to the applicant. Such perm~ shall be kept on the premises available for inspection throughout the work. e No building shall be occupied or used in whole or m 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 th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, 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) (A-ddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncmn, plumber or budde ............................................... ..... ................................................ No,-,-,e owner premises ....... G.a .... ..... If applicant is a corporate, s~gnature of duly authorized officer. (Name end title of ~orporate officer) Builder's License No. --- Plumber's L~cense No ................................................. Electrician's License No ............................................. Other Trade's L~cense No ............................................... Location of land on which I~roposed work wdl be done. Map No .................. ~ ................Lot No .... : .: ........... Street and Number ...~I..~....[I/~.~.L~(-...[~..~. ......................................... .~.~)..~...~'..~.0...L¢.. ~)...}..~.[, ¥., .................. Municipal ih/ State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Exisiting use and occupancy ................~...6..~..~....~ ~.~...~,.....Y~.....~. ~ ' /,, use and occupancy .......................... 5../~ .~...~......~-~.~'....~..~:..~...~.....~..~h~....~ .............................. b. intended / 3 Nature of work (check which ap b~e) New Building ............ Add~ ................ Alteration ............ Repair ................. Removal ............... Demolit~or. ...............Other Work (Description) 4 Estimated Cost ............... ..~_ ..~....~...0.. ........................... Fee .................. .~../.~.....~ ........................................ (to be pa~d on filing th~s apphcat~on) 5. If dwelling, number of dwelhng units ...... ;..~.. ............ Number of dwelhng 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 Dimensions of ex~stmg structures, if any' Front ..................... Rear ................................ Depth ................ Hmght ........................ Number of Stones ........................................................................................................ D~mens~ons of same structure with alterations or additions: Front ................................. Rear .................. Depth ............................. Height .................... Number of Stones ............................... 8 D~mens~ons of entire new construction' Front .................... ..---. ............. Rear ............ ..-:: ............. Depth .... -- ...... Height ......,-~J).~. ....... Number of Stories 9 S~ze of lot' Front ..................................................... Rear .......................................... Depth ............................. 10 Date of Purchase ................................................... Nome of Form~r Owner ..................................................... I 1 Zone or use district in which premises are s~tuated ................................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation: ....................................................... 13 Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises ~.l).l~.~..~l~,.~..'T.~.f~....j~.~..:~j~...(:.. Address .J~KI.I~.I.~...IL~. .......... Phone No ...................... Name of Architect ......................... Address ................................ Phone No ...................... Name of Contractor .~I(L~.I~.0.~,¢,5.). T~I,(~ ............. Address J~...~ .~...~..T...~[..~, ....... Phone No..~..~..~.:'-J.~.~.. PLOT DIAGRAM (~ ~i~ ~1 Locate clearly and distinctly all buildings, whether ex~sting or proposed, and ~ndicate all set-back d~mens~ons fron property hnes Gwe street and block number or description according to deed, and show street names and ind~cat, whether interior or corner lot STATE OF NEW YO~K., . !c ~ COUNTY OF .~i.q .i~.. P..~ .C-....~.. .......... ~' '~" ..... ~...J~.~...C:...~...~....~.. ..... .~...~....U~......J..!~.~..~...6...~..(~.~...~. .......... being duly sworn, deposes and says that he ,s the apphcar (Name of ~nd~vidual s~gning contract) above named He ,s the ......................... ~.~.~.~.~.~ ......................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and fil this apphcahon; that all statements contained m th~s apphcat~on are true to the best of his knowledge and behef; an that the work w~ll be performed ~n the manner set fo~h m the apphcation filed therewith. Sworn to before me th~s Nota~ Public,. .................... ~....,..-R.~,.., .......... C .................. : ........... . ................ (