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Home My WebLink About8442-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy .......... laa:e ............ ~ .............. , l~ .... THIS CERTIFIES ........................ that the building located at ~ ~ a._~Street Map No ..... ~ .... Block NO .... .~Y, ... Lot No....~. ..... ~..~ ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ . .~.Cia~.....~.,~19 7.~. pursuant to which Building Permit No. dated ....... .~..(..a/.~..7., 1976 .... , was issued, and conforms to all of the require- ments of the..~pplicable provisions of the ,lavL The oequpancy for which.this certificate is issued is ~ ~ .~ ~?L .~.~/~~ ...................... · . ................ ............... ~/ (owne~, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Ap~r~alr.x..~/r. . .~.' ......................... UNDERWRITERS CERTIFICATE No...L~...~. ~.'.'~'....~. ................ -- ........ HOUSE NUM2BER .( ?. ~-.~ .... Street i./.~. '~: :~'.....' .~.'..?..~. Building Ins~?~ctor FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8442 Z Permission is hereby granted to: ~o ...~d. ttA..~..aaa~t~oa.. _.:,~. . ,. ........................................................... at pre~mes l~at~ at ..... ~],..~ ............................................................................................ ted ...... ,..Z:_~{ ....... 'fll~t""l~ .......... :...., 1 ., and approved by the Disapproved a/c ............................................... APPLICATION FOR BUILDING PERMIT x~ Date ........ ~..,.~.,,.~ ........ 192~ .....~ INSTRUCTIONS a. This application must be completely filled in by typewriter or, in ink and submitted in triplicate to the B,,ilding-~ Inspector,_:with 3 sete of plans, accurate plot plan to scale. Fee accordi~'~g to schedule, 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 ofproparty 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 applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.~l) 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 nec,~sary inspections..n (sr 'otore of a .ic , o, nam., 1285 Carel Avenue., ?eceaic,, NY (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~.e.~.e.~...~.~.e..r.?t,...k~.. ............................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ ~ ........... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~/ I/ Location of land on which proposed work will be done. Map No.: ................ /.....~- ............ Lot No/.l ...................... ...... ~_. 1285 C~rel Avenae, Pec.nic~, ~'~ ............................ Mun~pality State existing use and occupancy of premises end intended use and occupancy of proposed construction: Re#idence a. Exisiting use and occupancy ................................................................................................................................. b. Intended use and occupancy ......................................... ~, ................................................................................ Locate clearly and distinctly all buildings, whether existing or proposed, and indicat~ Pw~OePt~ert~r inl~:iS~r GoirVceorSntre:eltot?nd block number or description according to deed, and sl~ I ' 3. Nbture of work (check which applicable): New Building.. ................. Addition ...~..~.. ........... Alteration ................ Repair .................. Removal .................. Demolition. .................... Other Work ................................................ . .... G~_~....~....- (Description) / 4. Estimated Cost .. ~.....~...7... .................................. 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 ....................................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 ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~e. ............................................ 13. Will lot be regraded .........~.e. ............... Will excess fill be removed from premises: ( ) Yes ( ) No f · ,~eee h ~tder~t, .............................. 14. Name of Owner o premises ......... ~ .................. ..~. .................. Address Cgrel Awe Phone No. ~..6.~.:~. ...... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM all set-back dimensions from )w street names and indicate -,,~, ' STATE OF NEWr~IiC~a~, //~ ~ c c COUN ........ ..... ".." ........ .~'~"-.~ ..'X'[ ~..~'Z....? ~'~ .~..'~(....."~'~.. ..................... being (Name of individual signing contracf) duly sworn, deposes and says that he is the applicom He is the ........................................... ~......~:~............ ................... L.., ..................................................................................... (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 that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this /' ~ ....... ........ /