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Home My WebLink About8122-zFOI~M ~0, 4~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.'2 ~7q/ Date OCT ~0 lg. THIS CERTIFIES that the building located at ............................ ~ree~ Map No .... ~ ...... Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ .~..~..~....~., 19~..5.7 pursuant to which Building Permit No..~. ! .~..~..Z_ dated ........... ./~...[/().... ~.(., 19 f. {Jr, 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 ! .b!. CT'Ff.O.U.I,)?...~?.~.,?...~.,.~.t..("-2...'~. f~.o...L.....fl'...~.~ .~. ~'..~. .................... The certificate is issued to ........................................................ (owner, of the aforesaid building. Suffolk County Department of Health Approval ~1 ;¢ UNDERWRITERS CERTIFICATE No .... ~,t ~ ¢4 ~ 0 ............................. ..................... HOUSE NUMBER I'~ ~0 Street ,,,JO¢~ i Building Inspector FOR~/ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8122 Z Permission is hereby granted to: ~J:.~om~a.~dy .................................................. .......... a~ut. ko~a. .................................................. toB..~LL3.d.. ~e.~.. :Lu,.a:roun&. ~,~Lu~ ..~po~l...~,..tth .. f®aee.. &.. ~e~ ~.$~r~ .................... at premises located at ..S/.~,.~l'~ek, e.~..Car~e.k..D.~e.:t, ve ...................................... ' ............................... .......................................................................... ~tt~ld ................................................................... pursuant to application dated ........................'~t,1~ ....... Il' .............. , 19~..., and approved by the Building Inspector. Approved .............. ;.(..~, ............. ..~.**.., Disapproved a/c ............~-.-.~.;~..~.....- ........... ~ APPLICATION FOR BUILDING PKRMIT TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~ C~RK'S OFFI~ ~UTHOLD, N. Y. 19.....~ ~ 7 , 19 ........ Peri No ..................................... INSTRUCTIONS o. This application must be completely filled in by typewriter oe 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 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 drown 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 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 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. 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. · ........ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature o~'duly authorized officer. Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed w~k wiU, be done. Mgp NR.: .......... t~r ........ .~3"x'.'_'""-.~ Lot No ......................... 2. State existing use and occupancy of premiseA and int,,ended ~use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building.. ................. Addition .................. o _ t- J/,__AIterati°n ..~ ........... ~. ,. tima,ed Cost ......... ...................................... .................................................................. (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 ............................ Z£ 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 ...~...d.~..../.... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........ ../..~6. ...................................... Rear .......... /......~... ................ ~,.... Depth ...>~.....~. .................. 10. Date of Purchase ............. .......................... Nome of Former Owner ..... ........... ~/,~o..,.~. ............. 11. 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 . ........../~r~.._...~ ..... Will excess fill~be removed from premises: ((,x) Yes ( ) No 14. Name of owner of premises ..J..~/..:....~ ...... Address ................................ Phone No. Z.~.~...'...~..~./...G~ Name of Architect ................................................ ~ ........... Address ................................ Phone No ....................... Name of Contractor ..~...~.....~'~ - "~ .......................... AddressU4~.~,~.~..~J....~.~/'Phone---- -- No. Locate clearly and distinctly all building's, whatnot existing or proposed, and indlc~te all set-lSack 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. ,,J o c y d_ t b D STATE OF NEW YORK, ~ ' COUN,~r'I)Fi/.ir '"~'"~"7'":'[s'S ..... .,,~g.-....,~/~t........t~cl,~....~n~.~ ....................................... being duly sworn, deposes and says that he is the applicam · [/(Name of individual sl~ning contract0 above nd~ned. He is the ............. ~..~.~z.- .......................................................................................................................................... (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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... ........ daY 'C":'e ........................ ' Notary PubJJ,c, ..,,,../~:~-'~./;:~(~ .......~, .......... County ....... ..~cV..X..~/~ .......... ~.:..:.,...~ ........ ~ ................................... f )// [ ~//_ / / ' ~ (Signature of op~l~cant) NOTARY PUBUC, State of New YorX No. 52-0113795. Suffolk Coun~ J~rm Expires March 30,. 1977