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Home My WebLink About8138-zFO~t~ NO. 4 TOWN OF $OUTHOLD BUII.BING DEPARTM~T Town Clerk'~ Office Southold, N. Y. Certificele Of Occupancy Map No ............. Block No ...........Lot No. conforms s~.~a~ti~l~ to the Appl~ion for Building Permit heretofore filed in t~o~[i~ez_- dated ...... ~..(t ....... , 19. ?S--pursuant to which Building Permit No ......... dated ....................... , 19 .... , was issued, and conforms to all of the require- The certificate is issued ~ ............ .~ ..... .~ ................................. (owner, lessee or tenant of the aforesaid building. /~. /~.~ Suffolk County Department of Health A~ j~:~ .............................. UNDERWRITERS ~I~Ip~TE No ...... ~d~ ~'~'1''' ~ '~f HOUSE NUMBER .............. Street .......................................... Building Tn.qpeetor FOP,,M NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 8138 Z Permission is hereby granted to: .... ~re. me s...Ro~e2-s ............................................... ............. ~"~'~"~'~t~t ........................................ to..~..a....n..~...~ .6.~.$.~.~..~;~...(...l~.e.e.~o.~.).. hou-~e.. &...Qn-~.age .............................................. et premises located at ..... ..~..~.~,.~.~,..~,..O~...0.~.]~..~. ....................................................... .......................................................... ~e.~ .~.. ~.~. o~ ........................................................................... pursuant to application dated .......................~.~.--...~l.~l ................ , 19.,~., and approved by the Building Inspector. Fee $..1~.*~. .......... Building Inspector b. n~ p~ ~'~r~ ~ i~ ~ ~ ~ ~;~, telatlomhip to adjoinS..' pmmise~ or ~ ~ o~ areas, and glvin~detoiled de~ription of Im/o~ ~ must be drawn on the diagram v~ich i~ prat ~ ~ app ication. d. Upon agl~mval of this application, the'Build~ impactor will issue a Building Permit to tim al~icant. Such permit e. No building shall be occ_upted or used in whole or in part for any PUrpose whatever until a Certificate of Occupancy shall have bees~ grantnd by the BUilding Inspector. ^PPLICATION !S HEREBY MADE to the Building I~rtment for the i~uance of a Build'_mg ~ ~pur~uane_ to the Building Zone Ordmance of the Town of ~ Su~mlk Caunty, New York, and ~ ~ ~ ~ or aamit aumonzed in.q:~'tors on preml~e~ aha in DUllam~ ~ ~ inlpaCllan~. "' i~,~;~';~"~'i~7;;'~Ti~"~'~i~'~ ........ ........ , .................................... ........................ , ................... (Address of appliCar~) State whether applicont is owner, levee, agent, arch,i, ~ eng. i~e~ general contractor, el~'trician, plu~r or builder. ..................................... ~1 .......................... ~ ................................................. : ........................................ Hom, of o~r of ~.mJ.~ ~~ .......... ~~ ...................................................................... If applicant is a corporate, slg~ of duly authorized officer. Builder's License No ......... Plumber's License No. ................................................ Electrician's license No ............................................. Other Trade's License No ............................................... 1. State existing use and occupancy of ~ise~ and intended use, and occupancy of pre~ comtmction: - a. Exisiting use and occupar~/...~....,~...........~.......o-~,~.~.~ ............... ............. ~ .............. , .................... b Intended use and occupancy ' ............. ~ ................... ~..~.....-~...~...i ...................... ~ ........... ~ ................. 3. Nature of work (check which applicable): New Building.. ................. Addition ........ ~.. ^lteration~,. ........... Repair ,~ ................. Removal .................. Demolitk~... ................... Other Work .................................................... ., '~- O "0 (Description) 4. ti oted ............................................................ .................................................................... (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 .................................... Pear ............................ Depth ....................... Height ................... Number of Stories ...................................................................................................................... 9. Size of lot.' Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ blame of~ormerAOwner ...................................................... 11. Zone or use district in which premises are situated ..~ .......... ~ .................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulatian: ..... ./...'r...: .......................................... 13. Will lot be regraded ...........~......U...... Will ~xcess fill be removed fi, em.~~pmmts~: ( Yes ( ) No 14. Name ~f Owner of nmmJ~~ ~--_.~._s.,~ .... A,~i'~ ~~ Name of Architect .......... ~ .............................................. Address ................... ~..' .......... Phone N~ ....~ .............. ~.. Name of Contractor ............... ...~'~ ..................... Address ............................... Phone No. ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and .indicate all I~tdxlck dimensioins 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 NE~I~J~, ~ ~ S c- COUNTY OF ,~:. ............ :..,..~rl~.c~,[.~..~.l~.~ ................... being duly ~orn, d~es ~ sa~ ~t ~ is the applican, a~e na~. He is the .......... (Contm~or, ag~t, co~r~ officer, ~c.) of ~id ~r or ~rs, a~ is duly a~rized to ~o~ or h~ perfo~ ~ ~id work ~ ~ ~ and file · is a~ ~t all st~m~ c~in~ ~ this a~lication are tree ~ ~ ~t of his ~1~ md belief; and ~ ~'~11 ~ ~m~ ~'~ ~n~r ~t ~ in the a~licatian fll~ ~. S~m ~ ~f~ ~ ....... . _. ..... ................... '~. 52~125850, ~flolk