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Home My WebLink About8157-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice $outhold, N. Y. Cerli icnte Occupnncy THIS CERTIFIES that the building located at . ~./$. eR2?..-..E ./S. ,Leon..t.~O~reet Map No. XX .......... Block No...xx ...... Lot No, . xX.., Soutt~alcl.. Iq,¥., ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 'k~g. --~' 1 ' ' ', 19 '7~' pursuant to which Building Permit No..8t ~. dated .. J~e. ].8 .&. ~ug.. 21., 1~5.., was issued, and conforms to all of the requir~ ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Erl.v~te..qne. ~ .¢we3.~i~g. ~..~r~V~..(.~qg~.~q~Y.).. g~Y~g~ .... The certificate is issued to .q9~9~..~gY~$ ..... ~. ........................ (owner, lessee or ten~t) of the aforesaid building. Suffolk County Department of Health Approval .. ~P,~ .~,, .~.~7~...~Y. )~ ~. ~ .... UNDERWRITERS CERTIFICATE No.. ($~N~Y. ~P~PY~. ~~P~ ....... HOUSE NUMBER .... ~0S30 .... Street. C.,J~,. 2F...&. ~.qOn. ~a ................. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8157 Z Permission is hereby granted to: .1~ o~ ....~3 a.~ic~i..~.C ...Q o~ ~.~.~T~..~. ........ ~ou4~ho~:d: .................................................... to ...... ~Bt~::l:Z. et-..lae~r-..p ~$ve:~a e...~e~,e~.§e ....... &.. ~. ,'t~.eh~e-..o~ .. e~.]..e t;.~ff...ffe~eff e .............. et premises located at .~./.~..~t,~..~o~.....(-~..~.~.) ...................................................................... ................................................. ~.o~.'bh~Z. & ...... .I,;.o *,'.., ........................................................................... pursuant to application dated ..................... ~tl~'"'"~ .................. , 19..~., ~nd approved by t~e Building Inspector. Fee $~).~0 ............ E×ornin~d .............. ~ .......... L ........... , praved ............ ........ 2/. ............ t~Ol~ NO. 1 TOWN OF SOUTHOLD "UILDING DEPARTMENT TOWN CLERK'S $OUTHOLD, N. Application No......~..f~i.~..~. ................ ~ Disapproved o/c .~ ....... ~ ............... -------- __ APPLICATi~I:J~ FOR BUILDING PEPJ~IT Date ........................ ~ t.~.k;...:.~.~ .......... , 19...../.~... NSTRUCTIONS a. This application must belf~npletely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accu(ate plotDlan to scale. Fee according to schedule. b. Plot plan showing Iocehon of~c~'~'~l o~udd,flgs~b~l~em,ses, relahonship fb~J~ih~i~j[premises or public streets and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. areas, c. The work covered by this a~pl cqtion may not be commenced before issuance of Building Permit. d. Upon approval of this opphc~ion, 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 shell 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. APPLIC,~T~LOi~,JS ELERE,B~.,bAAD£.to-the.J3uilding.~Dapartment~.fo[1,.the~ isSuance~o~..a. Building. Rerm/t .pursuant. Building Zone Ordinance cjf the Town of Southold, Suffolk County, ~ew ~odr~a~tJ~e~:applicable Laws, Ordinances Regulations, for the constr~ction of buildings, additions or alterations, jar fck~:removal c~r demolition, as herein described. The applicant agrees to co~nply with all applicable laws, ordinances, b~ildir~g~code, hou~sing c~le, and regulations, and to admit authorized inspector~ on premises and in buildings for necessar~ .... ...............................i ................. ' (Signature of al~licant,,or name, if a ~orporation) ............... L .:.4.v, ..,. ............................. ' ~ (Address of applicant) State whether applicant is ~wner, lessqe, agent, archite~:t, engineer, g~neral contractor, electrician, plumber or builder ........................................... ~ ......... e, .'/.a, 4!-.. -'.. J...~ .".,'. ~ ::m.. ! ....................... Name of owner of premise~ ' ~ .... '- ' '~' ~ If applicant is a corporatei signature of duly authorized officer. (Name and titl~e of corporate officer) Builder's License No.i .......~.~J,~l,Aif; ................................. Plumber's License No ................................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Mop No.: ........... ~ ..................... Lot No ...... Z,~,~_'.~ ........... Street and Number .,~. ~ ~',~A~.%.~, ~,~.,.~ J,.4.,~,~.Z~ ....... ,~4'~L,!,~;.~[t,~ ....................................... Municipality 2. State existing use and e~,f~D~l, ncy.~f ~p.r,~emi~es and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... :::.~.~2,].~;~,~;. ....................................................................................................... b. Intended use and occupancy ........... ,'~,~;,f,~...'.;,i.¢k....~;¢J,,~';~.t~...(~,i~?z¢~.Hm. ........................................................... 3. Nature of work (check which applicable): New BuHrJing.. ................. AcJclifion .................. ~,lferat]on .............. Repair .................. Removal .................. Demolition .................... Other Work .................................................... / ~) ,~________.._.......~ (Description) 4. Estimated Cast ............................................................ 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 ore situated ..................................................................................................... 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 .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from proparty 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¥~'ORJ~.t COUNTY ~":"~J~/~'"'""~* ~. ,-,v~,~ ~. ,~/~, ~-. __ ____ ~-- . ................ ~Cff~.:'.....ZJ.,...~.~..~.~.C.Z.JJ....being duly sworn, deposes and soys that he ,, the applicant (Name of individual signing contract) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have per¢ormed 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 fo~h in the application filed therewith. Sworn to before me this ~~.~ ........................ day of ............................................ , 19 ........ Nota~ Public ..................................................... Coun~ ............. ture o applicant)