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Home My WebLink About8178-zFOKM NO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, iN. Y. Certificnte Of Occupnncy INo.~2769 ....... Date .............?T.u.1. lr .... 8. ..... , 19. THIS CERTIFIES that the building located at .. ~llo~. Pond. Lazm ...... Street Map No. F~-~.v.$e~..Pl~Block No ........... Lot No, 2~[ ....... 8 .o~..t.h.o..l.tl .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........Sept.. 3..., 19 .?~. pursuant to which Building Permit No.8.¶.7.65... dated .............. .6.e.p~.. ,~, 19. ?~., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is . PrlYate..one..$.~.~.~Y..d.w;.1. i..ipg..w~t.h., a.d.d .i.t.i. qn. ...................... The certificate is issued to . .L~.oy. Os~;rosk:l, ..... Ovner ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... N.o.R, ............................ UINDERWRITERS CERTIFICATE No. l~$1~.d;l..ng .................................... HOUSE INUMBER ..... 200 .....Street .. ~X~.~.O~ .P. on.cl .L~u.e. .... ~O~:h.o.],~[ ...... ...... ......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOW~ GLERK'$ OFFIGE SOUTHOLD, N. Y. BUILDIHG PER~,~T (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8178 Z Dote ............................. ~ ....................... Permission is hereby granted to: .......... ............................. at premises located at ........................ .b ..................................... .................... ~ ................................ : ................ ~ ....... :. ...................................................................... Building Inspector. Fee $,!.~. ................. Building Inspector TOWN Application No ................................ ~ Examined .................. ~ ................ , 19....~...-- ,,.~ · . x.~,~ ¥ ~ '7 ~ ~' ~ ~,,,, ,~pprovea ........... ,.,...:.,~-:-~....., 19 ........Permit No ..................................... Disapproved a/c ~. . ....... (Building Inspector) APPLICATION FOR BUILDINe PERMIT Date .............................. ~'. ................ ,. 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter o~. 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, relationsh, ip to adjoining premises or public streets or areas, and giving a detailed description of layout ofproparty 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 Build!ng 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. 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 necessar~Inspections., · 'iSignG~'~ ap~i~oni:'~";~'~,"[f a (Address of applicant)~[ State whether applicant i lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~. .......................................................... .............. ............................................................................. Nome of owner of premises ..................% ................................................................................................................................ If applicant is a co,orate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ,~ l.. I:: Plumber's License No ................... ,,A/,.,~..~.....k.: .............. Electrician's License No ............................................. Other Trade's License No ............................................... !A,,,V~,h/. -F)q~ 1~, LotNo. ~:~ ~' Location of la~ on which p~o~d work will be d~e. Mao No .7 c r ~,,, ~. ~ ~,,' ~P' ~'"""iT~"~~ ............... ~,vT/~ .................. Street and Number ................................................................................................. ~ ................................................. Munici~li~ State existing use and ~cu~ncy of premises and intended use and ~cupancy of p~osed construction: a. ~isiting u~ a~ ~cupan~ I FA "' I~ y ~ ~ b. Intend~ use and ~cu~ncy ................................................................................................................................ 3. Nature of work (chec~ Which applicable): New Building.. ................. Addition .................. Alteration ....... ;. ........ Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... ~ 0 (') ~ ,. / ~- ~ (Description) 4. Estimated Cost ............................................................ tee .......................................................................................... (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 ? .c. Rear ............... ;~ ......Depth ~'; Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ' ~ 42 {5 Rear Depth I ~ 5' Z 10~ Date of Purchase ........................................................ Name of Former vwner ................................. ; ...................... ' 1 1. Zone or use district in which premises are situated ~ ~-~ ~'-~ ' 12. Does proposed construction violate any zoning law, ordinance or regulation: /k.' (~ . . 13. Will lot be regraded'. ........................... Will excess fill be removed, from premis.es: ( ) Yes ( ~o 14. Name of Owner of premises ............................ _~..c' ...................... Address .......;~4.~..~.¢..~..,..~.... Phone No. ...................... Name of Architect .............................................................. Address ................................ Phone No ....................... N6me of Contractor ............................................................ Address ................................ Phone No'. ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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. STATE OF NEW YORK, . I., ~ c c COUNTY OF ..... . .~. -.~ ~'. ,-'~.... f '~'"' ......................................................................... ; ........................... ~ duly sworn, deposes and soys that he Js the applicom (Name of individual signing cootracf) above named. He is the ....................... -~- '.('.:.'..L.~...N.!..[~.,'...~. .................................................................. i .......................................................... (Co'fltroctor, 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~iled therewith. Sworn to be~'e me this ........................ o, ................................. ..... Notary Pubhc, . ................................................... County .... i~r~,~l~:../f/~....l..~,,~,~.,,e,~¢~.~ ..................................... ~ ~, · ~ ~-~. ~-~ __ ~ ,~' ~SigrS~ure of applicant) ~ ELIZABETH ANN HE .lt.J.~.~;~-'"7.' ..... . . · . NOTARY PUBLIC, State of New Yo~ ' ' No. ~2.81~5~50, Suffolk Te~m E~pi~ Match 30. 19~ '