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Home My WebLink About8302-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy Date ......... $...U~..y..17~. ................ 1900. THIS CERTIFIES that the building ................................................ Location of Property 1~.~ Wood Large Peconio, N,Y. House No. 86 Street Hamlet County Tax Map No. 1000 Section ............ Block ............... Lot ....... ~. ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated Hay 17 19.7.7. pursuant to which Building Permit No. ~302Z dated .... .~.a.y.. !.7. ................ 19.1.~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Addition to Private One Family l~¢elling Annette Xnoblock The certificate is issued to (owner, ,e~c o, ~ of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ................. I?..~.7.0.6.. 9. 6 ........................ Building Inspector Rev 4/79 FOEM ]qO. 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 CQMPLETION OF THE WORK AUTHORIZED) No. 8302 Z Permission is hereby granted to: ................. ~ou~he~d ........................................... to ...b~i3A..a~.aclx~Lt~ie~..ot~..e~'~tL~g..~elX~a~t~ ............................................................. at premises located at ..~l~-~L~..~e~-.~a~ll ................................................................................... .................................................. Peeea~.e.-...~,~', ............................................................................... pursuant to application dated ........................~1~ ....... ~'3 ............ , 19.~.., and approved by the Building Inspector. Fee $.:15,Q0 ........... /~ ~d~ff_~_ ~ ~O'WrN OF SOU'YHO[.D PROP~:~TY R;CORD CARD ow~ ~s,~ v~ ] ~,s,~,~ ~ su~. FO~ER OWNER t ~ ff ,~ ,, E D h ~ ACR~GE ~ ~S~w ~ W,t ~()' ' / ~ F,' ~ ~PE OF BUiLDING I t / COM~' ~ ] CB. R~.~O S~S. j VL. FARM C" lIND. i LAND AGE ~, NEw ~;'~ Form Tillable ,Tillable 2 Tillable 3 Woodland Swampland B~shlond House Plot Total IMP. NORMAL 'Acre MISC. BUILDING CONDITION BELOW ¥olUe Per Acre ABOVE Valbe ' FRONTAGE ON WATER ~,~ jFRONTAGE ON ROAD __ BULKHEAD ,,~ ~' j DOCK LOT Est. Mkt. Value L×tension Foundation Basement cx,. Wails Fire Place Patio ,~ ]Driveway T- T L Porch: ; Roof Type Porchi Rcoms 1st Floor Rooms 2nd Floor Dormer t .I OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~SOUTHOLD, N. Y. Application No. 0~..~ 0 2-.--- Disepprove. d a/c ................................................................................. APPLICATION FOR BUILDING PERMIT ao INSTRUCTIONS This application must be completely filled in by typewriter at in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plat 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 o~ areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this application. c. The work covered by this application may nat 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 NtADE 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 o~, 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. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................... b.ui!d~ ............................................................................................................................ Name of owner of premises ...~;~,,~.~..JLTL13.~.~.~..,,T~L~]~,D.C~ .............................................................................................. 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 ............................................... 1. Location of land on which proposed work will be done. AAap No.: ........................................ Lot No ......................... Street and Number ........ ~.~,~,~...~.~.~.~..~. ....... ~.~.~.O~.~.C: ............................................................................. Municipality 2. State existing use and ~cupancy of premises and intended use and ~cuponcy of proposed construction: ~. ~isiting use o~ ~cupancy ....... .~.~.~;.~.~g ..................................................................................................... b. Intended use and ~cu~ncy sa~:e with an addition 3. Nature of work (check which applicable): New Building.. ................. Addition .~, ............. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 10o0 + ~ .....1.~.,.O.O .......................................................................... 4. Estimated Cost .......................................................... tee (to be paid on filing' this application) 5. If dwelling, number of dwelling units ........... or~ .......... 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 ........ .6. .......................... Rear ...... .6. .................... Depth ..... .6. ................. Height .................... Number of Stories ....9..n..~ ............................................................................................................ 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 ..!!~.!!...d.,~,s.~ ............................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ,T~D. ............................................. 13. Will lot be regraded . ......~.o. ................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..... ~;.t,e...~)~.]:.o¢.k ........ Address ......p..e.q..o..n.~.g. ......... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...k~,x..~'a.~.t..3_nc ............................ Address ...-qo~,~;l:;~o;D~, ......... 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 S S COUNTY Of .... ~.l~.~Dlk .......... ~ ' .................. ;'Z ........... -;-...~,..-..},~.~,~.19~ .................... :;~. ................. being duly sworn, deposes and soys that he is the applicant uName at inaivJauOl signing contracT/ above named. He is the ~J(]ontractor, agent, corporate officer, etc.) ........................................ B~i. ~er ............... : ..................................................................... : .................................. of said owner or owners, and is duty authorized to perform or have performed the said work and to make and file this application; that oil 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. .................... 3.2 day of ............. Notary Public,. ................. .~LLI?.~'DJ~..~ ...... ~. County .............................. i.~i~.~.~;~,~;.;;¢..~;;l~(i~;~t.7/I ............... ~/ JUT . J~OKEN Nota~ ?ubJic, Sta!e of New York