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Home My WebLink About7839-zNO. i TO~q' OF SOUTHOLD BUU.DING DEPARTM~T Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at .N.~'.t.h..R~d. (.C..~.) ....... Street Map No. ~ ......... Block No...~.. ...... Lot No..U- · l~l*eeltpol*~ · .II,Y.~. / ....... conforms substantially to the Application for Building Permit heretofore filed in thin office dated .......... &p~...22... ~, 197~.. pursuant to which Building Permit No. 783.~Z.. dated ............ &l{r.. P-~.., 19 7~., 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 {*~lYit~,~..OZUm..£mm;i~. (lw. eJ,~tg..~,th. ~n. a~d~t~t.o~t ................... The certificate is issued to .{i.,~ :{P~.~qtJt{~{ ....... ~. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...lq. eR.: ............................. UNDERWRITERS CERTIFICATE No. P~..~..~.~ .................................... HOUSE NUMBER ... ~.Q~.~ ..... Street..~.o.~..t.h..R.o..a.d..(C..i~.~.] .................... Building T,m.~pector / FOKM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (I'HIS PERMIT MUST BE KEPT ON THE P~,EMiSES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7839 Z Dote A ~le, L ~, 7 ~ Permission is I~ereby granted to: .............. .... ;",,'Z ..... ~,';~'"~ ~ :'~';,;'; ;~'""~';'~2" f/ ;';"f-('S c pursuant to application dated .............................. ..~..~(..L......~...~i.., 19.7....~...~_.~ and approved by the Building Inspector. Fee $,../...~....0..~.. .......... Building Inspector Exomined ........................................ , Approved ....................................... Disapproved a/c ~ ' ...................................................................... ...................... (Building Inspector) TOWN OF $OUTHOLD BUILDING DEPARTMENT ~ //' ~. TOWN CLERK'S OFFICE 19 ........ "~o(~ ..~'~' Z Application 19.'. ...... Permit No. " "' ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ................................................. 19 ........... a. This apphcation must be completely filled in by typewriter or in ink and submitted m triplicate to the BuildinL 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 oi areas, and giving a detailed descnption of layout of property must be drawn on the diagram which is part of this application c. The work covered by this apphcation may not be commenced before issuance of Buddmg Permit. d Upon approval of this application, the Building Inspector wdl issue a Buddmg Permit to the applicant Such permi, shall be kept on the premises available for inspection throughout the work. e No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupanc~ shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th, 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 w~th all apphcable laws, ordinances, building code, housing code, and regulations, and t, 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 Name of owner of premises ..... !..~.....!.~,. ....... .C.~..~...~!.~.....~'...~.'....!..?....(..~'.../,,q~ .................. If applicant ,s a corporate, s'ignature of duly authorized officer. (Name and title of corporate officer) Budder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Zrade's License No ............................................... 1. Locahon of land on which proposed work will be done. Map No ............................... Lot No ...................... Street and Number ............................................................................................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Ex:s~ting use and occupancy ......................................................................................................................... b. Intended use and occupancy ................................................ ./..~....J~....~...! ....J.. [....O.....~..~ ......................................... 3. Nature of work (check which applicable) New Budding .................. Add~hon ................. Alteration .............. Repair ............... Removal .............. Demoht~or ........... Other Work ...... (Description) 4. Estimated Cost ......................................................... Fee ............................................................................ (to be pa~d on fihng th~s apphcahon) 5 If dwelling, number of dwelling umts ........................ Number of dwelhng units on each floor .......................... If garage, number of cars ...................................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........................... 7 D~mensions of ex~stmg structures, if any Front ...................... Rear ................................ Depth .................. Height ........................ Number of Stones .......................................................................................................... D~mens~ons of same structure w~th alterahons or add,boris. Front .................................... Rear .................. Depth ................................ Height .................... Number of Storms ............................. 8. Dimensions .of~ entire new construchon' Front .................................... Rear ............................ Depth .................. Height .............. Number o~ Stones ......................................................................... 9 Size of lot: Front ...................................................... Rear ' Depth 10. Date of Purchase ........................................ Name of Former Owner ...................................................... 11. Zone or use district in which premises are s~tuated ............................. , ....... : ................................................... 12 Does proposed construchon violate any zoning law, ordinance or regulahon' . ..................................................... 13 Wdl 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 d~stmctly all buddings, whether ex~st~ng or proposed, and mdmate all set-back dimensions fron property lines G~ve street and block number or descriphan according to deed, and show street names and inducer; whether interior or corner lot STATE OF NEW YORK, COUNTY OF .............................~ ' ............................................................................................ being duly sworn, deposes and says that he ~s the apphcan (Name of individual s~gning contracf) above named. He ~s the ................................................................................................................................................................... (~Co,~t~a~c.t_or, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make end ill.. th~s applicahon, that all statements contained m this apphcetion are true to the best of his knowledge and behef, an~ tha~ the work will be performed m the manner set forth m the apphcation filed therewith Sworn to before me this ........................ day of ................................. , 19.. Notary Pubhc, . ................................................... County ~rm Expires M~r~I ~, (Signature of applicant) I~OR~ NO. 1 TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .................. ........... , ...... ............... ~sopproved ~/c ........ ~..~.... .......................................................... ........................................................... ....... .......... ~~...~.~~ ....................... {Buildino Insp~tor) INSTRUCTIONS a This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin~ 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, retahonsh~p to adjoining premises or public streets o, areas, and g~wng a detailed description of layout of property must be drawn on the diagram which is part of this application c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the apphcant Such permi 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 th, 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 t, admit authorized inspectors on premises and in buildings for necessary inspections. '§ pp' , ..... ;":'C3"'~;'i~;';i~;i';i~i ....... ........ .~.U.T.~).?..~..~. ...... ~...'.(. ............ 0,..~,.~./.. (Ad~r';ss ;f applicant) .............. State whether applicant is owner, lessee, agent, architect, engmeer~con~ electrician, plumber or builder Nome of owner of premises ....... ..(~/..:...~.. ....... .?..(_/q....~/......Z~....~....~-3.......~.....!..,~......~.Q .............................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Bu,lder's License No ..................................................... Plumber's License No ................ ._~,...A.....~...~..O.../J. ......... Electrician's License No ........... ~.E-....'~....LT....~.. ..... ~, Other Trade's License No ............................................... ~'E -q Location of land on which proposed work will be done Map No ' . ............................... Lot No I '~ Street and Number ...................... .~...O..~..~..?.~.......-~....~:/~..']~... ..... ..~..?./ ....... ~.L.=..E'...A(...]~.....7~...Z.' ............................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construchon' a Exisiting use and occupancy ............ ,.~.....k{.~ ....... .F..~...~ !..L...y. ........ .~.~..../r..V...b.:...L...L..I...N...~..~.. ....................................... b Intended use and accupancy ........ ..~...~....~....E.. ........ ..W.!...T....k/.. ....... .~...~).....-~..!....~...!...~....~. ............................................ 3. Nature of work (check which apphcable). New Budding ................ Addition .................. Alteration Repmr .................Removal ............... Demolmor. ............. Other Work .............................................. 4 Estimated Cost ................... =..-.- ............................ Fee ............................................................................... (to be pa~d on fihng th~s apphcat~on) 5. If dwelling, number of dwelling umts ............. ./. ......... Number of dwelhng umts on each floor .......................... If garage, number of cars ............................................................................................................................ 6 if business, commercial or m~xed occupancy, specify nature and extent of each type of use ................ 7 D~mensions of ex~stmg structures, if any' Front ........................ Rear ................................ Depth ................... Height ........................ Number of Stones ...................................................................................................... D~mensions of same structure with alterations or addmons. Front .................................... Rear ................. Depth ............................... Height ...................... Number of Stones ................................ 8 D~mens~ons of entire new construction Front ................ I..'7. ......... Rear .......................... Depth / 9 S,ze of lot Front ...................~'..Z...~z'. ....................... R ear ................. .'T ................... Depth ................ ...-m. .......... 10 Date of Purchase ................................................ Name of Former Owner ..................................................... 11 Zone or use d~stnct in which premises are sttuated ..................... ~....~.....~../..,.~...: ........................................... 12 Does proposed construction wolate any zomng law, ordinance or regulahon. /~ O 13 Wdl lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes (l~No Name of Architect ............................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and dmtmctly all buddings, whether ex~stmg or proposed, and red,cate all set-back d~mens~ons fron property hnes G~ve street and block number or description according to deed, and show street names and ~nd~cat~ whether interior or corner lot STATE OF NEW YORK, COUNTY OF .................. .................... ..'?T.':'....%.....'..'...'Z.'::.?f..Z.~.'T.:L.~. ........................... being duly sworn, deposes and says that he is the apphcan (Name of ind~wdual s~gn[ng contrac'0 above named He ,s the ................ ~...~.....~.../..~..~..~...T...~~ ........................................................................................................ ~~ agent, corporate officer, etc ) of said owner or owners, and ss duly authorized to perform or have performed the said work and to make and th~s apphcat~on; that all statements contained ~n this apphc~:hon are true to the best of h~s knowledge and behef; an~ thor the work wdl be performed m the manner set forth m the apphcat~on filed therewith. Sworn to before me this ............................................................ _S~.=" )'7-~-- r~ . ...... Notary Pubhc, . ....................... ~ .......... ~ ........... , C:ounty~ .,,~.....T.~. 1ELIZ/~'ETH ANN NEVILLE ~'DT^RY pIJBll0, State o~ Nr ~ Y0r~, No 52-8125850. ~f[oIl~ CIItnt, Term Ex~}~res M~rch 30