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Home My WebLink About7866-zTOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.~..~.?.~.0. ..... Date ......... .~p.r.:[1....2.6. ...... , 19..7.6 THIS CERTIFIES that the building located at ...ldood .La~m ............ Street Map No. ~ ......... Block No...~X ..... Lot No, . xx.. ~eer~port ................ conforms substantially to the Application for B~lding Permit heretofore ffl~ ~ ~s office dated ........ AP~.. ]~, 19.7~. p~suant to which B~d~g Pemit No...?~ dated .... ~P~$.~..3~., 19~.., was ~sued, ~d confor~ to ~ of the requlr~ ments of the applicable provisions of the law. The occup~cy for which this ce~fficate is issued is . Pr. irate..on~..fa~.~, dw~!iiug. ~ith addi.tio~ .................. The certificate is issued to . .~ ~. ~q~ ...... ~. (owner, lessee or ten,t) of ~e ~ores~d b~ild~g. S~olk County Department of Health Approv~ .~; ,~, ........................ ~DERWRITERS CERTIFICATE No. ~ ~ R., ....................................... I~OUSE NUMBER .... ~. ...... Street ... ~. ~ ............................ B~lding Inspector TOWN OF SOUTHOLD BuILOIHe DEPMTWT TOWN CLIRK'S SOUTIgOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7866 Z Permissian is hereby granted to: · Cba~les.-~°~....~C ..~Lt~L~a~.~I~k~n Jr ..... ..~.~......~3~.9a..A~. .............................. ................ O~.~e~po~ ..................... ..................... to .~_~_ ~_~.~u..m~LtXo~..&.~;Lte~o~a..ar~.~z~ta.~L~..~.L~L~ ............................. at premises located at ...~,~,~/~od...~.G~T~ ........................................................ , .................. [ ...... ............................................................. G:~een~t ....... .l~v:~-v .............................................................. pursuant to application dated ....................... A~Z'.~'I ...,1.~ ........... , 19..2~., ~nd approved by the Building Inspector. Fee St~.~ ............ Building Ins~cl~or ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 6 Approved , D,sapproved a/c ..~...~ ~ -------~- / r (Building Inspector) ( APPLICATION FOR BUILDING FERMIT INSTRUCTIONS Application No .... ~....~...~....~. .............. 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 Iocahon of lot and of buildings on premises, relahonsh~p to adjoining premises or public streets ot areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of th~s application. c The work covered by this applicahon may not be commenced before issuance of Building Permit. d. Upon approval of this apphcation, the Building Inspector will issue a Budding Permit to the applicant. Such permii 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 alterahons, or for removal or demolition, as herein described The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and ir~ buildings for necessary inspections. · .............................. (Signature of applicant, or name, if a corporation) ..... .................. ,~ (Address of applicant) State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ........................ ~.-~.~..~...~ ........................... ;...1 ........ , ................... ~ ............................................................. Name of owner of premises~~..~.~ ....... /.~.~. ~...~...: ......................................... If applicant ~s a corporate, signature of duly authorized officer. (Name and htle of corporate officer) Bu,lder's L,cense No ..... ~....~.~/.......~..~ .................... Plumber's License No ................................................. Electrician's License No ............................................ Other Trade's License No ............................................... 1 Location of land on which proposed work will be ~one M~ap No ../..~...61./.....L.~(/...~'J~...W. Lot No ....................... Street and Number Municipality 2 State existing use and occupancy of prem,(~)es and ~in~nded use and occupancy of proposed construct,on' 3. Nature of work (check which applicable) New Building ............. Addition .... ~ ......... Alteration .......... Repair ................ Removal .................. Demolmon .......... Other Work ......................................... 4 Estimated Cost .... . ..~. z.~...~..?. ......................................... Fee / ~ ~ (Description) (to be pa~d on fihng th~s apphcation) 5. If dwelling, number of dwelhng umts ....................... Number of dwelhng umts on each floor ..................... If garage, number of cars .......................................................................................................................... 6 If business, commercial or m~xed occupancy, speofy nature and extent of each type of use .......................... 7 Dimens,ons of ex,st,ng structures, ,f any: Front ... ~. ~....x .......... Rear ....... ~.....~ ...............Depth .... ~..~...~... He,ght ..... .~.~....x .......... Number of Stones ............ ./ .................................................................................. D~mensions of same structure w~th alterations or addmons' Front ........ .~..~... ................. Rear ..... ~..~' ........ Depth ..... s~4~...~ ............. Height ......... ./X'..~. x ... Number of Stories .......... /. ................. ~ z z · Rear ...... .xx~. ................ Depth .... ~ ............ 8 D~mensions of entire new construction: Front ......... ~ ........................ Hmght ................ Number of Stones ......... ./. .................................................................................. 9 Size of lot' Front ............ /.~..C.~.. ............................. Rear ..... /..~...~. ....................... Depth .... ............ 10 Date of Purchase ........................................................Name of Former Owner . .~.~.~..C4~...~........./..'..~/~-~..C~.. ....... 11 Zone or use d,str,ct ,n wh,ch prem,ses are s,tuoted ....... ./~..~..~..~..~.~..~..~./-~.~...~..~.. ............................. 12 Does proposed construchon violate any zomng law, oral,nonce or regulation' . ...... ,~..6 ......................................... 13 Wdl lot be regraded ..... ~ .~..~..~" .........W, II excess fdl be removed from premises: ( ) Yes 14 Name of Owner of premlse¢..4..~.. ?....~.:.. res~...~..~'.~.:q°hone No. 7.4~.~...~.~'../.~... Name or Architect ...................................... Address ................................Phone No ...................... .~..~ ~__.~~ , ' ......... .,~x~ ........... Phone No.~.~.Z..z~..x./~.~: Name of Contractor~~-.-.-.~-.~' ~...~-~.~.~..~.. Address PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~stmg or proposed, and red,cate all set-back dimensions fron property hnes Gwe street and block number or description according to deed, and show street names and indicate whether inienor or corner lot ~0~0 '1 STATE OF NEW YORK, ~S S COUNTY OF ..... ? .................... ..~ ............... ~~..~..~:~ -~ ......Z'(~..~.~'~.'~ ................ be,ng duly sworn, deposes and says that he ~s the apphcan -'(Name of mdw~dual s~gnlng contract) above named He ,s the ................... ~ .~,/~/Z-~..~.'~/'.~ ............................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duty authorized to perform or have performed the sa~d work and to make and th~s application; that ail statements contained in th~s apphcat~on are true to the best of his knowledge and behef; an~ thor the work wdl be performed m the manner set forth m the application filed therewith Sworn to before me this ........ .......... of ....... ':'' Noto ...................... -'~ (Signature of opphcant) // Rem m£ n Suffolk County Clks No 529366350 My Comrmsslon Expires March 30,