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Home My WebLink About7902-zIN)B]! NO. 4 TOWN OF SOUTHOLD BUH.F)ING DEPARTMENT Town Clerk's O~iee Southold, N. Y. Certificate Of Occupancy No..Z.6.6.1.~. ...... Date ............... Alii .... ~ .... , 19.?~. THIS CERTIFIES that the buildin~ located at .. l~l.l$e. F~al~l~ .D~ .... i ..... Street Map No..S..°.~..t.h.o.!.5..S~lock No ........... Lot No, .I~ ...... .~.l~qelall. o.T.~ ..... .N...Y. :... conforms substantially to the Application for Building Permit heretofore ~ed in this office dated ...........l~y... 8.., 19..7~ pursuant to which Building Permit No....7.902Z dat~l ..............14ay .... 8., 19.7.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is..P.~$.vtte. P~e. familY..clwe~ling .wi.th .an .&dd£tio& ................. The certificate is issued to .. ~.q133~y..t~oe~,bel ..... .°wItel~ ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Heslth Approval . tt,E o .............................. UNDERWRITERS CERTIFICATE No. p.e.n.d.i..ng .............. , ..................... HOUSE NUMBER .......... Street ..... iX],ue. ~,a~'ZL~ .~r .................... ....... ............. Building In ~,~r, or { TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7902 Z Permission is hereby granted to: ~J,..J~.,...l~Lt~.~/..C..i~e?~...~j3Jajt ..... ~o .. but It.. an.. ~adii ~t.a..on.. e.z~t ~, ~ ~..clw~l Ltu~ ............................................................... at premises located at .... ~..~...,~.-~;~ .......... .~.~.~.0.~..~...~.~.0.~..~.~. .......................................................... .................................................. iJtt~e..J~a~l.~..Dl~ ........... ~tt~eeape~t, .......................................... pursuant to application dated ........................~Jl~. ....... ~ ............... 19.~.~..., and approved by the Building Inspector. Fee $.~i5S~ ........... IUILDIN~ DEfAItTMENT ~ Application No .................. Z.~ ........... 4 Disapproved o/c ............................................ APPLICATION FO~ BUILDING PERMIT INSTRUCTIONS a. This appllcotlon must I~ completely filled in by t~/pewriter o~ in ink and submitted in triplie~ b ~lot plan ~h~in~ ~tion of lot ~nd o{ bu Id n~ on premise*, r~l~tion~hip to ~loinin~ premix* or public *tr~ o~ or~, ~nd ~ivin~ a d~il~ d~ripti~ o{ I~out o{pr~ mu~t b~ drown on t~ d ~orom which i~ ~ o{ ~h, ~1 e~fi~.q c. ~ ~ork c~r~ b~ thi~ ~lic~tion m~y n~ b~ comm~nc~ b*~or~ i~uonc~ o~ Buildinfl ~rmil. d. Upon ~ o~ ~i~ ~licotion, ~ 8uildi~ I~tor will i*~u~ ~ Buildino ~rmiI to ~h~ll be k~pt ~ th~ pmmi~ ~oilabl, {or in~p~tion th~h~t th~ ~rk. ~. ~o buildino ~h~ll ~ ~cupi~ or u~ in ~hol~ or in p~ {or on~ pu~ose ~h~er until ~holl h~ ~n ~mnt~ ~ th~ Buildin~ In~p~tor. ~[1~110~ IS H~R[BY ~D[ to th~ Buildin~ ~dmont {or ~, i~u~nc~ o~ ~ Bufldinfl P~it 8uildin~ Z~ O~inonc~ o{ th~ T~ o{ ~thold~ Suffolk Count, ~ York, ~nd ~r opplic~bl~ R~ul~t one, for th~ con*tru~ion o{ building, ~ddition~ or ~lt~mti~*, or {or mm~l o[ d~molit~on, ~ ~plicont a~r~ to comply ~ith a~l ~lic~bl~ I~, ordinone~, buildin~ ~, h~ ~, Other Trade's License No ............................................... Locot,on o,,ond on wh,ch work wi,, be one. ........ ........ Street and Numt~rZ~../...~.....~...~'-c~~- '. M~i~l~ ~ 2.State existing use and occupancy of premises and in~ended use and occupancy of' p~roposed construction: · a. Exisiting use and occupancy ............... ~.~-.~..~.~/~ '~'~'° .................................................................................... b. Intended use and occupancy ..................:;.1~ ........................................ t ......................................... Nature of work (check which applicable): New Building.. ................. Addition ..... Alteration Rel~ir .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) 4. Estimated Cost ....................................................... ~ee .......................................................................................... (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 c~rs .............................................................................. 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 ..,.,e¢;:~...~ ................ Height ....... ~....~.....~.. ........ Number of Stories ......... ./. ..................... 8. Dimensions of entire new construction: Front .......... ~...~....,~. ............... Rear ....... ~.....~.. ............ Depth ..... f....~7.,~. ......... Height ...../.~....~. ..... Number of Stories ~ ............ ./.. ............................................................................... ~,.~ ................. 9. Size of lot: Front ........................................................ Rear ....... ~,. .............................. De tptptptptptptptptp~_ J..7...7..~...I.I.~ lO: Date of Purchase ./~.. /. Name of Former Owner ., ~...~. ~ c.~ ,~ ..... 11. Zone or use district in which premises are situated ........... ~ ................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ /~...Q ..................................... 13. Will lot be regraded .......J~.~.~ ......... Will excess fill be removed from premises: ( ) Yes O(') No 14. Name of Owner of prem,ses .~Z.~.../~...~..~' zL ~ .~.../~.. --.~.-~'..Z-....~...~...~. Address ..~....~...~....'~...~....O....~...'~..... Phone No Name of Architect ........................................... --f- :. ................. Address ....... ,:,,.....;.....L;. ....... Phone No..............----"-~. ........ Name a* cant ctar ......................................... Address PLOI DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-tx~:k dimensions from properly fines. Give :treet and block number or description according to d~l, and show street names and lndlcate whether interlor or car aer lot. J '1 STATE OF NEW~(.,OI~/,./L~ [ S S COUN OF ........ (Name~ i~dU i ~ac~~f i~ividual s'g ' g c~t oc~ a~ve name. (Contractor, agent, co,rate officer, etc.) of said owner or owners, and is duly aut~rized to perform o~ have performed the said work and to ~ke and file this application; that all.statements contained in this application ore tree to the best of his knowledge and belief; and that the work will be performed in the manner set f~h in the application filed therewith. Swam to before me this . ~ , .......................... ~ W ~..;~.~.~.~.....:~.: ....... ~.~ ......... ~.~..~.;.~..~.~..~...~ ............ - (Signature of a~licant) /~¢ ,q Y~/_ //,./