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Home My WebLink About7928-zi~OR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. I~.7..2 .~. ...... Date ............ 0~.~ .....~ ...... , 197.6.. THIS CERTIFIES that the buil~g located at . ~*P..~O~0 D~$~ ......... Street Map No.. ~ ....... Block No. ~ .. Lot No, . ~... ~tg$lUok. ~ ,~ ......... eo~oms substantially to the Application for Building Permit heretofore f~ed in t~s office dated ........ ~$. 3~{~.. p~suant to which Build~g Permit No. ~/1~ dated ..... 5/3/76' f~ ...... 9 ...., was issued, ~d conforms to all of ~e requk~ merits of the applicable provisio~ of the law. The oceup~ey for which ~is eertfficate issued is .. ~gt~ ~~I .P99~ .~$t~. ~Qn0e ~ *O~9$*O~S .&..~00~. The certificate ~ issued to .JO~ .J, ~b*t .... ~e~ .......................... (owner, lessee or ten~t) of ~e ~oresaid building. S~o~ County Department of Health Approv~ . .~{*~ ~ .......................... U~DERWRI~ERS C~aT~CATE ~o..~83.836 ..... ~Y...t8 . .1976. .............. HOUSE NUMBER .... 2~0~.,. Street ...... Dee~ .Ho~ .D~ .................. ...... B~ding ~spector l~O~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7928 Z Permission is hereby granted to: . ...,,T..~m...~a,l,~ ~:I; .................................................. ............. N,a.~.~:L.~.~k ........................................... to ...~A~l,d....ala..aa~sc, o~,~..~u~&a.~._nij ..................................................................................... ot p~emises Iocoted ot ..,D~o~...}I~.~..I>.i'.~¥~ ..................................................................................... ............................................................... H,~¢.~.~-.....N-,-~.~. ............................................................. pursuant to application dated ......................... ~....jj~....j~...., 19...~, and approved by the Building Inspector. Fee $.-~ ~0 ~-.~)0 ........ FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. d,,4 ,/Td . APPLICATION FOR BUILDING PERMIT / Date ........... INSTRUCTIONS a This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi, 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 premmes or public streets areas, and g~ving a detailed description of layout of property must be drown on the d~agrom which is part of this applicatic c The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will ~ssue a Building Permit to the applicant. Such porn 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 Occupan. shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Build,ng Department for the issuance of a Building Permit pursuant to ti Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, I~,ild in~co_c/l~ housing code, and regulations, and admit authorized inspectors on premises and ir~ buildings for necessa~ ir spj~ct'~n~,k ......... ii' r;" ..... ............. ........ (Address of applicant) { State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde if opphcant is a corporate, signature of duly authorized officer. N< (Name and title of corporate officer) Builder's License No ..................................................... ~ Plumber's License No ................................................. ti Electrician's License No ............................................ / 1 Locat,on of land on which praised wor~w/i~t b~.done./.~p No ..... ~ No ............. Street and Number ......... ~..~..~ ........... 2 State ex~sting use and occupancy of pr~T~es an~ended use and occupancy of proposed construction: o Exislting use and occupancy ...... ~~.LT..~. ............. .~. ........................... ~..~} ................................... b Intended use and occupancy ..................... .c.! ........... (...~~...~.~.~.~.~'~" .................................. 3. Nature of work (check which applicable). New Bu .............. Addition .............. Alteration ........ Repair .................. Removal .................Demohtlor/ ................Other Work ..l~.~ ............... ~ Z/L~.~) / ~) ~ (Description) 4 Estimated Cost ....................................................... Fee ...................................................................................... (to be pa~d on filing th~s application) 5 If dwelhng, number of dwelhng 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 b/pe of use .....--~. .................. 7. Dm~ens~ons of ex,sting structures, if any' Front ...................... Rear ................................ Depth .................... He:ght ........................ Number of Stones ......................................................................................................... D~mens~ons of same structure with alterations or additions Front .................................... Rear ....................... Depth ............................... Height ........................ Number of Stories ................................ 8 Dimensions of entire new construction: Front ........... }'~ ..................... Rear ....... ~.. ................ Depth ................ Height ......J.~ ........... Number of Stories ........... /. ......................................................................................... 9. Size of lot' Front'""'"' """'"k'"Z_ ,/""~'"~' ........ ! ............ Rear .......... / .~..~. ..................... Depth ......... ~.:.~..~. ............ 10. Dale of Purchase '""'"'.."""'...f~...~...~..~.. .......... Name of Former Owner ......... = ......................................... 1 1. Zone or use district in which premises are s~tuoted ............ ~~-~... ................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation: ......... . .~....~. ..................................... 13. Will lot be regraded ..... ~-.v. ................. Will excess fill be removed from premises: ( ) Yes ~' No ............. 14 Name of Owner of prem,ses ...... ~.~. Address ~..~/~..~.. Phone No. Name of Architect .............................................. Address ................................ Phone No ..................... Name of Contractor ............................................. Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~st~ng or proposed, and md~cate all set-back dimensions fro~ property hnes. Gwe street and block number or description according to deed, and show street names and indlcoi whether interior or corner lot COUNT ~'~'~ .......... i~~~...~.'. ...................................... be,rig duly sworn, deposes and says that he is the appl,co; / (]~me df ~nd~vidual signing contract) ,- ~ He Is the ............... ~ ...... ~..~ ............................................................................................ (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and f~ this apphcat~on; that all statements contained in th~s application are true to the best of his knowledge and belief; ar that the w~k w~ll be performe( Sworn toJ~j:~4[ore me th~s ~ .......... ~ ....day of ...~... Notary Public, ~ ~n the m~nner set forth m the app~hcation filed therewith. ........................................................................................ ~ (Signature of applicant)