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Home My WebLink About7942-zNO. 4, TOWN OF SOUTHOLD BIJ~.DING DEPARTMENT Town Clerk's Office Southold, N, Y. Certificate Of Occupancy No. Z6,~.~ ...... Date .......... Ju.lz....~ ....... , THIS CERTIFIES that the building located at .I;./.S..N.?¥..3.u..f.f.o.t?.,..ky.et .... Street Map No....XI(,Y.. ...... Block No. ;[~.(.X. ..... Lot No, . .X2:~....!,.a.t.t..!.~.u.c.k... ?.:k.: ....... conforms substantially to the Application for B,ilding Permit heretofore filed in this office dated ........... ~4.¢~.. ~.Q.., 19 ?.~. pursuant to which Building Permit No.. dated ........ Ma~. 20 . ., 19.7.~., was issued, and conforms to all of the req~!re- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .,.~$y.a.l~¢..o;a~...¢~4.~.~-~..d. wtLl.~.'.zn.g .w..i.t.k: an addition The certificate is issued to . ~.t.e .v.e.n..b.' .k.ey.q .f.e.l.i.x.. {..Wif.¢....o..w-qe..r.s ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N...R: .............................. UNDERWRITERS CERTIFICATE No. p.~.n.d..~.n.g. ................................... HOUSE NUMBER ...~09~ .... Street . .N..e~..~..f?.c.]:k...Ay.e.., ..................... Building Inspector t FOKM 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 CQMPLETION OF THE WORK AUTHORIZED) N? 79 2 Z Permission is hereby granted to: ....~[ke.~o...~.~].i~ ............................................. .......... ~...~..u.f.C ~l.W... A:w.e. ............................ ...................... ~t~.~t.%~k. ................................ to .bZd./~t..a~.~d~..i.ti o~..~n.. ~x.~ ~.ti~.~..d.-:,:~.".~li.:g ............................................................ at premises located at ..~Z'...~..~.~...S.~.~ff.~.t..~..Av.e ............................................................................ ........................................................................ t.i¢ .~ok.....~J..Y. .......................................................... pursuant to application dated ..........................~...~......~...0. .............. 19.7~:.., and approved by the Building Inspector. Fee $.:l,.~',.[I0 ........... Approved .............. f.~ ......... C~. ....... , FOll,M NO. ! TOWN OP $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. ..... '(Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s apphcatian must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the BuildiJ 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 premmes or public streets areas, and giving a detailed description of layout of property must be drawn on the d~agram which is part of th~s 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 w~ll issue a Budding Permit to the applicant. Such pern shall be kept on the premises available for inspechon throughout the work. e No budding shall be occupied or used in whole or in part for any purpose whatever unhl a Certificate of Occupan 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 t 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 alterahons, or for removal or demolition, as herein describ: The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and iN buildings for necessary inspections. ................................ (Signature of applicant,~ name, Jfa corporation) ........... ....... .zL;..z...., ............................................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build .................................................. a4~e~t..4) f...o~e.~. ............................................................................................... Name of owner of premises .~........S..~...e..~..9....q~...e.~:~ ............................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's bcense No. owner Plumber's License No ................................................. Electrician's License No ............................................. Other T rade's L,cense No ............................................... K/?~/'~ 1 Location of land on which proposed work will be done. Map No ............ ~ ................ Lot No ........ ~ .... Street and Number . .;kT/.~..~[e:[¢..f,q.Uf~O&]~...A~,-~. ......... ~zca.J~.$~..~k ......................................................... Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Exisiting use and occupancy ...... ¢lW.e. ili~ ............ " with an addition b. Intended use and occupancy ....................................................................................................................... 3. Nature of work (check which applicable). New Budding .............. ^dd~tion .....~ ... Alteration ~..Y~ Repair .................. Removal ................ Demoht~or. ............... Other Work ................................................ (Description) 4 Estimated Cost ............... 2.~.~0.0.......+.. ..................... Fee ..1..~....0...0. ....................................................................... (to be pa~d on fihng th~s application) 5 If dwelling, number of dwelhng umts -'..~.. q.~...e. ............... Number of dwelhng umts on each floor ........................ If garage, number of c~rs ................................. 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ................. 7. Dimensions of ex~sting 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 Dimensions of entire new construction. Front ........ ~.2~,.!,Cl ............... Rear . ...1. ~. .m .1...0. ............ Depth ...... !..2. ........... Height ................... Number of Stories ...... .O~f~ ............................................................................................. 9. Size of lot Front ................................................... Rear ....................................... Depth ............................ 10 Dote of Purchase ................................................... Name of Former Owner ...................................................... 11. Zone or use d~stnct in which premises are s~tuated . .'...~.~..t!...cl.£s.t, ............................................................ 12 Does proposed construction violate any zoning law, ordinance or regulation ..... T~.~. ............................................. 13. Will lot be regraded ..... DO. ................. Will excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises ....8~e,~.Q..~.f~:L~z, ..................... Address ....~,!~t~.t;,i,.~,~ ..... Phone No ..................... Name of Architect ................................................ Address ................................ Phone No ..................... Nome of Contractor ............ 8~rne ....................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~sting or proposed, and red,cate all set-back dimensions fro, property lines Give street and block number or description according to deed, and show street names and ind~cat whether interior or corner lot STATE OF NEW~YQ.P~, ~ c S COUNTY OF ....b.'..l~..z..z..p.~¢. .......... ~ ~- ....................... ~].~..J~b.'i Jsy~ .............................................. being duly sworn, deposes and says that he ~s the apphca: (Name of individual signing contract) above named He ~s the ............ ~.ge:p.t, o:[' o!~ez' (Contractor, 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 and fi th~s apphcat~on, that all statements contained m th~s apphcahon are true to the best of his knowledge and behef, ar that the work wdl be performed ~n the manner set forth m the apphcation filed therewith. Sworn to before me this Notary Public,. ................................................... County ...... 2~'~.t-. .... ~ ............... (Signature of applicant) ~ '