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Home My WebLink About9366-zTOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office · $outhold, N. ¥. Certificnte Of Occupnncy No. · g79a9 .... Date ................qq.~...3 ..... , 19. ?.~ THIS CERTIFIES that the building located at . .~/8...~.a.~.n...~.o.a.¢.l ........... Street Map No... xx ....... Block No .... xx ..... Lot No.. xx ,, Penonie~..[q,Y., ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Jnly, .1.$ .... , 19,77. pursuant to which Building Permit No..9.~.~:~.Z., dated (a~l .~:~t~,~t.)...~p,~y..~.8., 19.?~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate i~ issued is P.~.~y.a,~.,..ox~.e.,. $'.a.t.~. ly. ~].~,.~e. ?...~.~.~.~g. ~.r~.,.~.~.. ~.~L((~.~ .~9.n..~..a.,'].4n...~.q.~.e.e2'. ~?l.d.g · The certificate is issued to ,Ado~,~).h .(L .~,(fl st,c~.l~fl ....... .0,~r~r .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~(*.i.~: ................................ UNDERWRITERS CERTIFICATE No .... p.e.n?:~.n..g ................................. HOUSE NUMBER ...... .~.l·f?:~ .0.. Street ...~'~kl.~.~. t.~.o.~d. ..... P. ~?.c.o.~.~..~ .... i? .,~i..,. ....... SOUTHOED,~N~ Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES~UNTIL ~ULL' . COMPLETION OF THE WORK AUTHORIZED) ..... ~.~~...¥~...~ ........ *.~~..~..-....../.~...~... ........ at premises loc/areal at _...~ ....... ~..,~~~ ~:;'":'"~'~'"*';"~' ............. .................................................................. . ........................... .~...._............~........~ ....................... pursuant to application doted ......................... , 1 , , and approved by the Building Inspector. Fee $ FOl~! NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .........~.---~ .................. , 19/../.... Pemit No..../...'.....~:..~.......~m. ........ u,sapprovea a/,c ........................................................................................... (BuildirC'g inspector) ~ ...................... , ..... ~NSTRUCTIONS a. Thts appiication must be completely filled ~n by typewriter or in ink and submitted in triplicate to the Building Inspebtor, 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 or areas, and giving a detailed descriptton of layout of property must be drawn on diagram which is part of th~s application. c. The work covered by this application may not be commenced before issua~ce o~ Building Permit. d. Upon approval of th~s apphcation, the Building Inspector will issue a Building Permit to the applicant. Such permit 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 unti[ a Certificate of Occupancy 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or 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, cod regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ignature of applicant?O'r name, if a corporation) .................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner of premises .......~, , ,, -- ~-z -~/.(.~~.,.....~...,...,.~~Z ....................................... Name of // If applicant is a corporate, signature of duly ~f~thorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done?~Map No.: ............... ~ ..........................Lot No ......-.-,,~. Street nd ........ ...................................................................... =2¢/ ~,Z/~ ~1~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed cons~rcJction: ; · Ex,st ng use and occupancy ..................... ;~Y. 2/'.~-~--~.. Z2~,.., ¢~z~.¢~'.~ b. Intended use and occupancy ..... .~~ ........................................... ..~,, .......... 3. Nature of work (check which applicable): New Building ....................... Addition ....,~ ....... Alteration ............... Repair Removal ......................... Demolition Other Work .................................... ......................... ' ....................... I Description) 4. Estimated Cost .~,.......-~. ........................ Fee ~..,~. ..................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ................. Numbe of dwelling units on each floor ......................................... if garage, number of cars ............................................................................................................................................ 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 ...~,.;2, ...... .~. ....... Depth ,,,~,,,,,,~..~. .................. Height Number of Stories ............. ~ ............................................ y .............. Dimensions of same structure with alterations or additions: Front ~..~..,7..~. ............ Rear ..... ,'~......~c...=...~.. .................. Depth ...... /~,. .................................... Height ........... L...~..'~..~H,~ ...........Number of Stories ...... ~. ................................ ~. Dimensions of entire new construction: Front ...9~..~../J. ........ Rear ,o.~.~.~...~.~ ............Depth ........ .~... Height ............................................. ... Number of Stories ......... .~. ~. Size of 1or: Front ...................................... Rear .......................................... Depth ~0. Date o~ Purchase ..................................... Name of Former Owner ~ ~. Zone or use district in which premises are situated ....... z...~ ........................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~ ........................................... 13. Will lot be regraded ............. ~ ................ Will excess fill be removed from premises: [ ] Yes [ ) No · . 14. Name of Owner of premises ~: ..... ~ ........ ~...~~-~ (Address) Name of Architect ....................................... '~;"'"'L' .......... (Add~ess)/~ · ' ......... i~'~'l~"~'~i ............... Name of Contractor.~'.~-..~.~,,. ,~..-.. ~. ..... ~~.;~,f~*....., .~ ~. ,~..4~¢¢rv~.~[Aooressl .............. p'none' ~'~' ' ~2"'-~/~ ~ '~'"~'"' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back d~menslons from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATF OF NEW YORK, ~S co2 ;rY ..................................................... .~-.-~/....,~.~,~..,,,.2,.,,,~~~ ................. being duly sworn, deposes and says that he is the applicant above named, He is the ......... ~..~...~ ............................................................................................................................................................ {Contractor, agent, corporate officer, etc.) of said owner or owners, and is du~y authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and t~ ~,he work will be performed in the manner g E. DAWSON set forth in the application fired therewith. NOTARY PU~£1C, State of New Yar~