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Home My WebLink About9239-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . ~C~ D.I~e ............ Street Map No..:~ ........ Block No..:l[X ..... Lot No, .. XX... hatlr~l.. N.o.][, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... ~alr... 9 , 19.77. pursuant to which Building Pemit No.. dated ..... .l~.y..9 ..... , lg ..., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P..~$.'(.22~ &¢e. 9~.s.o.r.y .8to.l'.ag0 ~.dt~ .............................. The certificate is issued to F~.a~ &. J.e..m~..,l.~l~.z.o.~...t~..k ....0~0:~ ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N,1t, ............... UNDERWRITERS CERTIFICATE No...N,R,, ................................... HOUSE NUMBER .. ~I~D. .... Street . tt~rCl~ Ill~v~ ....... Lau~t ........... Building Inspector FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KERT ON THE P~.EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ......................................................... ....................................................................... ............................. ~ ~ L,_'~ ' ........................ ~'L~ "~:~' ~ ............ ~- ~.'~I.~"~;'~ ~ ": ............................................................................ '~ pursuant to application doted'~W :'~'"',~-~""t"~"_ ............ 1~,.,...~., and approved by the Building Inspector. ~: ~¢'' ' ~ Approved TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19./?~... Permit No...~..~.~..~...~. ...... Disapproved o/c~ ...................................... APPLICATION FOR BUILDING PERMIT Date ~2~..]. .................................. ,19..P....~.. INSTRUCTIONS a. Thru application must be completely filled in by typewriter or ~n 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 location of lot and of buddings on premises, relahonship to adjoining premises or public streets o areas, and giving a detailed description of layout ofproperty must be drawn on the dmgram which is part of th~s application c. The work covered by this apphcation may not be commenced before ,ssuance of Building Permit. d Upon approval of this application, the Building Inspector w,II issue a Building Permit to the applicant. Such permi shall be kept on the premises available for inspection throughout the work. e No build,rig 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 alterations, or for removal or demolition, as herein described The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and in buildings for necessary inspections. . ...... .......................... /'~ / g ~.gt ~ e .~d~lic , , if corporation) ....... f~) 7~} (A~z~s~f applicont~ J State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrictan, plumber or budder ........ ............................................................................................................................................................ Name of owner of premises ..~/~)./~.....~.....~. f~.j~... ~/~./~.~./~/$ s~'. ~ .............................................. ~f applicant is a co~orate, signature of duly authorized officer. (Name and t~tle of corporate officer) Builder's License No .............. ~ ........... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... I Locahon of land on which proposed work will be done. Map No ......................... ..~ Lot No ................../../~., Street ohd Number ~. ,. ................................................................................................. Municipality 2. State ex~sting use and occupancy of premises and intended use and occup.ancy of proposed construction: o Exisiting use and occupancy ........................................................................................................................ b. Intended use and occupancy ..... .~...~-./~.,~.~...~JT..~-~.....,~.~--~ ........................................................................... 3 Nature of work (check which applicable) New BuHdm .............. Addmon .................. Alteration ...... Repa,r ................. Removal ................ Demohhor ............... Other Work ........................................... ct~ (Description) 4 Estimated Cost ....................................................... Fee J...~.....~.....'.'"' ........................................................ (to be prod on fihng this apphcahon) 5. If dwelhng, number of dwelhng units .......................... Number of dwelhng 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 ex~stmg structures, if any. Front ....................... Rear ................................ Depth ................... Hmght ........................ Number of Stones ..................................................................................................... D~mens~ons of same structure w~th alterations or addmons Front ................................ Rear ................. Depth ................................ Height .......................... Number of Stones ............................... 8 D~mens~ons of enhre new construction' Front ................................. Rear ............................ Depth ................ Height .................. Number of Stories ............................................................................... 9 S~ze of lot' Front ................................................... Rear ............................. ,,-o ~,__~" Depth .............................. 10 .Date of Purchase ..................................................... Name of Former Owner .... ...~.....~..~....~..T.. ................................. 11 Zone or use district in which premises are s~tuated .................................................................................. 12 Does proposed construchon v~olate any zoning law, ordinance or regulahon 13 Will lot be regraded . ....~....o ............... Will excess fill be removed from premises' ( ) Yes (P~ No 14 Name of Owner of prem,ses .JTJ~k).~..~.~-_~/g...'~../~,~C~Y~,b~Z'Addres~;~.J~)~,~ ............... Phone No.~.~....~.~.~ Name of Architect ............................................................ Address ................................ Phone No ...................... Name of Contractor ............................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether existing or proposed, and indicate all set-back d~mens~ons frorr property hnes G~ve street and block number or descnpt~on according to deed, and show street names and ind~cat¢ whether interior or corner lot ~CC t~ CTATE OF NEW YORK, ~ '-- ~ ~OUj~T/Y,~OF .~-/ .....................~S.S ~ _ _ ~.'~ ~., ~ove na~d. He is the ..~~ ........................................................................................................................................ (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and th~s apphcat~on; that all statements contained m this apphcohon are true to the best of his knowledge and behef, ant that the work will be performed in the manner set fo~h in the apphcation filed therewith Sworn to b~fore me this ,,/ ) 7~ ....... day ~...~/~ .................... , 19~. "( ........ ....................... ............................. N~ARY PUBLIC, State of New York No 52-4643721, Suffolk Cou~ Term ~mres March 30,