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Home My WebLink About9341-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupancy No. 7..,-7..893 ...... Date ............ Sept...1.~ ...... , 19. ?7. THIS CERTIFIES that the building located at . $./S. ~fa&n. R~.d ........... Street Map No. ;~ ......... Block No. XX ..... Lot No..x.~.. Or..~.el~:t...~,~., ........... conforms substantially to the Application for Building Permit heretofore fried in this office dated ......... ~'.lAne .29 , 19.7.7. pursuant to which Building Permit No...R3t+~Z. dated ........ .Ju~.e. ~.9. ..... , 1~?.., was issued, and conforms, to sll of the require- ments of the applicable provisions of the law. The occupancy for Which this certificate i~ issued~ ..~$~O.~CCO~.~OrY .g~rage ........................................ The certificate is issued to C. arl.~lab~ne. ofthe aforesaid building. · O.~xler ................................. (owner, lesse or tenant) Suffolk County Department of Health Approval I~.R. ........ , .................. UNDERWRITERS CERTIFICATE ~o..~.?.R., .................... I ................... HOUSE ~UNIBER .. 2~2~0... Street... Ma~l.n. l~ad ..... 0~:tlmt ................ Building nspecmr FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ' SOUTHOLD, N. Y. BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PT~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Z~T.° 93~11 Z Dote ..~/-U~.~ ...... Z.~... .................. Permission is hereby grant~ to: ~ / ~ . .......... ~.~.~.~:~.~.~ ,o ..... ...... Fee $~ ............... '" ~ Builcli~ ............... % TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... ...... ........ .... ' z ......... ............... {Buildin~ Im~tor) [Application No ........... APPLICATION FOR BUILDING PERMIT / INSTRUCTIONS Date/~'''~?''' '~'' .................... ,9.?....?.. a. Thcs application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Buildir 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 premises or public streets, areas, and giving a detailed description of layout ofproperty must be drawn on the dmgram which is part of this applicatio, c. The work covered by this application may not be commenced before issuancelof Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such perm 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 Occupant 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 tV Building 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, building code, housing code, and regulations, and [ admit authorized inspectors on premises and ir~ buildings for necessary inspections,; '(Signature ot applicant, or name, rf a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contrac'tor, electrician, plumber or builde If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... Plumber's License No ................... ~/)...~. ......................... / Electrician's License No ............./.... ......................... f Other Trade's License No ............................................... 1. Location of land on which, proposed work will be done. Map .,,N~.' .-:~......~. ....... ~..'. ................ Lot ,~ ........... ~.~ ....... Street and Number ........ ~...~...~..' ............. ......................... ..~~.. Municipality 2. State existing use and occupancy of premises and intended use an_d/occup, an~ y of proposed c,onstruction: b. Intended use and occupancy ...~.~../...~- / Repair ................ Removal ............... Demohb0r. .......... ,., Other Wo~k ............................................. , (Descnphon) 4. Estimated Cost .......... ~'.. 5Z.~........'~...''. .......... *.Fe~ ./...~....~. ............. : ...................................................... (to be pa~d dn fihng th~s application) 5 If dwelhng, number of dwelling units - ....Number of dwelhng units on each floor ....................... If garage, numb~r'of cars ...................................................................... i ..................................................... 6 If business, commercial or m~xed occupano,, spec,fy nature and extent ofI each type of use ...................... , 7 Dlmens,ons of exist,rig structures, ~f any Front ..... ~ ~ ............. Rear ........ He,ght ...... ./'.....~....~ ....... Number of Stones .......... ~ ............................. i ................................................... D~mens~ons of same structure with alterahons or addmons. F'ront .... ~.z2 ........................ Rear ... Depth ..... .~.....~.. ............... He,ght ..... /..~.. Number of Stones..~.~..r.?...... ............ 8 D~mens~ons of enhre new construchon Front ..... _... ?.~.....=~ ..........Rear ..........................Depth ............... Height ............... Number of _Storl~? ..., ..~;.~ ........ .r '~ 'L ...... * ........ ;:'~ ........ I .......................................... 9 S,ze of lot Front ..~.,............................ ............. Rear ........................ i ............. Depth ............................. 10. Date of Purchase/~/'//,7' ,./,~..~.-~....-. Name of Former Ownei ~.~.....C~:~.~ 11 Zone or use distr,ct m wh,ch prem,ses are situated .:...~.... .......................... I' 12 Does proposed construchon v~olote any zomng ~bw~ ordinance or regulahon I .............................................. 13 Wdl lot be regroded ........... ~ ............... Will exce~s fill be removed . from.preml.ses; ( ) Yes., . ~ No ]4 l'~ame of Owner of prem,ses ............... ~, ................... ' i ........ 'Add ~ ............... ~ .......... ; ...... ~hone No, Name of Architect .............................................. Ackiress ............ ~,,.~ .......... 'Phohe~No ..................... Nome of Contractor : ...................................... Phohe No. p ' ,LOT, DJAGRAN~, , , Lo~:ate cleaHy and d~stmctly all buddings, whether ex~sting br pro~ed, and ~d~6te all s~t-back dimensions property lines Gwe street and block number or description accordm~ to deed, ~nd show street ~ames ~nd ndic~t whether mter~or or corner lot STATE OF NEW YORK, ~S S COUNTY OF ...................... ~ " Be,r~g' ddJy sv~orn, d~po: (Name of individual signing cant.tact) ~ , , . abOV~He ~s thenamed-- ........... *" // /(Contractor, agent, corporate offmer, etc ) of sard'owner or owners, ond ~s duly authorized to perform or' have performed tf th~s apphcahon; that all statements contained ~n th~s apphcchon are true to the .~s and soy[ {~h~<:t h'~ ~s the applica~ '~ ~did w'ork'*dmd;t0 ~nake and f, est of his knowledge and behef; ar that the work wdl be performed ~n the manner set forth Sworn to beftre me this · ........ .~.....~....~... day of .~.62/'~.~_~ . ., 19 ................. .,.,. o,, .......................... Cou. ........... ............ o p,icant) ..... ..... No 52-4643721, Suffolk CouD~f~ Term ,F, xplres March 30,