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Home My WebLink About9161-zFOR/IVl NO, & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfificnte O~ Occupnncy No..z765.5 ..... Date ................ lta~r...~ ~t... -, 19..7.7. THIS CERTIFIES that the building located at . ltolcl®n, L~Z ............. Street Map No. ~..Go~.2~. Block No ........... Lot No, . -%0 .&. ~. 8.~ ]...Go~ho~8. ·. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ~ar...30.~., 19 77' pursuant to which Building Pemit No. dated ............ lp~..~ .... , 19.7~., was issued, ~d confoms to ~1 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate issued is .. P~tvate .one..fami.ty. ~wolling. w$~h-addi~io~. (.seasonal) ........ The certificate is issued to . . St~ley...KemDne~ ....... U~F. · .................... (owner, lessee or ten~t) of the aforesaid building. Suffolk County Department of Health Approval · .N,~, .............................. UNDERWRITERS CERTIFICATE No. N33~795 ....... ~/'~'3/77 ..................... HOUSE NUMBER . 2~0 ......... Street ... ~1~ -~ ............................ .......... t ..... B.ildi~g .s~e~lor ]FOI~¥~ 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) 9~_~_ Z Dote ......... - .......................... 19 ........ Building Inspector. 0-% Fee $...',:: .............. TOWN CLERK'S OFFICE/~/~,''~/~A ~ ~,~)~'- o,~ .-~.~,~ SOUTHOLD, N. Y. ~ ~ . ~ ................................... ~. ........ , ~..../... verm,~ mo ......... ~ ........................ ~ , /~ . - , -~ ................ .................. l ....................................................................... ..... ...................... .............................. &(~ildin~ Inspecto~ ~o~ ..,~.r.~ ........................... ,~......z.._7~ I~STRH~IO~S ~. This ~pplicotion must be complotoly fillod in by typewriter o~ in ink ond submitted in triplicote to the Buildln~ Inspector, w}th 3 set~ o~ pl~ns~ occumte plot plan to ~olo. F~e ~ccordinfl to schedule. b. Plot plon showin~ bcotion of Iot ond of buildings on promises, relotionship to odjoinin~ premises or public stmots o~ oreas, ond ~ivino o detoiled doscription of Ioyout ofproperty must be drown on ~he dio~rom which is pa~ o{ this ~pplic~tion. c. The work covered by this opplicotion may not be commenced beforo issuonce of Buildin~ Permit. d. Upon ~pprovol of this opplicotion, the Buildin0 Inspoctor will issuo o Buildin~ Pormit to the opplicont. Such permit sh~ll be kept on the premises ovailoble {or inspoction throughout the work. e~ ~o buildin0 sholl be occupied or used in whole or in p~rt for on~ purposo wh~tover unHI o Ce~ificote of Occupancy sh~ll hove been or~nted by the Buildin9 Inspector. APPklCATION ~S H[R[BY MAD[ to the Buildino Deportment for the issuance of o Bud n~ Perm t pursuont to the Buildin~ Zone Ordinance of the Town o~ Southold, Suffolk County~ New York, and other opplicob o kows, Ordinances or Re~ulotions, for tho construction o{ buildings, odditions or olter~fions or {or removol or domol t on, as horoin described. The opplicont o~rees to comply wffh ol opp icoble I~ws, ordinances, buildin0 code~ housino codo, ond ro~ulotions, ond to odmit outhorized inspectors on premises ~nd in build[n~s for n~oss~ inspections. .................................... (Si~n~turo of opplicont, or homo, i{ ~ corporotion) ..... 2...-~..~.~.~.~.~.,,.~.ee~.~:~.,~,.g (Ad,ss of applicant) ~ / /( State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... l~..~..;.../.~.~..r. ....................................................................................... ....,~.:.t:~..~" Name of owner of premises ....... '~>..k...t..~..f:'...~>..~..~.l..~...~¢~.. .................................. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...~.~..~...../~....-~......; ...... I...~..¢/ ........... Plumber's License No ................................................. Electrician's License No. .¢~.~.....~. ............................ Other Zrade's License No ~'~;~ -~ ~ II Location of land on which proposed work will be done. Map No.: ..... /.Z~..(,~. ........... Lot No ~ ' .~.z. ?,~¢_~.~ Stre~,t and Number .....~,¢../~,~,~ ........ .~,..~.~.~ ................................................................ ~,(~..~..~.~],..~., (/' Municipali~ ' ~/' State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... 'Lc..~..~.'J...c{.....'.'~...~:..-~., ............ ~ .......................................................................... b. Intended useandoccupancy ....... ~.~.~..i..~...~...c.,..~.~....~......~...L...~....' '-- ....... '3. Nature of work (check which applicable): New Building.. ................. Addition,.~. ............... Alteration .......... Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... (Description) 4. Estimated Cost ,~.~yQO ........... Fee .......................................................................................... ................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..~..'~..~...-: .............. Number of dwelling units on each floor ..~..,'~.~ ................. If garage, number of cars .../~.a'~,e~ ............................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use .......................... 6.7. Dimensions of existing structures, if any: Front,~..Q....~.. ............... Rear ..~.~.....~. ................ Depth~.~...~( ..... Height ..J.~......,~....... .... Number of Stories ....J.~ ................................. ,zr~ LL;;~'"T''''~'''tl ........................ :~'~'~"'""~ ............ Dimensions of same'structure with altera/tions,~or additions: Front ....~d.d......;L .................Rear 5~.'....~. ............... Depth ....~.~. ...................... Height .Z.~......~.. ........ :.....Number of Stones ..L.,:~., ..................... ,,, 8. Dimensions qf entire new construction: Front 2../. .............................Rear .~...~ .................... Depth../...~. ................ Height ....~...~. ........... Number of Stories .~.. ................................... ; ...................................... ~..~.~.,.7~,~..~ ............ 9. Size of lot: Front .../~.~,~..~.. ...................................... Rear ...'-~.~.,Zk~.. ................... : ....... Depth,.z~....~:~..,.~. ............. i0. Date of Purchase ..........(.. .......................................... Name of Former Owner ..,....:..,r .,.,..~.:.../.,.~./..L, ................... 11. Zone or use district in which premises are situated ............................................. .~ ................................................... 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. . ~. ~.~.~ ...... Addre ,, on~ No...:,.-~ ................ Name o¥ Architect ....................... ~. .................................... Addres~ ................................ PhoAe No. ' : Name of Contractor ...................... Address ~¢=Y...?.?.~.~:;.~.. ......... Phone No. PLOT DIAGRAM I_oc~te clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate STATE OF NE~YORK, , , [SS COUNTY OF .~...~....~...~,..o...~..~ ....... f · ..~....~...d.i...~.....~.;...~..../~...~.~..~....~... ............................................ being duly sworn, deposes and says that he is the applicam (Name of individual signing contracf) above named. He is the C~, Q///'~'/~'~/~ .......... · ............. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly 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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...... ................. ...-..::- .------------------ , 7 ) doy of '..~.~...~..' ~ , 19 t /~ ~ ~, Noto Pub,e, Co,n .................................. NOIA , . ', .'lew York £ornrmsstlm Lx/ir:~s ~;:]rch 30, 197,~