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Home My WebLink About9862-zFORM TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No... ~..9.~.? .0 .... Date .4.a!l..~..a~Y. .... 2..6 ............. , 19..7.9 THIS CERTIFIES that the building located at J..~.~.5....F.a.t..rw...ay..D.~: ....... Map No...6Q.6.~ ...... Block No ........... Lot No ..... .2.8, .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...,I~9-¥.... ~1~ ........ , 19.7.~t pursuant to which Building Permit No. 986.~..&. 9862 dated ...JuLy.... 25. ......... , 19.7.8., 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 .... ~. ~.v.a.~.e...0~..e..F..an. ~.ly...1~..e.l.l.i.n.g..w.t. th..F.e.n.c..e ....................... The certificate is issued to ....... ?l?.m. 97.~. J}?'.n.n.9~. ................................ (owner, of the aforesaid building. Suffolk County Department of Health Approval 8-S0-82 ---January 22, 1979 ........ HO~'~ ' &; ' Vill~ ......... UNDERWRITERS CERTIFICATE No... N4'15~9.~.6 ................................. HOUSE NUMBER .............. Street .17.~..~. Cutchog~/e, New Yo.r.k. Building Inspector County Tax Number 1000-109-5-1~. 28 1~0~ ~0. 2 TOWN OF SOUTHOLD BUILDING DEPARTM~ENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. 9862 Permission is hereby granted to: ' ~" (THIS PERMIT~MU,ST, BE K?TON THE PREMISES UNTIL FULL" z '~:~ ~,~ .....~~::..~ ................. 9..~ Building Inspector. Fee puquant to application dated and apprqved by t~he FO~M lqO. ! TOWN OF SOUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~..~..c.~_ ~ ~UTHOLD, N.Y. ~' / ~'"'" ......~E ........ z z ............ 2~ ..... .~x/~ '' '"'-'"'"'"' ............... ............ . ..... ........ ......... ................................................ ............. ......... ~s,~u~o~s ~,~....~...z.~// ................ ~*..Z~. ~. This *~licotion must be completely {il}~d in by typowritor o~ in ink and submlttod in tripllc~te to tho Buildinfl Inspectort with 3 set* o{ pi*ns, ~ccurate plot plan to ~al*. ~ ~ccordinfl to schodulo. b. Plot plon showin~ ~ocotion of lot ~nd o{ buildings on premisos, rolotionship to odloinino premises or public streets o~ oreos, ~nd Oivino ~ detoilod doscription of la,out ofprope~ must be drown on the dioflrom which is p~ o~ this opplicotion. c. Tho work covero~ b~ this opplic~tion m~ not bo comme~c*d bofore issuonce of Buildin~ Permit. d. Upon opprovol o{ this ~ppllcotion, the Buildin~ Inspector will i~ue ~ Buildin~ Permit to tho opplic~nt. Such permit sha~ be kept on tho prem}ses or, ii,bio {or inspection throughout the work. e. No buildin~ sh~ll be occupied or usod in wholo or in port for on~ purposo whatover until ~ sholl h~ve been omnted by the Buildin~ 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, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ........ ~..~c~....~....~..- .4..~.~.~Z.~..~z...¥~:<~.~ ...... (Address of applicant) ,~2 ~ //~-~, ~J State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . 4.~6':.Z.*~:..c..7.~..:.>.. ........ ::....~;Z.~:A.~?.~ ...................................................................... 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 ....... ~ ..................................... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ,..:.,.<.:~.~.f:-.:./...~.~.-2~..~..~.~.~.,Lot No. ~ Street and Number .....~../.'.).~6~..~;:?..(2~.. ....... ~,('~..(.?.~Z~ .................. ~..~...C....~.?..~...~.~..~2..~/..~ ................................. Municipality State existing use and occupancy of premises and intended use and occupancy of praposed construction'. a. Exisiting use and occupancy .......... ..~..~..~-~../.~.?'"" ............................................................................................ ~.,~z,.,;~..~ ~......... .. ~ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................. ... ~ / ~ .../../ / (Description) 4. Estimated Cost ........ ..~..~/...~ ................................. Fee ....~:.?'..~'..~'...(~.....~i ......................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~..4~....~...- .......... Number 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 ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Num, ber of Stories ................................ /, 8. Dimensioas of entire new construction: Front .......... ~?...~. ................... Rear ............... ~ .......... Depth ... ~...~. .... ,/ Height .................... Number of Stories ........ ./...Z.:~... ........... ~ .......~ .........~ ........................................................ 9. Size of lot: Front .......... ~ ..................................... Rear .............................. y ......... Depth ................................ ............. :./ ............................................... ~x ~.i-~ ~J 4'~Z.s 10. Date of Purchase ,/~,z~ /~r'/~'~ ixl~m~ of Former Owner ..,~af...'.~.:....,....~.,.~..: ......... H .......... 1 1. Zone or use district in which premises are situated ......... ..~..~...,S.'. ............................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... 4,~'..~. ............................................. 13. Will lot be regraded ..... ~..~[~ .............. Will excess fill be removed from premises: ( ) Yes (~x) No 14. Name of Owner of prem.ses ......... - ..................... ~...~ ...... Address ......~/.:.?y:;~,/~.G...,,..~ rhone No .... Name of Architect .............................................................. Address ................................ .Phone No ...................... Name of Cantractor ........ ..~?.6..&~.41../...~.:.'.~'. ................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex/sting or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, end shaw street names and indicate ~vhether interior or corner lot. L ¥ STATE OF NEW Y4DRK, COUNTY OF ,:~//Z ~..~..~... ........ ~' ~'~ ............ ~7~.~.~7.~'. .......... ;~J.~¢~.~.4~.D~.~ ...................... being duly sworn, deposes and soys thatshe is the applicant (Name of individual signing contracf) above named. ~He is the ~'~ontractor, 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 applicafion; that all statements contained in this appIication are true to the best of his knowledge and belief; and thor the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ........ ~ ............. day of ........ ~,....,....-~ ............. , 19..~. ................. .............................. ;M. DOL.LY ~I~FF~N~H ..... f~ignarure at applicant} No. 90.1 fled TOWN I-IF- E~OUTHOLD DFFICE OF BUILDING TOWN r. LERK'S OFFICE SDLITNGLD, N. Y. 119'71 TEL. 765-266D