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Home My WebLink About9963-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z10390 Date February 18 .,19~. THIS CERTIFIES that the building ................................................ Location of Property ..... 3.3..0. ?.t. 1..1.a~e...L.a.n.e..~ ............. .0.v.~..e.n.~. ~.. ~.,.Y.: .......... House No. Street Ham/et County Tax Map No. 1000 Section ...... Q 85...Block ...... q 1 ....... Lot ...... 0. .0 ,8 . , . 0. Q .2... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ...... .F.e.b.v.u..a.r.y.. 1. :3.., 19.8..0 pursuant to which Building Permit No ..... 1. .0 .5.6.2.. ~...&...9 .9.6.3 Z FEbruary 15 ~0 dated ............................ 19 ....was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ............. 3.qc..e.s:s.qr. ~,. gu. ~..~.c~.t.n.& .a.n.~...&~g.~..t $.o.n. ............................. The certificate is issued to ...... J.e..s.s.~. A. ,..~.o..u.~.d..&...R.u.t.h.. ~... ?~9.u.l.d. ................. (owner, 4e~ee-~r-tetmrrt)- - of the aforesaid building. Suffolk County Department of Health Approval N / R UNDERWRITERS CERTIFICATE NO.. N / R ,~ / Building Inspector Rev. 1/81 FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEK~RTMENT TOWN GLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE8 UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) 9963 Z Date Permission is hereby granted to: .,I~A. ~'l ~u L b pursuant to application dated " Building Inspector. Fee $ ........................ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...................... ....~...~..J~ .....~.., 19.~.......~ Approved .................... .~..,,c,~,?,....Z lg.Z...~Permit No...,.,,~,,,,~,,,,~..,,?,..,,~,,..~ ..... Disapproved a/C Application No. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sere of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relatidhship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn On the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, 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 until 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, end other applicable Laws, Ordinances or Regulations, for the construction of building.s,, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housir~g code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is ow.~.~ner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Neme of ow.er of premises ...... .............................................................................................................. 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 Trode's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No ......................... Street and Number .................................................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. ExisJtJng use and occupancy ........ J~.J~..~l ............................................................................................. b. Intended use and occupancy ...... ...~..~1.....~. ............................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~ .~0 ,~ (Description) 4. Estimated Cost ................ ,.~..~.. ................Fee ............ ~..~.!...~...~.. ................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number af 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 ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... '.~.~ ...................... Rear ...~..~ ..................... Depth .~' ................... Height ...... .~J .......... Number~j!o~ Stories ......................................................... 9. Size of lot: Front ...._~...~'a-a~..'~'....' ................................ Rear ........ ,f..~..~..~..'~. ........... ; ..... ~u.epth 10. Date of P~;c~s~ ~....~r.~mi~s.~..~i~.~[~;~t......N~e of Former Owner ....~.~.~J....J~'l~.J',~ll~/~ ..................... 11. Zone or us d' tr'ct in wh'ch p ' ' . ...... ./;-..I ..................................... ~/~ .............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~r.~,~ .............................................. 13. Will lot be regraded . .......................... .,Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..~'4.~,.l~J~.~.JJ:J. ...................... Address .....~...J~.... .......... Phon~ No.~.~ ..... Name of Architect .............................................................. Address ................................ Phone No ....................... r Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate 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 whether interi, o,r or corner lot. STATE OF NEW~¥O~I(./. ,~ /.. IS S COUNTY OF ~.....~' ' \ ...............................n/''~',~') ,~..~.....~.~.~.~.~. .............................. being duly sworn, deposes and soys that he is the- applicam (Name of individual signing contracf) above named. He is the ..................................... ~.~.~ ................................................................................................................. (Contractor, agent, corporate off cer,~ of sod owner or owners, and is duly authorized to perform or have perfo~ed ~ e said work and to make and file this application; that all statements contained in this application are true ~o the' ~est of his knowledge and belief; and that the work will be performed in the manner set fo~h in the apptica~ ~the, ~with. Sworn ,obefore methis ~ __...~ ....................... ~.; ' 4 -~ J~ n ........ ..... o, ',- .................... c... ........... ......................... ~ ' ~' / (Signa~ of ~p~nf) ~