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Home My WebLink About9715-zI~OB~ NO. ~ TO~FN OF SOUTHOLD BUrLrUNG DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No...Z.~.~..89 ..... Date ....A.u. gu..s.t...2.~ ............. , 19...7.8 THIS CERTIFIES that the building located at . .~7.6.O. .I~. ~.n~..~ .h.a~..a.. B..].y.d.: ... Street Map No...9 J.7. ...... Block No ........... Lot No ....... ~. .......................... conforms substantially to the Application for Building Permit heretofore fried in this office dated . .M~Y...~..0 ............ , 19..7.8. pursuant to which Building Permit ~To.. 9.7.1.5. Z.. dated . .1~..ay...~..0 ............., 29.7.8.., 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 .... p~.~v..a~.e..0.n.c..F..~, k~...D~..e.~.~.~.n.g. ~.t.h. A~.a. $.t.~.o.n. ................... The certificate is issued to ..... .H.a?.o.]...d..&..¥~.r~.n..:L.a..1~. o..~..h.o.m.a. 8. ................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ........... N/R ..................... UNDERWRITF, RS CF, RTIFICAT~ No .................... ~/.R. ..................... HOUSE NUMBER ..... ~?.6.0. ....Street ......... ~.:L..n~.e..h.a~...a...B~xd..: ............... ............................................... .s.°.~. 9.z~,..~;X'. ................ Building Inspoctor 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) N? 9715 Z Permission is hereby granted to: pursuant to application dated ................................ .~.?./.)..~i....../...~...., 19..7. ?..., and approved by the Building Inspector. Fee $..[.-,5.~. ....... .............. ~'..::....... ../..:./....~::z:~. . ............ Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×amined .................... oproved ................... 19.Z. ermit No. _9 Appli¢otion No. 0-~ '7/~'/)~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Dote ................................................ , 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter o~' in ink and submitted in triplicate to the Building 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 or areas, and giving o 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 Deportment 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. (S'g atue of appl~,oK ~me, if a corporation) (Address of appl~//~t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Nome 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.: ..~.?.~. ............................... Lot No ...... .~.-. ............... Street and Number ...~ ............................................. /.~ ......... - ........................................................................ !Q/, .......... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ......... ~.¢....~..zc.'.l..%-.?. ..... ! ............................................................................................. b. Intended use and occupancy ................... ? .......................................................................................................... 3, Nature of work (check which applicable): New Building.. ................. Addition /'~' Alteration Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost .?....~..~/.~.?..: ........................................... 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 ........... /.' ................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front.... ....... 3'~,................ / Rear ........ ~./~ ................... Depth .. Height ........................ Number of Stories ......... ./. ...................................................................................................... Dimensions of same structure with alterations or additions: Front ..... ..¢~...~.~. ...................... Rear ...~...~.. ................... Depth ...... :ts.f..f~?...~./.. Height ............................ Number of Stories ..........~. .................... 8. Dimensions of entire new construction: Front ..... /~. .......................... Rear ........ ~. ................. Depth ..-.~. ................... Height .................... Number of Stories ...... ~. ............................................................................................................. Rear ..... .~.~ ................................ Depth ................................ 9. Size of lot: Front ..... ~...~.:~ ........................................... ~ /9~6- 10. Date of Purchase ...... .~../..Z ....................................... Name of Former Owner .~..~.~.~..C...?...~.£/.r.~,.f;....~3.C..Y.i..h. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 3. Will lot be regraded . ......~ ............... Will excess fill be removed from premises: ( ) Yes (//'~ No Name of Architect .............................................................. Address ....... '. ........................ ,Phone No ....................... Nam~ of Contractor ~.~.~.~.r~,..~..X.~,~.. ............................... Address ~.~,J~, ............... Phone No..~.~..T..'~:~.~.c).. 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 interior or corner lot. STATE OF NEW YORK, ~ ~ ¢ COUNTY OF ................................ ~'~'~ .................................. · T.. ............ ...................... uly sworn, (Name of individual signing contract) above named. He is the ....................... ~.~...~..(~]~..~.~.~ .................................................................................................................. (Contractor, agent, corporate officer, etc.) of s~id 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 contain~ in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ,~ m /0 , I ........................ aay of ........................................... ] 9 [ ~. ~_t~ (Signature of a~nt) TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN OLERK'S OFFICE SnMTHOLD, N. Y. 11971 TEL. 765-2660