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Home My WebLink About11504-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..~.12.-3.5. z~ ......... Date March 14, 1984 ................................. 19 ... TItlS CERTIFIES that the build~g .Q.np..f..a.m.~.~.~ dwelling Location of Property ~4. olf..r. 9.a.d.w.a.Y..S./.S...R.qa.d., .t.o..E..a,s.t..E.~).d.. ?.' .i.s.h.e.r..s..I.s. 1..a.n.d.. House No. Street Ham/et County Tax Map No. 1000 Section .8 ........... Block ...3.. ........... Lot 6.3. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .3.a.n.:...1.5. ........ 19 .8.2. pursuant to which Building Permit No. 1.1. 5. .0.4.Z ............... -dated 3.a.q,. J,.5. .................... 19 8 2., 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 ......... .... ~ddi~ian. tc~ .one..fami&y. d~.all lng ...................................... The certificate is issued to Rita Cushman ..................... join'o), 'Ids'sds'dr ',~a'n't/ ..................... of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... 15007 UNDERWRITERS CERTIFICATE NO .......... ~.4. ...................................... Building Inspector Rev. 1/81 FOl~ 'NO. 2 i BUILDING DEPARTMENT TOWN 'HALL SOUTHOI~D, N~ y. ': (THIS PERMIT MUST BE KEPT ON THE PAEgISES UNTIL EULL COMPLETION OF THE WORK AUTHORIZfiD) ; DOdO .,...,....~ ............ ~... Building Ir~spector. Fee $..?....i.: ............. Inspector~ Permission is hereby granted to: ........................................ t ............ r"~'*"~* .............. ~'~ . , .................... , ..~ ;.. ~ ..~. ....................... at p~emise~ located at,,..,, .........................., , , ,, .,,. · , .. . · ,,,,,.{~ ...................... ~ .......................... ~ .,~Pou~' T~~ Map No. 1000 Section .. .................... ; ?~ Bilk ?...?~ ............... ~kot' No ......................... pursaant ~0 epplication doted ............................................ ~ ........ , ]9 ,,., ond ~pproved by the ~I-E~D INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFI¢£ ~UTHOLD, H. Y. //~ ................. .......... , ............... 5. ........... ..... ........... ......... ............. ................ APPLIGATION FOR BUILDING PERMIT Dote ..................... INSTRUCTIONS a. This application must be completely filled in by typewriter or 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 ofpraperty must be drawn on the diagram which is port 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 o 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, os 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 i~licon~ or name, if a corpora 'o ) (Address of applicant) ~ :3 ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buiJder. 'N~r~e of owner of premises ..~..~T.~...~...~.?...~~ ......................................................... 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 ......................... .... /..,..,,~...--~, ~.~.~.~.~ .~y' ~0Dr~ ~ ~ ~ ~ ~ Street and iNumDer ..... ~.~.¢.~....~-~.~...;~.~.~ ......................... '~';L'"~"~*~'~';Z'"':'Y'";::'"'~'", ~ /~ [ ~umclpa~ y_~, 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. ~isiting use and occupancy ...~;~-~ ............................. :~.~..L-.: ............................. ,, ,, ~' ~~. ~- ~ b. Intended use and occupancy .................................................................................... ~?~.~;...~[3-....d.....~.~.-~ ............ 3. Nature of work (check which ;applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal i .................. Demolition .................... Other Work ................................................ ..., (Desm'iption) (to be paid on filing this application) 5. ' If d elling, number of dwelli~ng units ....... ~i ................... Number of dwelling units on each floor ............................ If garage, number of cars ..... i ................ ~ ................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...................................... Depth ................... Height ,..~.~.. ............ Numb? of Stories ..... ..~ ...................................................................................................... Dimensions of same structur~ with alterations or additions: Front ..... .~....-~../. ...................... Rear ...~.,~. ................ Depth ..../.....~....~. ................ Height ...~...~ ................. Number of Stories ...~. ....................... 8. Dimensions of entire new cqnstruction: Front ....... ~...~ ....................... Rear ....~..,~. .................. Depth ..~-..~ ................ Hmght ....... J..~. ........ Number, of Storms .~ ..................................................................................... Date of Purchase ............... ~ ..iL...........' i .......................... Name of Former Owner~..~ ................... Zone or use district in which premises are situated ...... ~x .................... .~. ............. Does proposed construction violate any zoning law, ordinance or regulation: .~ .......................................... .....~;;~ Will jot be regraded ....~] ........... Will excess fill I~e removed fror~ premises: ( ) Yes (~.? No Name of Name of PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from ~ck number or description according to deed, and show street names and indicate 10. 11. 13. property lihes. Give street and bh whether in~erior or corner lot. STATE O~ NEW' '~.Rl~,/)~,..p 1, ~S.S C.OU~IT,Y OF ....~.u..,,..,~......., ........................................ being duly sworn, deposes end says that he is the applicam " inane '~f~il~divi~Jual sil 'lning contract) above named. ~ He is the l ... ............................................................................................................... I (Contractor, agent, corporate officer, etc.) of said o.Wn'er or owners, and is d¥1y authorized to perform or have performed the said work and to make and file this application; that ell 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 ,,-x [ . , .~ ........ !..~. ........... day of ........... ..:~......,., ........ : ......... , 19.-~..... ~/' , / ~. ~/ ~'/ No,o Nb,c, .,: ............... Coun ................. g ~/,,,J '~ · J~ ~,J~ (Sf~fnoture of app icont) ..-c,, %,; o 6z Notary r No 52-9509185 Tern~ Exp,res March 30, 19~--?~