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Home My WebLink About14333-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No. Z13908 Date October 8 19.~.~. THIS CERTIFIES that the building ..... ~.~..d .~.t.~.o..~ .................................. Location of Property lcl~s'e hJo[ ' ' ' 7 ~.0. .L. $ .1.a.q .L. .ap.q ................. C.u. ~. .c.h. qgu. ? ......... Street Hamlet County Tax Map bio. 1000 Section .... ~..0.4 ..... Block .... 1 ........... Lot .... 2. fi. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated .... $.e.p.%,. 9 .......... 19 ~5. pursuant to which Building Permit No..~.~.3..3.3.Z. ............. dated .... .09.L.... ? ................. 198..5. , 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 ......... ~.q o..~..~.~. ~..~..a.~. ~..a.~.h.q ~., .~.q .~..~?.~.~. $ .na. ............................................ The certificate is issued to ...... .~.O.B.E.~.?..q....~.~.E.B.E.,.&. EL~.LEN. E.. RIE. B.E ...... (owner, of the aforesaid building. Suffolk County Department of Healttt Approval ..... i~ / ^ N/A UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 . Building Inspector TOWN OP $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 14333 Z Permission Is hereby granted to: ~ ~, ...... ~.~-......~~ ....... ....~-~/,.i~,v..., ....... ~/ ......................... L~'"'L"'~ ............. ~; ............................................ ot prem,ses located o, .~...........~.~..., .~...- -~.-...~.~....~....~.~..~..z ...................... .~ ....... .......................................... ....... /&.. ~.. ../....~.,~ ....... z.z.~.~ -' County Tax Mop No. 1000 Section .... ~.~.....~... ...... Block ........ /. ........... Lot No ...... .~...~.~....~'~. .... pursuant to application dated /--~..... ............ /....~... ................ 19.~..,~and approved by the Building Inspector. Fee/~..~-~/~. ~.....~'. · .... Building Insp~tor Rev. 6/30/80 "FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ., ., 19~ .~ermit No../.¢~..~.~ Disapproved a/c ..................................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 issued 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, 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 in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address ofapp ' a t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 0 co ................................................................. Name of owner of premises ... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....t:~??...-v,~--,~... .............. Plumber's License No ......................... Electrician's License No.. Other Trade's License No ...................... 1. Location of land on which proposed work will be done... ....... /~,5-0 ..../-,/'k 2~'~......~. ~-. ?...~.. ................. House Number Street Hamlet County Tax Map No. 1000 Section ...... /..0..C/. ...... Block . ./. L_ot....~... :-. ......... Subdivision ..................................... FiledMap No ............... Lot ............... (Name) 2. State existing use and. occupancy of prpmises and intended use and occupancy of proposed construction: ' a. Existing use and occupancy ....... .~. l.AJ..~./~. ~....~..~. O.t....)r. .... ~ ../~. ~... .......... ~ ........ b. Intended use and occupancy .. ~ .~ ~ .~. ....... ~ ..... ~i?. ;%n,:; , ................ 3. Natur o ecl~ whi~31~ a ~plicable): New Building .......... Addition .. L'~' Alteration Repair . 'Zq~ ~ ~' ~k' ~e~'rr oval .............. Demolition .............. Other Work ............... "~'~' '~ ~ : ~ (Description) 4. Estimated Cost '.~.': ~, ,: ?.,.a..o. .................... Fee ............................ . · '.';':7. '. ;¥f ~' (to be paid on filing this application) 5. If dwelling, number of dwellin i 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 ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... i... Height ...................... Number of Stories ...................... "8. Dimensions of entire new consiruction: Front .............. Rear ............... Depth ............... Number of ,qtnrleS Height ........ 9. Size of lot: Front ...i ............ Rear 10. Date of Purchase l 1. Zone or use district in which p~emises are situated.. ..................... Depth ..................... ;. · Name of Former Owner ............................ 4, 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ I .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ............................ Address ................... Phone No ................ Name of Contractor ........................... Address ................... Phone No .............. PLOT DIAGRAM Locate clearly and distinctly a~l 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 comer lot. STATE OF NEW YORK, COUNTY OF ....... ,- .................... ; ..................... being duly sworn, deposes and says that he is the applicant ,~ (Name of individual sig~ing contract) above named. He is the .................... (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 cortta~ned 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 h