HomeMy WebLinkAboutZ-6672 FOBAi NO.
TOWN OF SOUTHOLD
BUII,DING DEPARTMENT
Town Clerk'e Office
Southold, N. Y.
Certificate Of Occupancy
No..Z667~ Date 8ipt ~ 3......, 19..75
THIS CERTIFIES that the building located at . Balloek. ~ ~treet
Map No.. ?Q........ Block No..~ ......Lot No. Mattituok , _19.Y. _ . _ , . .
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ~?~4.. 2 19.71x. pursuant to which Building Permit No.... ~!a!
dated J?~ 19. ~5, 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~rivatq , qAY .~~~,],p, dvel~lXt6 d: , ttlogat.d, ptt , eaten, ,(ePprovod b
&t Appaala~
The certificate is issued to .11x8 $?~a+4~?9x. ~~~~!~p .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ~!a!.
UNDERWRITERS CERTIFICATE No. ~~a! .
HOUSE NUMBER Street ...$4~?:~k. ~ . ~.Q .
"".~nn.......................
K~_
.
Building Inspector
_ _ _
~ ?
goaas NO. 1 .
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Exomined / ` ~ ~
19.7.}... Application No. 'v ~
Approv~d~..~~. ~i......... f.~.........., 19..7. ~ Permit No.... ~
9 c
Disapproved a/c a^ .........jl.(i.5~..
205 ~ ~ ~
',l 1 (Building Insp ctor) ~
~ 1p~' APPLICATION FOR BUILDING PERMIT
1
P~ Date `!-`.^..~'z-...°t 19~.s. ~
INSTRUCTIONS J
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building r'
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 ofproperty must be drawn on the diagram which is part of this applicotion. ~
c. The work covered by this application may not be commenced before issuance of Building Permit. C'
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the opplicant. 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 o 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 opplicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections(.I ~
(Signature of applicant, or Home, if a corporation)
J. i'-'~~.L..~..~.~
~ ddress of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~ 1.........
Name of owner of premises ....).h1~..S.....~~-K-Q-~^"'" .......F.1
If applicant is a corporate, signature of duly authorized officer.
(Name and title of co~~rp77oragte off//i~~cer)
Builder's License No. ~....d...,(...`..(.•7••`•~m••:. ( 1
..................Z.............~...((.jj.~~
Plumber's License No. I ` ~ /
Electrician's License No. .~•••y••••••• ....C....~Ll.
Other Trade's License No
1. Location of land on whit, proposed rwork ill be done. Mcp No.:...~j...n~ yL-ot-~No.'~.....................
Street and Number .~~~c~.jL•l~.o'u<L,.~.G::v~R....).~..~~!~N•..4.1::~.-~.x.......11'1.G4:~,ta.rCs.~E..{.~.:....:....
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ...C~.-..,.~...c'.... ¢
~f- ~1 ~
b. Intended use and occupancy ...~c!!.....~:-!!.!:k:?~:4'...........~.f.':4~yr.........rG.-a:'f
V
! V
1
3. Nature of work (check which apple): New Building Additi Al/t/eration
Repair Removal Demolition.........,.......... Other Work ~.i,t.-f(u~,~.ltv.'?-~.9~: .
~ (Descriptior~
4. Estimated Cost uG..Q.j...a-u-t1 ...............................Fee C. Vo
(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 ........c~.
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use
7. Dimensions of existing structures, if any: Front ~..cS Rear f Depth ~ ~
Height ~..t~...~...... 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 Number of Stories
9. Size of lot: Front ........~...U..~s..' Rear .......~..~..P......................... Depth ..~ii..`t.A...................
10. Date of Purchase ........................:-...........................Nta~me of Former Owner
11. Zone or use district in which premises are situated .......1~.:.....~
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be regraded Will excess fill be removed froom p._r~em~isye-s: )Yes (x) No
p YYtI~..~a..../~:!`.?,ddress . ~"'~.45.:4:5<~+~x~.Li}t. hone No
14. Name of Owner of remises .
Name of Architect .~,~...$.`..>/3!Ie4!~4.!!~ Address ~.w~!!~~h.. Phone No.......................
Nome of Contractor ..~...4cll.C:!]N.~.~.`.'k............ Address ~^.`.:.:~~..^~...i.!/..'yPhone 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 interior or corner lot.
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_TATE OF NEW Y RK, / ..•.25.....
COUNT 9 g
)
(-individual si nln contract' ..................being duly sworn, deposes and says that he is the applicant
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 contained in this application are true to the best of his knowledge and belief; and
than the work will be performed in the manner set forth in the application filed therewith.
Swo//rn to before me this r - ~ ~ I ~
.....(..~y... day of ..........~'~:h¢.,.......... 19.Z~. G / ~.J~~"l.-C...
Notary Public . .County
C~.~~ ~ Slg~~olf applic t)
l/~~ ~ ,
ELIZABETH ANN MLLE
NOTARY PUBLIC, State of New York
No. 528125850, Su folk Ca~yr
Term Er.D~res March 30, l9 [a
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LGYHd o°7" The sewage disposn~ and tinter supply - -
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/ ' ~ I O iUTNORIRZID ALTEU~Ai
~AOMEGM
pp i i \ SECTION 7209 CT THE NEW YORK STAIE
PCI ~ I Q~ 1 ~ ~ EDUCA710N LAW.
• ~ ! ~ COPIES OF THIS SU0.VEY MAP NOT BEARING
THE LAFD SU: VEYOR'9 ~NK.D 'CAL OR
I ~ ~t TO B¢ A VALID TI.U
LOOPY. Bk CONSIDERED
y GUARANIEF3 iNDIGAt--0 ti'i R.C:". SNALL RUN
- 0 ~ ONLY TO THE P 50 Fr' vi.:., rn THE SUkYE
~~yy - _ ~ ~
IS PREPARCD, A D O H'E G.ALF t0 THE
O ~ tC ~E b~ ~ S~. TITLE COMPANY OV ;:.N-At A%+WCY
"«C~~~ _ LENDING INSTi2UilON L'AiD 1{,k.ON, AND
V • 0 TUT ON. GUARAEMEEST ARE NOT TRANSF [IAM.
Q TO ADDITIONAL INSTITUTIONS OR SUB9EOUE
~ OWNERS.
5uvv~~ser~ July 19'74.
RIGDb`.f21CK VAN TUY1_, P. C,
_ Noie ' CoH-4ou~s appvoxir++ate froT+~ T_
Lt. S. G~oloq;cc=; suvve:~, tt rr LiGeristd L.c~Hd Stwv~l_',evs
E1rt7eClCiBn OG#'• 8,l97S GYE.°H~OOYf, New ~('q~k .