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Home My WebLink About7054-ZFOBM NO. ~ TOWN OF SOUTHOLD BUll.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. 6.~.6.3. ...... Date .............~.a.y...'1..2 ....... , 19.7...~. THIS CERTIFIES that the building located at ...Lllp.~o..n..P.t~..R.o.a.d. ......... Street Map No.. ~ ....... Block No. ~ ....... Lot No.....x~....~.a.t.t.t..t.u.c.k....}i.;Y.; ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..............J.a..n...l.., 19. ~.. pursuant to which Building Permit No..7.0..~.Z... dated ...........Jan.. 3 6 .... , 19 ?.ti.., 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 Private accessory (storage) building The certificate is issued to ...J.u. 1..e.s..~.-..D.o.r.i..s..A.d.r..i.a?.n.$.s.e..n~ ..... ??.n.c..r.s ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N .ti. UNDERWRITERS CERTIFICATE No. N .R. HOUSE NUMBER ....~.~. ....... Street ...L..up.~.o.n...P.t..~.o.a.d. ...................... Building Inspector ~01~ bO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N~ Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) pursuent to opplicotion c~3ted ................. ,~ ........... 1 .... nnd opproved by the Building Inspector. ~ Exomined ................................. Approved ~ ........... !.~ ..................... , FO~ NO. 1 ~~ ~ ~ TOWN OF SOUTHOLD -'~' ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. ~" 19.Z. ,~. Permit No. Z.~...Z..~..~...~ .... Applicotian No ............................... ~, 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 set~ 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 o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which Js 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 o 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, 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 buildings for necessary inspections. ........... (~ddress of applicant) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... :~....~ ...... ~..~ ........ If applicant is a corporate, sigr~ture of duly authorized officer. (Name and title of corporate officer) Other Trode's License No ............................................... 1. Location of land on which p)'oposed work/~ilL be done. Map No.: .................... Lot No Street and Number ..... ..~...~..~.~..._.~~. ....... ..~..~.., .......... L..~.~....:.iii::i:::iii:iii: Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ..... ~ ...................... ~..~------/~i~.....~ ................ 3.r Nature of work (check which applicable): New Building ..: ............... Addition .................. Alteration ............... ~, Repair .................. Removal .................. Demolition .................... Other Work .................................................... 4. Estimated Cost ..........~......~...~.....'T.. ................................. Fee / ~ ~ (Description) (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 ............................................................................................................................................. business, commercial or mixed occupancy, spectre and extent of each~t~pe of use .~ ........ 6. If 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 ./~...111~.....~ ...... Rear ..... ./.~..~. ........Depth ...'./.~....: / / Height ..... .~....~ ...... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded .............. .,~........,~Will excess ill,[ be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ........... ~.1 //~Address ................................ Phone No. ~?~.~c~..~..~..~. Nome of Architect .............................................................. Address ................................ Phone No ....................... Nome of Controctor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, end indicate all set-b~ck dimensions from property lines. Give street and block number or description according to deed, end show street names and indicate whether interior or corner lot. STATE OF NEW '~'~R]~,,/~ ~J COUNTY OF ........................... ~.~...~-~r......'r~....~z..~..z.~...oeing duly sworn, deposes and says that he is the applicant (Name I/F individual signing 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 alt statements contained in this application ore true to the best of his knowledge and belief; and thor the work will be perforr~ in the manner set forth in the application filed therewith. Sworn to before me this \ .................. /... day of ...~~ ................. , lC)...../. ,, ,.~l/,, / /, Notary Public,. ............... ............................ County ......... C?..~.....~~ (Signature of applicant)