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Home My WebLink About7374-ZNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTM'~IT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z666.0 ...... Date ............ .A..l~g .... ~.? ...... , 19.7.~.. THIS CERTIFIES that the building located at . .l~..~. ~..~....I~..~..o..n...L~.... Street Map No. A.a. .D..i.a~..qn..d~Block No. .Lot No .......... .N./.~..~..o.m!..d' . .V.i.~.~...Ay.~... Peconic conforms substantially to the Application for Building Permit heretofore filed in this office J~1.7 2 7l+ · ? .... ~. dated ' . AUg .'2!). ,., 19.7-~ pursuant to which Building Permit No... ~6~Z dated ......... · ....... 2'u3'I.~ .29, i9 .~?~, was' issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to .. ¥.r..a~l.s..~. 0;L.I~....¢~0r ......................... , ' · . . (owner, lessee or tenant) of the aforesaid building. NoRo Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No. pending HOUSE NUMBER 200 Street ?v~ Rcl ~ ~. .......................... Building Inspector lvOB~ NO. ~ 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? 7374 Z Permission is hereby granted to: at premises located at ....................................................................... ~ ............ ~:~./J~ ...... ~.. ................................................................................ .~..~:.~ .P..~...~...c~ .............................................. pursuant to application dated ................................. .~........,~....I/..~.~...., 197./., and approved by the Building Inspector. F. ......... Building Inspector gxamin~ " ' / 19......~. ~plicati~ No. ............................. ~.~,....~ 19..Z./.. ~it No.-..-....,,...'....~...~'/ Di~pp~ a/c ...................... .................................................................... ................................................. ................................... ........ ............. x..-...~...~ ...... ~...~:....~..a ..................... APPLI~ FOR BUILDING PE~IT · ................................................ , 19..~ IN~RU~I~S In~tor, wi~ ~ ~ o{ ~1~, ~um~ b. ~lot plan ~h~inO I~tion of lot ~nd oreo~, and ~ivi~ ~ det~il~ de~rlpfion o{ c. The work c~ered ~ this a~lication may n~ d. U~ appeal of ~is application, ~e Buildi~ Ins~tor will issue a Building Permit to the ~licant. Such shall ~ k~t on the premis~ ~ail~le ~r e. No buildi~ sh~l ~ ~cupJ~ or u~ in whole or in pa~ for any pu~e ~ever until a ~ificate of ~cupancy shall have ~en gmnt~ ~ the Building In~or. ~ ~PLI~TI~N .IS HERE~Y ~DE to the Building De~ment ~r ~e ,uance of a Bud ng Pe~ t pu~ant uiza?~ ~ u?inanc~ at the T~n o~ ~th~ld, Suffolk Count, New York, and ~er applic~ · ~, O~ina~es egumnons, ~or me cons~m~ion or ouild~s, ~itims or alterati~s, or ~r mm~al or de~ Itlm as heroin e apphcant agrees to Comply w~th all applic~le I~, ordi~nces, bulldl~ c~, h~i~ c~, admit authorized in~to~ on premiss State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (~ ~, ~,..'/- ~.~. f re ' /-; ~ ,- r ~ ~ / / ! Name of owner o p m~ses ..................................................................................... [ ............................................................. - if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......................... ~ ........................... Plumber's License No ..................... i ........................... Electrician's License No ................. ~ ........................... Other Trade's License No ................... ! ........................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .............. .............................................................. ~.. ~ ........................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy . / [ /~ ~' ~ .~) ~ ' b. Intended use and occupancy /l ~ ! i ~, / 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............... i';. Repair .................. Removal .................. Demolition .................... Other Work / ~- / Z' / (.. (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 ............................ Rear ................................ Depth ....... ....~ ........ Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ............... 7 ................ 8. Dimensions of~e~ntire new construction: Front .............. 7 ................... Rear ............................ Depth Height .................... Number of Stories ................................................................................................................. 9. Size of lot: Front .................~:~.~....::.....~ .................. Rear .................................... '~V Depth..., ....... , , ......................... ? ,.. 10~ Date of Purchase .............................. ~......~. .................. Name of_Form~er Owner ................. '..~ ................... ..:.... .......... 11. Zone or use district in which premises are situated .......................................................... :,...~ ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will Ict be regraded ............. ,.?~.;: ....... Will excess fill be re~m~ov_gd fro~ pmmi~es: ( ) Yes (>) No / , / 14. Name of Owner of premises ..:.~i:....~'..'...~i...'...'...~ ........................ Addres~ ...~:.'.:.,,.i~ ....... :i..'.... Phone No. '.i ...... i ........... Name of Architect ..................... ~..... ............................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone 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. .:~ ~_ STATE OF NEW YORK ~' !' COUNTY OF ................................ t",t /, I', ~" I ~ ! .', I '~ ................................................................................................. being duly sworn, deposes and soys that he is the applicant (Name of individual signing contract) above named. He is the ............................... ~..i.;...~i..../.......~. ................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly authorized to perform or hove 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 that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this , f ! ': . -/,/ .................... [.~.' day of..: .............................. :.~.....:~.,, ~9 ........ · Notary Public, . ....................... ;'. ........... ...'. .....Coo ......................................................................... ~ ....................... (Signature of applicant) / NO 52 0344963 Suf[olk Commission Expires March 30,