The URL can be used to link to this page

Home My WebLink About5103-zFORM NO. 4 / TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. A51f7.0. ..... Date ...... ~;.Ql0t~lnher. 2.0! .... , 19.73. THIS CERTIFIES that the building located at . 13r.o.~qt'~;,.t.~I'. ada s. ~I.~85a.~ l~t, eet Map No. l~a~.au. P~, Block No. ~ ....... Lot No.. 26~ ........ CI~,gQhOlDI8 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... D.e¢erab.er. ~L~sl9.7.0. pursuant to which Building Permit No... dated ......... l);:¥;~.e.~. ~.4.! 19.70., 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 Ruth Bailey (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...;.~,g.. ............................. UNDERWRITERS CERTIFICATE No. PEIqDII"~G HOUSE NUMBER... 2.2.Q0. ..... Street...13.:l?9.a.d3q~.~.~3'.~..BO..~ ........................... ..................................................... ~ut;¢ho~ue ................. Building Inspector ~o~v~ NO. ~ ~OWN OFSOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERM. IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5103 Z ~ission is hereby granted to: at premises located at .......~ll..J. ............. ~lll~13il~Jll..~l~ ................................................... ......................................... Jaa~J,,,a.. · .Ik~.:Ja.t,, ........... ~"e~el~l',ae ......... .11,'~,,, ..................................... pursuan,t to application dated ........................ ~1 .......... ~ ............. , 19J~IL., and approved by the Building Inspector. re. $..J.*.~. ............ Lt 19..?..... Permit No. ,.~10 '~ 7-~ Affray__aa ed ........................................ , ............................ TOWN OF SOUTHOLD J ' BUILDING DEPARTMENT//~-~'/ ~'~ TOWN CLERK'S OFFICE .-~*' '"~ SOUTHOLD, N.Y. ~*~ Application No...~'../...8..~.. ................ Disapproved a/c ....... ~ ............... ~' ............ ~g;i ................................. APPLICATION FOR BUILDING PERMI'r ~ ~te .................... ~......~.e..~ .......... ~.~ ........... , ~9..?..o. ...... INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building~~ Inspector. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premJees ar public streets or~ areas, and giving a detailed description of layout of pmparty must be drown on the diagram whlch Il part of thio application. ~ c. The work covered by this application may not be commenced before issuance of Building Permit.'~ d. U al~ ~n~, onTM___of this application, the Building Inspector will Issue a Building Permit to the applicant. Such permit! premises available for inspection throughout the progress of the work. shall e. No building shall be occupied or used In whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. B .A, ,PPLI.CATION IS HEREBY MADE to the Building Department for the issuance of a BUilding Permit purmdQnt to the ui~aing Lone Ordinance of the Town of Southold, Suffolk County, New York, and other pppllcoble Laws, Ordlrmnces or ~. Regulations, for the construction of buildings, additions or alterations, or f.or removal or demolition, al herein cle~rlbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. Geo Bailey A/C Ruth Bailey (Signature cf applicant, or name, If a corpamtlon) ......... .g.w,$.~.~,~.g.~. .................................................................. (~)~ ~Jb ~.,~0 ~ (Address of applicant) State whether applicant is owner, lessee, agent, architect',engineer, general contre~l~r~l~r or huller. ............................................. Agexi~,of...owme~. .................................................................................................................... Name of owner of nremie-- Ru.~h Bailey If applicant Is o corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of lend .on whiCh_ groposed work will be done, Map No.: Nassa Pt ' /~ ~ 0/(-'~ 2~oo ........................................ Lot No.: .~... ............... Street and Number ...,~1~.~.~,~P,.$.JJ~...J~.~ ....... .~...a.§.s...~..'g.....~;... ......... .C..~.~...o..~..9.J~.~...e' ...................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of propaeed comtructlon: a. Existing use and occupancy ...... J~,e.~&~g..~.Ae:e:ssozg...b~ildL~g ...................................................... b. Intended use and occupan:., . ......... ~a~e...9/"l~;b,..a,cl. cLO,...(~,TX~..$.~g~.~'.)...g~,...~.~..~ ......................... 3. Nature of wolk (check which applicable): New Building ~ ................. Addition .....~ ....... Alteration ...3;3r. ..... Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost ..........~t.O00..e' ................................. Fee ....~.e.00. .......................................................................... ' - (to be paid on f/ling this application) 5. If dwelllng, number of dwelling units ...i3,qn_~. ............... 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 ...~..~..e.~.J~.O3t~. .... 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 ........ ~.1~) ..................... Rear ........... .1~ ............ Depth ..... 2.~' .............. Height ..................... Number of Stories .&clc~..~,~l......~Zt.~ .................................................................................. 9. Size of lot: Front ...;.../aa ............... Rear ........... .1./D~) ................. Depth ....~.~.....bc~.O ........ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ) 1. Zone or use district in which premises are s~tuated ..... ~......~,i~.~ ............................................................................... 12. Does proposed construction viol~.te any zoning law, ordinance or regulation? ..... 33.0 .................................................. ! 3. Name of Owner of premises ..~l,l.~J3...~,~,~.J~. ...........Address ....{~11.~3. ........................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...~.........H..O..r..~.O...~. ............................ Address ....~.e..~'........~..,.l~..~.o....].~.. ........... PI'rune 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 Jndicate whether interior or comer lot. STATE OF NEW YORK, JS.S. COUNTY OF ..8'i~,"',Zlc ............. Geo Bail.e.2. ,n ............................................................................................... be' g duly sworn, deposes and says thor he is the applicant (Name of individual signing application) above named. He is the ........................... ,~,~.e33.t,..D.~...QW3ci.e3: .................................. '~; ....................................................... (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 oil statements contained in this application are true to the best of his knowledge and belief; and that the work will be p~e£formed in the manner set forth in the application filed therewith. Swam to before me this .................. day o, ......... ............ . ........./..?. ........... Notor/ Public,~...~....: ../..~nt~ ~'-~~ature of appl~' Na. 52-3233120 Suffolk Coun~ ,, ~*Aml F-,xpires March 30, 19_~.~ ·