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Home My WebLink About5105-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z1+17~4 ..... Date .. March 16 , 19.. 71 THIS CERTIFIES that the building located at Main Read & Leigon ave Street Map No. xx . . Block No. xx Lot No. Xxx ~;attituck };,5~, conforms substantially to the Application for Bmlding Permit heretofore filed in this office dated Dec, 16 , 19 70 pursuant to which Building Permit No. 5105Z dated 'Dec 16 , 19 7(~ 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 Busines~ .building .(St~re) The certificate is issued to Attg~tst Hackatauel~ of the aforesaid building. Suffolk County Department of Health Approval House /~ t1155 Main Read Owner · · (owner, lessee or tenant' FO~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRF_..MISF_.S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 5105 Z O~e .......................... Permission is hereby grantee[ to: ................ &~..l~~ ......................... to ...... ~t,~..~,.~t.t.~n..~,.. ~~r,,.b~.. ~~ ..... ~ ~t,~ ............. at premises located at ........~411"]i~N~"&"~'~ ............................................................... ..................................................... X~l;'t;~t;'m~lc ...... .It'~ .................................................................... pursuan¢ to application dated ......................... ~11~ ............ $(~ .......... , 19....~[/~1~ and approved by the Building Inspector. Buildin'g l~~p~t TOWN OF souTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SaUl'HOLD, N. Y. Approved ........................................ , 19... Permit No ............ ..~......~........~. Disapproved a/c ............................................................ " Application No ............................ APPLICATION FOR BUILDING PERMIT Date C_. / b ................... .............................. °. .... INSTRUCTIONS ~ ~ a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premleec or public streets"'or~c~ areas, and giving a detailed description of layout of property must be drawn on the diagram which I! part of thle 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 progress of 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 pureuant to the Building Zone Ordinance of the Town of .Southold, Suffolk County, New York, and other applicable Lawl, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al herein described. The applicant agrees to comply with all apglicable laws, ardinances,~lding cede, hawing code, and regulations. ..... ...... ,, ................ ...... i~Tg~'~L"i'~p~i~',;~, o, nam,, ~f o ~o~o,..on) ............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, lalumber ar builder. Name of owner of premises ...:....~./~(~.(.,(.~'~...//'/C~'.C..~..ff..~'.~..(~.. ...................................................................................... If applicant is a corporate, signature of duly authorized officer. 1. Locatio~ of land on which proposed work~will be dane..Map No.: .......... 'i...~. ....................... Lot No.: .....~.. ....... Street and Number ................ ~.~.....~..; ...c~. ..... ~~ ~ '~'1 ~,, 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupan? .................. c.~ ............. ! ..................... ,,, ............................ 3. Nature of work (ch~ck which applicable): New Building ~ ................. Addition ...~.~.._....... Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... ................ .................................. Fee ......................................................................................... 4. Estimated Cost 6 ~ (to be paid on fi~ing 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.e~ch type of u~e ..~....~..~.~.~...~.~.. ...... Dimensions of,~ex'i~sting structures, if any: Front ........ .~...."~ ....... Rear ...~......~.....". ................ Depth ..,¢~1.~ .~'/ ...... 7. Height ...... /.~x~._.~ .......... Number of Stories ...... ~... .................................. .: .................................... ~..... ...... Dimensions of sa~rne structure with alterations or additions: Front ....~?.....~... .................... Rear ....'..~... ................. Depth ....... ..~....~. .................. Height .......x(~...~ ............ Number of Stories ....... ../. ...................... 8.Dimensions of entire new construction: Front ......... ~ .......................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ...... .~...~.. .............. / Rear ....?-.~. .......................... Depth ..../~...~.. ................... ........... /~..~...~'.:...../...~...~....~... .......... Nome of Former Owner" - ,/'/~.~..L~...~.CZ~t.~C, ./~Y~..~.." .......... 10. Date of Purchase 11. Zone or use district in which premises are situated ..................................................................................................... 12. Dces proposed construction viol~.te any zoning law, ordinance ar regulation.;> ../~'..~ ................................................... Name of Owner of premises .~.~..~.~f.~r..~//...o.C-/.~..../~.~..~.~'.Y...Address-- -- ~[g~:~.j~..~.~..c.?..../~...~.. ........... Phone No. 13. Name of Architect ...................................................... Address ............................................ Phone No ........: .......... Name of Contractor ...... ~'....z'~......~.~'.:.....d~.'......~....M...~'..~.../..~.......Address .~....~'.~...~.~:>.~..¢./...C./~,'..~./~ Phone No..~.~.~..?..~...~...~. .'~' PLOT DIAGRAM Locate clearly and distinctly oll 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 nterJor or comer Jot. STATE OF NL=~-YO~ ~_ tee OF _ ,. .... .......................... /../.-.~ .............................. being duly sworn, deposes and says that he is the applicant (Nome of indivicrO'al signing applic~i_on) 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 that the work will be performed in the manner set forth in the appltcati~n-~iled therewith. Swam to. before me this ,, / / . ................................................................ i ........... ...................... Notar't Public, . .................................................... ....... Cou~h C/ (Signature of applicant)