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Home My WebLink About5003-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . ~'~.&l~. I~la® ............ Street Map No.~.$11. ~?.~. Block No ........... Lot No. 20 ..... Ma.~t~][..Ii,II, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... .. 0~...~6..., 19.~. pursuant to which Building Permit No. -~)0~. · dated ........... 0~...~.6..., 19.~., 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 ...1~ .~.~..~. ~.a,l~l~y .~.~,1~I1~ ..................................... The certificate is issued to N.~I. M~,ald. & .~[J.f~ .0~ll®l*~t ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . Ja~..11..1.972...by Ko .V~X~ .... Building Inspector FORM NO. 3 TOWN OF SOUTHOLD i BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 5003 Z Permission is hereby granted to: ...... ..,~/~.....~V.~ ....... ~!.~..~...~.c~..~z~ to at premises located at .................................................................. , ......................................................... ............................................................................... ........ ............... ...................................................................................................... i..~..~?...:Z;.~/..~.~ ............. pursuon¢ to application dated /~ ~r 7 197 ~ and approved by the Building Inspector. /~.~ Fee $ ..........; ............. Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldgo Permit NoG =~---~ TO WHOM IT MAY CONCERN: at The sewag~ disposal fac, i'~ities for a~ structure located v ' (Give ~eed ~ocation) have been inspected by this department and fdund to be satisfactory. ..BUILDIHG D EPARTMEHT., , - ' TOWbl CLERK'S OFFICE Otsapp ed a/c ............... '"ii ...... ........................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ' ;~..i ;.....O~....t..o...b~....r.....]:.6..s. ........................ , 19.....~..: .... - INSTRUCTIONS a. This application mt~st be c~)mpletely filled in by type'~riter or in ink and submitted in duplicate to the Building Inspector. b. PI0t 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 of property must be drown on the dmgram which is 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 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 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. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. ge~ ~.a~,...~ ~.t;~.~. g.J;o~. ....................................................................................................................................... Name of owner of premises Hr. & Hrs. Nell Macdonald If ant is cz corporate, signa re duly author,' d officer. .~...~;~.~....:~r;~ .....~ . (Name~d title of corporate officer) .. No.: 1. Location of land on which proposed work will be done. J~ap ........................ ~.. ............. Lot No.: ........................ Street and Number ......... .V,~.,~ .e,..~Lv~,~X' ~at~:~tuck N.Y. ~/~/-- Z ~ (:7~'~ ~,.~ Municipality 2. State existing use and occupancy of premises and intended use cznd occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ...D,~...gD,e,..;~;~,~....d~,~:~T~ ...................................................................... 3. Nature of work (check which applicable): New Building.. .............. X .. Addition ..... ............. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..... $~1,8~.(~0~ ....................................... Fee ....$]I,.0?D.0. ....... : ................................................................ (to be paid on filing this application) §. If dwelling, number of dwelling units ....O..~.~ .................. Number of dwelling units on each floor .....o...~..~. ................. If garage, number of cars o~.e, 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 ................................ 8. Dimensions of entire new construction: Front ........... .~.0.! ................... Rear 60t Depth 24 t Height ....... ],./f.~ ...... Number of Stories ................ o.,'~ .............................................................................................. 9. Size of lot: Front ..... 10.0.] ............. Rear ........... 9.~.! .................. Depth .....2.5.7..!.....2.7.8.! .... 10. Date of Purchase ..............~R.~.....~..D...7..O. .......................... Name of Former Owner ...... ~,~,],~,~..,B~,l:f~. ................~' 11. Zone or use district in which premises are situated ........ ..~r...~.~...~.~.~..~..]: ................................................................. ~. 12. Does proposed construction violate any zoning law, ordinance or regulation? ................... ..~..O. .................................... 13. Name of Owner of premises ..~r...~.]'....~ .~..O.~..~..]:.~. ...... Address ...[~...~..~...~.~.9~.,...~¥.~. ...... Phone No.~.~...8..'..~.4...~..0... Name of Architect ....... ..C~....~.~..o.~.....A~....Z:..e:~ ................ Address ..~..~.L~....~.~.e.....N..-.~if ...... Phone No.'7....~.~.'....~.....2..7.... Name of Contractor Be Hart:on & Sons ~nc, Address ~,.~....~.~,l~O~,e...~]...~'~,.... Phone No.?~./f.-..5~2.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck 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 NE'M~O~. ~ ~ S S ~ COUNTY OF .',~ffi~ .............. .f '' ~. .............. :.": ........... ~.~....~...."[~"....~..O....~....O.~. ............................. being duly sworn; deposes and says that he is tt~e applicant (Name of individual signing aj~pljcation) above named. He is the .......................... .0.?....~...?..~.~.?...?...~,.~...~..0..~...~. ...................................................................................... (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 application filed therewith. ].6~:h da,, ~ ~o~ 19 70 ........................ ............................. : .......... , ....... m Nota~ ~ublic /I ~tlza~. ~ ~ltt[ .... Count ~re ~¥'opp~cant) ............... ~ NOTARy PUBLIC. ~e of New ~o,~ ~ ' No. 52-S125850, Suffok~ ~erm ~p res March 30,