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Home My WebLink About5043-zFO~M NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z,~.19~ ..... Date ........... A.pr$1 ..... 20 · ·., 19..71 THIS CERTIFIES that the building located at ...R, 0.,.W ,. E/~. 0oaklawn .AvoStreet Map No. ~ .......... Block No...~.~ ...... Lot No. ~ ..... ~O~ltah®l& ... N.,¥, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... llev .... 1+.., 19.70. pursuant to which Building Permit No... ~O.l*3Z dated ......... ltcv .... be ..... , 19. ?0, 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 ... &cceas~l~. l~ldg .................................................... The certificate is issued to . .Richard. ~hee-~'er' of the aforesaid building. Suffolk County Department of Health Approval H®use ~ 30~ · '~'em;ant ........................ (owner, lessee or tenant) Building Inspector FOEM NO. ~ TOWN OF SOUTHOLDi BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOkD, H. y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5043 Z Permission is hereby gronted to: ......... · ~'~ ................................. i ................. pursuan¢ to application dated ............................ ~1~ ......... ~ ....... i...., 19..~, and approved by the Building Inspector. Examined ........~ ...... l ........... ,197...~.. lrOB~ NO, I TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................. Disapproved a/c .............................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........................ ~....~.. ............. , 1 ~..~.....~.. .... INSTRUCTIONS ~ o. This application must be completely filial in by typewriter at in ink und submitted in ~plicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or gublic streets or~ areas, and giving a detailed description of layout of property must be drawn on the diagram wl'~ch is part of ~hie oppllcat on?~' c. The work covered by this application may not be commenced bafore issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o 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 Occuoanc~"' 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 Ordinar;ce of the Town of Southold Suffolk County, New York, and other applicable Laws, Ordinances or~ Regulat OhS, for the construction of buS dings, additions or alterations, or for removal or demolition, 05 herein described. The applicant agrees to comply with all applicable laws, ordinaDr~s, bqJlding code, housing code, qnd regulations. (Signature cf applicant, or n_.g~e, if o corporation) ...... (Address of applicant) State ~ether applicant is owner, lessee, agent, architect, engineer, general contractor, eJectrl¢lan~ plumber or builder. ~..e.. ~.x..o.. ~ ,, ......................................... ............................. ................ Name of owner of premises ................................................................................................................................................. .~ If applicant is o corporate, signature of duly authorized officer. .................. ................... land on which oroposed work will be_done, ~ No.: ........................................ lot No,: .,.~ ................... ,. of ,,c"u' Street and hJumber Municipality 2. State existing use and occupancy of p~is~,~nd intended use and occupancy of propoeed con,truction: a. Existing use and occupancy ........ z..~w.....w........~ ....................................................................................................... b ntended use and occu['an", ..~ . .~..~ ~ ~ .... ~ ...~.~.. ................ 3. Nature of work (check which applicable): New Building ....~... ......... Addition ................. Alteration ............. Repair .................. ~,,~/ova! .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost .......... .'./'....?......O. .................................... Fee ...................................................................................... (to be paid on fi!lng this application) 5. If dwelling, number of dwelling umts ........................... 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 ................................ 8. Dimension%~of entire new construction: Front ...... ~..~.....~.. ................. Rear ..../~...~......~.. .......... '... Depth ..../....~.....~... Height ..~,..... ~x!'.. ....... Number of Stories ...................................................................................................................... 9. Size oi: lot: Front ............................ Rear ................................... Depth ................................ 10. Date of Purchase ........................................................Name of Former Owner ....................................................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction ~iolate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... 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 NEV~'J¢,,~/'(' }.¢ c COUNTY Of ~~..-7../,.....J"~"~,~ / ....................... · ~.....~:~..~.~..:/'....~ ............ being duly sworn, deposes and says that he is the applicant (N~/fle of individual signing application) 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 fife this application; that all statements contained in this application are true to the best of his knowledge and belief; an.4 that the work will be performed in the manner set forth in the application fi[ed therewith. Sworn to before me this , _-~ f ~ ~ / /'~ ~,/// //' // .................. day of ........................ , (fl ........ ..................... Notaw Public, ~-~l.~.. Counh~n~ (Signature of applicant) ELIZABETH AN~NEVILLE NOTARY PUBLIC, Stale of New York NO. 52-8125850, Suffolk Count u~. Term Expires March 30,