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Home My WebLink About5056-zFORM NO. 4 TOWN Or SOSTHOL BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupat cy No. k;!k~.8? ...... Date . .... l~ta~.tlh...~.~ ..... , 19.7.]. THIS CERTIFIES that the building located at ./~tl~la. I~ .................. Street Map No.R].cko~y .Ac~tJ~ock No ...........Lot No. 6.....~tChOg~.. N.,~ · ......... conforms substantially to the Application for Building Per]mit heretofore filed in this office dated ...........IIo~...'l.O.., 19 ~1. pursuant to which Building Permit No.~0.~6~... dated ..........lqO~,,r ..... ~9.., 19..~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occut~ancy for which this certificate is issued is ...PrLv. e:.~e..orca. £a~l~ .d;~,~J~.~tng ........ ............................. The certificate is issued to .. Dore~,t;hy. B.t®lag~,e ....... 0',~t~e~. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI"HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5056 Z Permission is hereby granted to: pursucu~t to application dated ................... ~ ..........~9 ................... , 19.1.~., and approved by the Building Inspector. Fee ~...~.e,,,~0 ......... ..... ................ APPLICATION FOR BUILDING PERMI'I' November 19, 1970 Date ............................................................ , 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of. lot and of buildings on premises, relationship to adjo n ng prom sas or public street.s or areas, and giving a detailed descriphon of layout of Property must be drawn on Yhe diagram which is p~rt of this applicatmn. 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) · Robinson Road, Greenpor%, N. Z. ............................. ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~' Name of owner of premises uoro~u~, o~enge~e If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No.: 8825 ........................................ Lot No.: ........................ Street and Number Lupen Drive East Cu%chogue. ~ I '-- C/~'~0 Municipality 2. State existi.ng use and occupancy of premises and intended use and occupancy of propose construction: a. Existing use and occupancy ~nilding lo4 b. Intended use and occupancy l~iva%e dwelling 3. Noture of work (check which opplicable): New Building .................. Addition .................. AIterotion .................. Repair .................. Removol .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost $30~000 Fee $ 10.00 (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .o...n..e.....~ ........... Number of dwelling units on eoch floor If gorage, number of cars .....o..a:...e. .................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7, Dimensions of existing structures, if ony: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with olterations or odditions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front 53e Rear ....5...3.~ .................. Depth 3'/t 5" Height....................]'St Number of Stories .............. on~ ............. ........................................................................................... 9. Size of lot: Front............................]'3§e Rear .....1.3.5.'..1...8..~. ................ Depth .....1...6..]:.'..~.0...~. ........... 10. Date of Purchase ........................................................ Name of Former Owner ]buee & 11. Zone or use district in which premises are situated ..]~.~,.~..e.T~..~.~..e:..]- ........................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation.;> ....... .N...o. ................................................ 13. Nome of Owner of premises ,,D.°..r..°..~.h..~......~..%..e...~..g.,~.]:e...Address ..~.?..e../'..,h.,e.,~.~. ..................... Phone No?..2.,?.,-..]:...9~...]'..i. Name of Architect ...N~...o..n...e. .......................................... Address ............................................ Phone No ..................... Name of Contractor .C...*.....I[.*....P..°.w..e...]'..1. .............. ' ......... Address Greenpor$, Phone No. 4~'~-eeg5 PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street ond block number or description according to deed, and show street names and indicate whether interior or corner lot. ~', 0'*~ -i'~'~ J STATE OF NEW YORK, I~ .... '...4~4,elc~n~c~.....~f~. ......... ~....'<.=.?...~.;=..~ .............................. being duly sworn, deposes ond soys that he is the opp[icant (Name 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 file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .......... /. ...........~., day of ....... ..~.: ............. ,, . 19 ........ ~ · ............... ........ ......................... ELIZ.~BETH '~,NN NE_VI.I~L[ ,, ~( V NOTARY PUBLIC, State of New Yor Co 52.8125850, Suffolk ~.o.u~/~.~ No. Term Expires March 30,