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Home My WebLink About5059-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. ~b~2.~9 ..... Date ............. Apr,.... P-~.., 19 ~l · THIS CERTIFIES that the building located at . .Bayv-:Low. lid .& Gle~ ~tMo8~ Map No.. ~ ....... Block No..~ ..... Lot No.. ~ ..... ~th~ ............. confoms subst~ti~ly to the Application for B~ld~g Permit heretofore fil~ ~ ~is office dat~ .......... ~ .... ~..., 1970.. p~su~t to wMch B~ld~g Permit No... ~0~ dated ............ N$~... ~, 19.7.0, was ~sued, ~d conforms to ~ of the req~ ments of the applicable pro~sions of the law. The occup~cy for wMch this ce~icate is issu~ ~ .. ~vate. a~a~e..(aceosso~, bu~ld.~g) ............................ The certificate is ~sued to .. ~tho~ .~o ....... ~W ......................... (o~er, lessee or ten,t) of ~e Mores~d b~ld~g. Suffolk Co~ty Dep~ment of He~th Approv~ ....... N.,~, ........................ H.~..' 16~h ~.v /~ Clea~i~ Ave ~est f ~, ............... ~. F . .~. "'"V' "' TOWN OF SOUTH~LD i TOWN CLI[RK'S OFFICE ~ SOUTHOLD, N. Y. BUILDING PERMIT MUST BE KEPT ON THE PREMiS~ CrHIS COMPLETION OF THE WORK AUTHORIZED) .UNTIL FULL 5059 Z Permission is hereby granted to: to .... '1~"~' ............. !"- ............................................................. et premises located at ..... ~...,.;. ' ' .,, ...... ' pursuant to application dated. ...................... ~., .... Building Inspector. Fee $..:~.~j~ ........... IPO~if ' NO. I TOWN OF $oUTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No ¥o Examined ...... ~..~ .......... ,19Z.O... '' 19..'.!.... Permit No. ~..~..~...~...~... Approved ........................................ , Application No..-~...0... ;.~,..~. ............. D,~approved a/c ................................................ ' APPLIGATION FOR BUILDING PERMIT INSTRUCTIONS ~ ~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildings, _~ Inspector. . g7 b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets g ~-~ areas, and giving a detailed description of layout of property must be drawn on the diagram whlch Is part of ~hie 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 perm~ ~ shall be kept on the premises available for inspection t~.roughout the progress of the work. ,~ e. No building shall be occupied or used In whole or in port for any purpose whatever until a Certificate of Occupancy<~ shall have been granted by the Building Inspector. ~ APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Bul d ng Permit punsuont to the ~ ~Build!ng Zone. Orfl. inance of t.he Town of Southold, Suffolk County, New York, and other appllcob · Lawl, Ordinances or .~K.egulati,.ons, tar the constructton of bulldtngs, additions or al!orations, or for remove or demolition, os herein descr bed tne apphcant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations. .................................... i ........................ (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. ....................................... ................................................................................................................................. Name of owner of pram Ns .A:...~.~.b...o.~.7...~.....3.~...o.. ................................................................................................................. If applicant Is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ....... ~ ............................ Lot No..Z~.... ................. .S..a..~...iev ~c~ & C:le~tz'v:Lev Ave 2. State existing use and occupancy of premises and Intended use and occupancy of proposed construction: a. Existing use and occupancy ........... ~..v..e..]....~..~...~.~ ..................................................................................................... b. Intended use and occupon? . ...... sMae...v:Lth..cl.e.~,a~,.l'~...~,~,~'~l.g.~ .............................................................. 3. Nature of work (check which applicable): New Building ~ Addition Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ....................................... 4. Estimated Cost ...........~.TSO0 ...................................... Fee ...... ~.A.(~. ......................... ~ ................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...~9.~ ............... ~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. Dimensions of entire new construction: Front ............ 2~. ................. Rear ........ ~.~.. ............. Depth ..... 2b~ .............. Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated .......... A.....81~.t, .......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ ~O ........................................... 13. Name of Owner of premises .JL)..~r~IG(~ .................. Address ......~ ........ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~.~..~O~.I~DZ~ ............................ Address ......]~e~..~.iLt'fo,~i[ ........... 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 comer lot. STATE OF NEV~ Y~,I~,. COUNTY oF .~.L1,T.~D,LI~ ............. ~ · ................................ ~..~ ................................. ~ing duly ~orn, d~s a~ says ~t ~ is the applicant (Name of i~vidual signing applicatJ~) above named. He is the ....................~Q~: .................................................... ~ ........................................................ (~ntmctor, ~t, co~te officer, ~c.) of said ~ner or ~ners, and is duly authoriz~ to pedorm or ~e p~o~d the ~id work a~ to ~ ~d file this application; that all statements contain~ in this applicati~ am tree to ~e ~t of his ~1~ a~ ~lief;.and that the work will be ~rfor~d in the manner ~t fo~h in the a~licat~ fil~ ~ith. Swam to ~fom ................. 20.. ~y of ~be~...., 19....~0' .... ........ ................... N~a~ Public,~..~~... C~nW ~~ ~ig~m of a~licant) ~ EL~ABETH A~N NEVlLL~ ~ ~ '/ NOTARY PUBLIC, ~ate of New Yor~ No. 52-812~50, Suffolk Cou~ Term Expires ~rch 30, ~9~