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Home My WebLink About5068-zFOKM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~1~.191 ...... Date ............ &l~r~,l..- .k0 .... , 19.71. THIS CERTIFIES that the building located at . 8®~l~d. ~ ............... Street Map No. ~ ......... Block No.. ~ ..... Lot No... ~... ~reenpert ..... ~...Y.... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~... ~.., 19. ?0 p~suant to which Building Permit No .... ~ dated ........... ~e~ .... 2~.., 19.~0., was issued, and conforms to all of the requffe- ments of the applicable provisions of the law. The occup~cy for which this certificate is issued is ~riva~ ' ~ 'f~ly' ~eli~g ....................................... The certificate is issued to .... E,. ~k~ ......... ~e~ .......................... (owner, lessee or ten,t) of the afores~d b~lding. Suffolk County Department of Health Approval .......... ~.R, ..................... House ~0 /~.~ ~q ~ ~ , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMIS£S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5068 Z Dote ........... : .............. .~,.V:,.,~......'~., Permission is hereby granted to: .,..~,,~...~,~....~ ....~.~..]~,~..;~l~.... · .tle~.. ~ei,....~a.~t, ..~e~,tehes ....... i ................. to .... ;l~t,~t...~.. e~ ~t.t~.$e~ · .e*a.. ~x.$S~-tag. · ~l,,eet~i~ .......................................................... at premises located at .........7.,]~,..I~G'OiI~..~ ................... ; .................................. ~ ...................... ................................................ ~ . . .~ee, eripe'~G ........ .l~ ~'tl-,r ......... L . : . .. .: ................................................ pursuon¢ to application dated ......................... ~ ......... l~t~...:.-,. ,,.-, 19..~/0., and approved by the Building Inspector. .Fee $...~.~. ........... ....... · q.. .................... """~'~;""~1 ....................... Building Inspector ~ , lUll. DING DEPARTMENT TOWN CLERK'S OFFICE SOU'THOU), No ¥. Approved ........................................ , 19 ........ Permit No ............................. Di~spprovad a/c .............................................................. APPLICATION FOR BUILDING FERMI'T~.[ pete ........................... . INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink und submitted in duplicate te the Buildlng~.D Inspector. b. Plat plan showing location of lat and of bu.ildings on premises, relationship to adjoining pmmiee~ or public ~tmet~ or araa~, and giving a detailed description of layout of property must be drawn on the diagram whlch le pprt of ~hle al~ll~atlon. c. The work covered by this application may not be commenCed before i~uance of Building Permit. d. ~U approval of this application, the Building Inspector will Issue a Building Permit to h al~llcant. Such permit~ shall be [¢~t on the premises available for inspection throughout the progreu 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 punmam to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other al~li~able Lawl~ Ordlnancee o~ Regulations, for the conStruction of buildings, additions or alterations, or for removal or demolition, ee heroin dsecrlbed. The applicant agrees to comply with all applicable laws, ordinances,~L/ ,-///building cede, ~u~,~nde, and r~. ulatlonl. (Signature r,~'~)~l~fpllcont, or name, If a COrl~ratl~n) . ...... ' ................. c^~,-'"'"'""~"of ~,-'""~i~";~i ......................... State whether applicant is owner, Iossee, agent, architect, engineer, genarQ) contractor, electrician, plumber or builder'. ....................... /.~...:~../.~..~..~...~ ......................................................................................................................................... Nome of owner of praml.se ....... ~...~..~.~.,,....~.~.../......~T.....X~...~....~..~).......~ ............................................................... If applicant IS a corporate, signature of duly authorized officer. .................. ................... . I. Location of land on which proposed work will be done. Map No.: ...... .... ................................ Lat No.: .................. ............ 2. State ~istlng use and occuppncy o{ pmmi~ and Inter~d use and oc~u~c¥ of p~ a. r.x s ng se ana occupancy .... ~...~....~.¥....../.....6'~...~..../.....~.....~ ...... ~...~..~..~,~...~.....~. ................................. b. ~,te,deduseandoc~,~on:', ......./.. ....... ~..~....~ ......... ~....~....ZL.~...~L.....~..... ........ , .............................. 3. Nature of walk (check which applicable): New Building ~ ................. Addition .................. Alteration .............. Repair ............... ~,, Removal .; ................ Demolition .............. ,,,,,Other Work (Describe) ..................................... 4. Estimated Cost~....7,/..~...~......~...:..~.~ ............. ..i ......... Fee ......'~../..~,.~,........~. ................................................................ (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 ..... O/~ ~ .................. 6. If business, commercial or mixed occupancy, specify pature and extent of e~ch type of use ................ ~. ......... 7. Dimensions of exis, ting structures, if any: Front ...~.....~..z~... .............. Rear ...~.....~.. ..................... Dept~....,O Height ......~...~. ........... / Number of Stories ....~...;~ ............................................................................ ... :!~ ............. Dimensions of ~arne structure with alterations or additions: Front ....................................Rear ..... :,;...: ................ Depth ................................ Height ...................... ~.~..Number of Stories ............. ;.. ................. ., · 8. DimenSions of entire new construction: Front ..../..~3~.~.----~ .................... Rear ...~......~...../.....~....;./... Depth ...."~.....L>..~ ............ Heigh~:._ ................... _-,--~Number of Stories ........ ., ......... ~.:~ ............................................... r~ ............................................ 9, Size of lot: Front ....~'....//....~..." ....... Rear ...... ----~x/...../.../.- ................. Depth ..../......~.....-~.. ............. 10. Date of Purchase ........... 4~....r~.....~.....~..- '~ -' ........................ Name of Former Owner ....~.~.L.......~......./...~). ..................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ~.~.r...~...~./~...~.. ....... Address~.~....~...~....t/'.....l~)......~..~.~... Phone N .o~...'~..T../.'.?...~....~.TM. Name of Architect ...................................................... Address ............................................ Phone No ..................... : Name of Contractor .~./.~-~...~,., ........ ~ .................. Address ..a~...~...~......~.~.~,,/..~...~..~u~ Phone N .~.,Z..~. ...... ~.... PLOT DIAGRAM · · Loc0te 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 ~hether interior or comer lot. STATE OF NE)N1YCJP~,,~ ~ COUNTY OF~,4~. ........... J' '~' ..... ..~. ............ ~j~.~ ...... ~ ..................... being duly sworn, deposes and says that he is the applicant (NErrl~ of indi~al sigR~Kmation) ' .... ~ ~ ~ ~_~_ ~ a~ve name. ~e. is the ...................,....~.. ' . ......................................................................................... (~ntmctor, ag~t, co~omte officer, ~c.) of said ~ner or owners, a~ is duly authoriz~ to perform or h~e pe~o~ed the ~id work a~ to ~ke ~d file this a~lication; that all sta~ents contained in this application am tree to the ~st of his kn~ledge and ~lief; and tha~ the work will be ~rfor~..in the manner ~t fodh in.the a~licati~ fil~ therein. Swam to ~fom me ~is ~ A .... o, ........... - ................... Ex....~ ~rch 30,