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Home My WebLink About5071-zFOB. M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No. ~.~.20.1 ...... Date ............ Ap~ .~.. .... 2.2 ...., 19.71. THIS CERTIFIES that the building located at .... E/S. C®da~ .I~ .......... Street Map No. Baysi. de. ~e~ No ........... Lot No... J~ ....... $~t. hol~.. N~X, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Ecv... 25.. , 19.70. pursuant to which Building Permit No .... 507.1Z dated ......... Nov .... 25 .... , 19.70, was issued, and confoms to all of the requi~e- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is .Priv. ate..one, f. amil~..dwe3.1ing ....................................... The certificate is issued to ... ~iJ, lia~ .~.. B~J;ty. ~cCray ...... 0~ers .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N,Ro ............................. ......... ....... ' Building Inspector { FORM lqO, :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) lb, ~/ 19..~.... N°. 5071 Z D~te........................................................ , Permission is hereby granted to: ~ in 8ddition (beh:~. (Ill ezi...rt..~M ~t~J~.ll ..... at premises located at ..~..~...~.q~Jl~. ~lJL~ll "~- ~ .............................................. ~ ....... ~...~.. .............................................................................. pursuan¢ to application dated ...................... ]JJJl~ ....... ~.~ .................. , 19.~., and approved by the Building Inspector. BUILDING DKPABTMIrNT TOWN CLERK'S OFFICE IOUTHOLD, N. Y. Exomlned 19...,4..,. Permit No. ^ppraved ........................................ Application N ............................. Disapproved a/c .............................................................................................. '~ /~ '~'- . ," APPLICATION FOR BUILDING PERMI'I O Date ...... ............. ,19.ZO. ..... INSTRUCTIONS ' a. This application must be completely filled in by typewriter or in ink und submitted In duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adj~inlng premiere or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which Il i~rt If ;Iflle application. c. The work covered by this application may not be commenced blfore iuuance of Building Permit. d. Upon approval of this application, the Building Inspector will luue o Building Permit to the applicant. Such permit' shall be kept on the premises available for inspection throughout the pragre~ 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 I-tEREBY MADE to the Building Department for the issuance of a Building Permit pureuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lawl, Ordinances or Regulations, for the construction of buildings, additions or alterations or for removal or demolition, el heroin described. The app icant agrees to comply with all applicable laws, bui ding code, housln code, and regulatlens. ' / (Signatum,e'~ aapllcc~_gl~narhee~'~ra caq~ratlon) (Address of ol~llcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ........................................................... :. .................................................................................................. Name ~ of owner of prem m ................. ~ ................................. ) ............................................. .' ....... ~ ............................... If applicant Is a corporate, signature of duly authorized officer. ~.~ (Name and title 'of corporate officer) /'J'~'~ ~ ~' ~ ' hi 1. Location of land on which proposed work will be done. Map No.: ........................................ ~ ..a.: '~ Street and Number ...9 ....................................................................... ~.l:~)j ................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of pmpaeed comtructlon: o. Existing use and occupancy .....~R:~.~ ............................................................................................................... b. Intended use and occupant', ......~...~ ................................................................................................................ 3. Nature of work (check which applicable): New Building .................. Addition ....~. ........... Alteration .............. Repair ............. :~.. Removal ..................Demolition .................. Other Work (Describe) ..................................... 4. Estimated Cost ~ .............................................. Fee ~ .............................................................................. (to be paid on fi!ing this application) 5. If dwelling, namber of dwelling units ........................... 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 ................................ B. Dimensions of entire new construction: Front ....' .......... ~. ..................... Rear ............................ Depth ........................ Height .................... Number ~f Stories ...................................................................................................................... 9. Size of lot: Front .I....~...~ .................. Rear ................................... Depth .~..~-...O...r. .................... 10. Date of Purchase ..~)...O...~..~.......~..!...~...~..9..--- ' ...................... Nome of Former Owner ...~.....'~.....o....1~....~.. ........................... 11. Zone m_ use ,district.in. ~h'[~ ~!~s are situote~, ............ ........................... .,..~._. ........................................................ 12. Does propose~l ~onstru~io~ ,,:iolate any zoning Iaw, ordinance or regulation? ........................................................... ~., 13. Name of Owner of prem,ses 6.~..~/^.~..~d~.~. .......... Add~ ...... '..~...~....~'R~ln~.. Phone No~....~..7-~.~.. 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 comer lot. STATE OF NEW~DRI~ . · tee COUNT~( OF ..~ ......... J'~'~' ................... ~...,.~..~ .................... being duly sworn, d~o,s and says t~t he is the applicant (N~e of in~vidual sign~n~ applica~on) a~ve named. He is the ................................ ~ ...................................... '[ ........................................................ (~ntmctor, ~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfo~ the said work a~ to ~ke and file this application; that all statements contain~ in this application am tree to ~e ~st of his knowledge and ~lief: and tha~ the work will ~ performed in the manner ~t fo~h in the applicati~ fil~ ther~ith. Sw~ to ~m ~ ~is --- o, ,,/.. ~ ELIZAg~ AN~NEVILLE ~ ~ v NOTARY PUBLIC, State of New York N~. 52~J2~50, Suffolk Cou~ Term Expires March 30,