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Home My WebLink About4778-z FORM ~0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUtLDIHG P~:RM)T (THIS PERMIT MUST BE_KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? t778 Z Permission is Eereby granted to: ............. -q~b~..C~r~ ................... , ................. ..................... ~hcv]za ........................................ to .............. ~..1~ --~e~ ..~ee~s-or~'*.~,t~ -. (. ~o~ra~:e') ................................................. at premises located at ...................... ~'f~*'"'~l~ut~"'~a;,!~t]F*']~[~ ................................................ .................................................................... ~t~ot~t. .......... ~-,.~.~. ..................................................... pursuon¢ to application doted .................................. ~,~ ....... ~:tl~******, 19.**.V0 and approved by the Building Inspector. Fee $....5.!~0 .......... ' '' Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z .~l ~59 ...... Date ............. April.. THIS CERTIFIES that the building located at E/.8.8.o~t;h. II.arbor..Road... Street Map No. xx ......... Block No..mx ....... Lot No. xxx....qouth(~ld.. ~,Y .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... l~a¥...2.9..., 19. ?0. pursuant to which Building Permit No.. b??SZ dated ......... Play...29 ..... , 1970.., 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 .. Ac.c..e ~.s. QITy..b.~k.t.dj..ng..(.atorage.) ..................................... The certificate is issued to . .. R. qb.e. ;'~c. .C.r. g;x.e. ....... Q.w~. 9.r .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .I~,R.. ............................... UNDERWRITERS CERTIFICATE No. ItOUSE NUMBER.. 5.(}2. ~ ...... Street... {50.'o,~,t'.1. H.~:E. bOr..P~Qa0. .......................... Building Inspector ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE Exo~,,,d ....... ~Z~;.:~:~. ...... , -'r:^pp,~t~on No....~.Z.Z:~ ..... ,o Approved ............................ ~. ........... , 19 ................... Disppproveda/c ................................ ~ .................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted In duplicate to the Building I nspoctor. b. Plot plan showing location of lot and of buildings on premisps, relationship to adjoining premle# or public streets or~ areas, and giving a detailed description of layout of property must be drawn on the diagram whlch Is part of thio eppllcation.~ 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 pragreu 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~n~ shall have been granted by the Building Inspector. th? APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pumuant to ,Build!rig Zorn, O~inance of the Town of Southold, Suffolk County, New York, and other appllcuble Law~, Ordinances or Kegwations, mr the construction of buildings, additions or alterations, or for removal or demo Ition, a~ hareln d~cribed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and ragulatlons. .. ......... i ...................... (Signature cf applicant, or name, If a corl~ratlon) (Address of Ol~pllcont) State whether applicant is owner, leues, agent, architect, engineer, general contractor, electrician, plumber or builder. 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.:A~ ............... L,~ Street and Number ..... ~........~..~....~..~ ~..,~,..~.,..~..~.. ........ -- Municipality ........ 2. State existing use and occupancy of p(emlses and Intended use and occupancy of propo#d construction: a. Existing use ancl occupancy ..... ~..~....~:~/. .................................................................................. b ntended use and occupant, 1~ .... ...~/./........~.,., ,,c~..,~...~Z9 / 3. Nature of work (check which applicable): New Building ~.....~.. .......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Ot~he~r. Work (Describe) ........................................ (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ....~....I.....~... .......... 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 .................................... Rear ............................ Depth ........................ Height .................... Number of Stories .................................................................................................................... 10. Date of Purchase .................................................... No,me of Former Owner .............................. 11. Zone or use district n wh ch prem ses are s tuated .~. .................................................. 12. Does proposed construction vi~l~t~a~y ~ning law, ordinance or regu at on' ..... 13. Name of Owner of premises .f.....~....T...r...~~..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 Indicat'e whether interior or corner lot. STATE OF NEWc~ORI~ ~ lee ................... ~...'~'~'....V.....~. ~ .............................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing a_ppllcatlan) .-~ 6/1 above named He , the ............... ~ .~......./~~ ............. ':L ............................................ (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 ..~ work will be performed in the manner set forth in the application filed therewith. Swam to beforec~ me this "~'. m~~~ .................... day of ........ ,,, ...... ........ , ...... ..... ................... U ELIZABETH ANN NEVIllE NOTARY PUBLIC, State ef ~'ew York No. $2-8Z258§0, Suffolk Ggo~ Term Expires March $0, I