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Home My WebLink About5515-zNO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ...... Date .............. De.~... ~ ..... , 19.72. THIS CERTIFIES that the building located at . 8/3 .$olff~d. Ave ............ Street Map No..Xz ......... Block No. xx ....... Lot No..]~..~t.t~uok..~,~, ......... confoms subst~tially to the Application for Building Permit heretofore fil~ in ~is office dat~ .......... ~ept.. 20.., 19.~. p~su~t to which Bufl~g Permit No.. ~1.~. dated .......... ~.~9~...20..., 19.~1., was issued, ~d conforms to all of ~e r~r~ ments of the applicable provisions of ~e law. The occupancy for which ~ ce~ficate is ~su~ is ... ~..~a~rl~ .a~.e~O~. at~.~e..(ele~..bl~.). ............... The certificate is ~sued to ...&~. ~PP ....... ~. .............................. (owner, lessee or ten~t) of the Mores~d buil~ng. Suffolk Co~ty Department of He&th Approval . ~,~, .............................. UNDERWRITERS CERTIFICATE No...~,,R, .......................................... HOUSE NUMBER... ~.~.~ .... Street...~0~ .A~e .................................... Building Inspector FOF. M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5515 Z Permission is hereby granted to: A~va.v Z~e [~..a. tu~s (We bi, m) to ... ~gAl~..X~l~..&~g~.#/~.~. ................................................................................................. at premises located at ........~t~....~l13~l~..Ave .................................................................................. .................................................................. l~t,~,/~ tmilk'" · J~ .......................................................... pursuance to application dated ........................... ~lt~t, ............ ~)......, 19..~.., and approved by the Building Inspector. Fee $..~[.l~lQ ............ TOWN F SOUTH LDO. BUILDING DEPARTMENT TOWN CLERK~ OFFICE SOUTHOLD, N. Y. ,, ,, ,, ~prov~ ........................................ , 19 ........ P~it No ..................................... Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT Date Sept 20 19 71 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted Jn duplicate to the Building Inspector. b. Plot pJan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty muSt be drawn on the diagram which is part of this 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 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. Agway Inc (Signature of applicant, or name, if a corporation) Mattituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. .e. .e. ................................................................................. Name of owner of premises ....A....g~/...a..y.....[.~.¢. ........................................................................................................................... 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.: ..... ~ .............................. Lot No ..... Z-~ .............. ~ Street and Number ...~../.~......~.QLL~,..~.e. ............ ~[a.t~i~l.c,k. ............. ......................................... : ..................... ~I'~ { {.~ 0 ~ /V%unicipality ~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~' a. Exisiting use and occupancy ..... .............................................................................. b. Intended use and occupancy ......... ..S.~9..~.~.~.h ..a, Rg.~,S~.IT~....S.~_~I2C.l~Ll.T. eS ................................. 3. Nature of work (check which applicable): New Building 3C3C Addition Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .............. .~.~)0......+. .......................... Fee ,..~...eD.O ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....ZtD~ff ..............Number of dwelling units on each floor ............................ If garage, number of oars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each t~pe of use ..~.~..~..s...~. ............ 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 .......... .1..0.. ..................... Rear ........ .1...0. ............... Depth ....... ..2..0. ............ Height .................... Number of Stories ........ D.13~ .................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ ]0. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..... .t~..O..~...~,~fi.~,. .......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation;~ TJ.O 13. Name of Owner of premises ...~.~...~.~....[...~..C. ................. Address .......~...a:..t;,.,~.,~..~..~..C...][. ................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor sa~e .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck 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 NE~,¥~g~,I~,~. 1.¢ c CO NTY OF-'~'~'~ ~'~ .................. '~).~t~,1~ ....... .~.~.~ ............................. being duly sworn, d~oses and says that he is the applicant (Na~e of individual signing application) above named. He is the ............... ~.~.~.~...9.~...9~. ....................................................................................................... . (Contractor, og~t, co~orate officer, etc.) of said owner or ~ners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contoin~ in this application are true to the best of his knowledge and belief; and that the ~rk will be performed in the manner ~t fo~h in the app~filed therewith, t ,wom to ,o,e .,__ .................. ~.~v o{ .................... ~=~.....;.~, ~..t..~..~ . ~ ~ ~ _ ~ ~'~ _ ~ [} /~[_ ?~J ........... ~.~.~.(.~....~.B..~m .................................. Nota~ Public,~~Ng. NEVILL[~'~' . Coun~~] (S gnature of applicant) ~ARY PUBLIC, State 0f New York fla. 52-8[258~ ~ffelk G0u~t~ Term Expires'~ ~. ]9~