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Home My WebLink About5169-zFOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z.~360 .... Date ......... AUg .2.~ ... , 19.7.~. THIS CERTIFIES that the building located at . . W~S. G~le.~ge. Dr. ...... Street Map No. ~$0~ .~ock No ...... Lot No..~9 ..... E~S~ ~r$0~...N.*~... conforms substantially to the Application for Building Permi~ heretofore filed in this office dated ....... 0.et.. ~0 , 19..~0 p~suant ~o which Building Permit No.. ~69Z. dated ......... ~.~.~ 19..~, was issued, and conforms to all of the requir~ ments of the applicable provisions of the law. The occupancy for which this certificate is issued is PXivate. ~. f~ly. ~weli ~-.g. (. aide. ~ds. approved, b~ .Bd~ppeals) The ce~ificate is issued to Sa~va~o~e. ~~$ ..... ~ .................. (owner, lessee or tenant) of the afores~d building. Suffolk Co~ty Department of Health Approval . N,R, ..................... ~ou~ ~ ~0 /~/_ ~ . .t. . . . . ~'C)V(N DF SOUTHOLD I~JII. DING DE~ARTM£NT TOWN CLERK'S OFFICE · SOUTHOLD, N. Y. ~ BUILDING FERM~r (THIS PERMIT MUST BE I~EPT ON THE PREMISES UNTIL FULL COMPI~ETION OF THE WORK AUTHORIZED) Z Dote ..... : ..................... ~-~Jl~.....~ ...... , 19..~.1.. Pe~rmission is hereby granted to: ....... ~,.,..,.~. J,~';.~t,/~...a.,,...~'~u~. ......... ~ .... to .......... ~Lt,~I..~U~..a~L~LJ~..e~..~zL~..~v~ .................................................... ................................. ~&~..l~..~M.~l~e~) ..................................................................... at premises located 9t ...... Jlj~..~:j~i~..~j ..... ~4l~-.~..*J~t---.J~aJ~J~lJlJ..JJlll~ ........ : ............ .......................................... -lJe~l .~ -.J,~sJ'.~-~¥ -. ttv ¥.~. ............................................................................ pursuan¢ to al~plication d~ted .......................... 1OO~ ...... .~(~ .............. , 19...?.1., apd approved by the Building Inspector. lJ~B]f ' NO. ! ~N OF sOUTHOLD (Building Inspector) APPLICATION FOR BUILDING PERMI'I' '.~ ~t. ....................... O.. ................. ..~. .......... , ,9'.~...°.. .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted In d~pllaate to the Building~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or areas, and giving a detailed description of layout of property must be drown on the diagram which c. The work covered by this application may not be commenced before issuance of B~tldlng Permit. d. U on approval of this application, the Building Inspector will Issue a Building Permit to the applicant. Such shall be ~ept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used iff whole or in port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. RB APPLI,CATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit I~nmant to the uildlng ,,one. Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or .~geu ations, tar the construction of buildings, additions or alterations, or for removal or demolition, al herein described. · c =pllca.nt.~arees to comply with all applicab · aws, ordinances, bul d ng code, hous~n code, and regulotlonl. ..................................... ~' .... _L'~ ~--~'/~ _ '~'q'~'~. ' ~. ; (Signature of ap~'li~"~'~'~'~, If a corporation) ~' ~--r-..~ ' ~ ~'%~;-~.,~.. ~ ~ ~ .................. ~^dd,.ss of o"""""'""'""'""~"~,ii'~i ............................... · _. State ~flu,,urupphcanr ts ~ngr, I~s~,-e~e~~engJneer, general contractor, electrician, plumber or builder. Nora, o~ owner o* prem~,es ..~'A.~...T~ ....... ~ ........ .lff.~.~..~.t...~..~..t ...................................................... If apl 'icant "a c°rp°rate' ~'nafure °f d~ly authariz/Id OffIcer' ~;of corporate officer) ~z - ~. L~at,o, o~ ~ond o, which p~po--.~ ,ark ,,~ be do,.. M.p,o.: ...~ ................................. LOt No.: ../.~ St~ and Num , ............. ~4..... ..................................... ~.~ ...................... ~ ~. ....................................... ~b, ~ ~L~-~- £- ~ o~ 2. State existing use and occupancy of premises and intended use and occupancy of propaesd conetructlon: a. Existing use and occupancy ...... ~ ...................................................................................................................... b. 'nt.nded~s. ondoc~u,~an:. · .~.~. ~-:.. ~t.~ ....... ~..~.~..'...~..~.~ .................. 3.. Nature of work (check which applicable): New Building .................. Addition ..... ~ ......... Alteration ~ ......... Repair ............ i ..... Removal .................. Demolition ....... ~ ....... Other Work (Describe) .................................... 4. Estimated Cost ...... ~ .............................................. 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 ............................................................................................................................................. 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 ...................................................................................................................... 9. Size of lot: Front .........t..O.....0. .......... Rear ..... [.0.....0.. .................... Depth ....(...0...0.. ................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...... '/~.u.....~...t'..~....?.: ..................................................................... 12. Does proposed construction violate,,., i,J _o-- _°nY zoning law,, ordinance or regulation? ............................................................ 13. Nome of Owner of premises~...*...~...fl..~/...I~..!...G...~...L...Address ...~..:..~j~..(..~.../~...: ........... 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 accc ding to deed, and show street names and indicate whether interior or comer lot. STATE OF COUNTY OF ..~. .......... } s.s. ................................................................................................ being duly sworn, deposes and says that he is the applicant (Name of individual signi~9 appli~f~tL_on) above named. He is the ....~ ......... ~.?;.~......~...~..~...~..:~ ........................................................ ~' (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 that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ....... /....¢. ',¢_..2 ...... NOTARY PUBLIC, State of New York No. 52-8125850, Suffolk Cougty. Term Expires March 30,