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Home My WebLink About5213-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Of{ice Southold, N. Y. Certificnte Of Occupency No. Z~312 ...... Date ............. Aug..9 ........ ,19.71. THIS CERTIFIES that the building located at Three .~d&tera La .......... Street Map No. 0rJ. ent. by ~ck No ..... l .....Lot No. b2 .... 0r~t.. ~ ,~. ............. conforms subst~tially to the Application for B~lding Permit heretofore fried in ~ office dated .......... april. · .3. , 19..~ p~su~t to which BuildMg PemB No...~l~. dated ............. Apr,.. ~, 19..7~, was issued, ~d confoms to all of the req~e- ments of the applicable provisions of ~e law. The occup~cy for which ~s ce~fficate is ~sued is .~wate. a~oes~. ~ld.~g ........................................ The ce~ificate is issued to ...T~ .Ke~y. & :dire...~era ...................... (o~er, lessee or ten~t) of ~e ~ores&d building. S~olk Co~ty Dep~tment of Health Approval ...N ~., ............................. .... /. -1.'~ ~-~ ...............1 ............. Burid~g Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUli~DING PERMIT Ci'.HIS PERMIT MUST BE KEPT ON THE PRF-MISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Pe~issi°n is hereby grant~ ~ ~ A ~ ~ Tk-~k'SA ~,~,~e~,~,e~ ~, ............... ~.5~ ......... ~4~..~..~.~. ....... ~.~.~ ......... ~e.~.~:~ ........ ,pursu~ to ~pplication deted ............................................... , 19 ~nd app~ by the ~uJlding Ins~ctor. :Fees ..... .~.~.. ..... ................ Buildinfl ~'~f_..- '~- ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. AD roved 97'I p .... Z. rr ............................. ~t .,,~.., ermlt i~o ............................. Disapproved a/c ........................... ~ ...................................................... ................................................ ............ (Budding Inspector) Apphcat~on No.....~-.?.../....':~... ~ FOR BUILDIHG PERMII' ..... .. ....'7.,, INSTRUCTIONS a Th~s apphcation must be completely filled in by typewriter or ~n mk and submitted ~n duphcote to the Buddinf Inspector. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or pubhc streets o areas, and gwing o detailed description of layout of property must be drawn on the d~agram which is part of th~s apphcat~on 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 ~ssue o Building Permit to the applicant. Such permi 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 o Certificate of Occupanc; shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Budding Permit pursuant to th. Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, Regulations, for the construction of buildings, additions or oHerot~ons, or?or removal or demolition, os herein described The apphcont agrees to comply with oil applicable laws, ordmanc~_~~i~b d ~ng code housmg~ode, and regulations (Address o{ applicant) / State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budder ........................... .... ......................................................... Name of owner of premises ...... ~...~....~...~.......~.......~.~....~?...~...~.. ..... ,.~..~...~ ~y. ....................................... 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 ...~.Z.~..7 ........ Lot No.' ........... Street and Number ...~..~C ./..~..~....~....~..~.....~/..~...~../F_~ ~Zd~ ~ [ ~ ~ Municipality 2. State existing use and occupancy of premises and ~ntended use and occupancy of propos~ construction .' )~ /~ a. Existing use and occupancy ..................................... m ..................................................................................... b. Intended use and occupancy .............. ~.~.7.2.~.~ ............... '~.~ ........ .~c ~ .......... ~.'l ..................................................... Nature of work (check which applicable). New Building ....... ~ ......... Addition ................. Alteration ........ Repair .................. Removal .................. Demolition .................. Other ~'ork (Describe) ............................ 4 [stimoted Cost ..........~..'.... :. ....................................... Fee ........... .~. ...................................................................... (to be paid on filing th~s opplicahon) 5 If dwelling, number of dwelling units ............................ Number of dwelhng umts 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 .......................................................................................................... D~mens~ons of same structure with alterations or additions: Front ....................................Rear ..................... Depth ................................ Height ............................ Number of Stones ............................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ................. Height .................... Number of Stories ............................................................................ 9. S~ze of lot: Front ............................ Rear ................................. Depth ............................ 10. Date of Purchase .................................................... Name of Former Owner .................................................... 11. Zone or use distnct in which premises are situated .............................................................................................. 12 Does proposed constructmn violate any zoning law, ordinance or regulation2 ................................................... 13. Name of Owner of premises ................ /. ....... /.~.~... ddress ............................................ Phone No ................. Name of Architect .................................................. Address ........................................... Phone 1'4o Name of Contractor ............................................... Address .......................................... Phone No ............... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and ind.cate all set-back d~mens~ons fro~ property lines. Give street and block number or description according to deed, and show street names and ind~cat whether interior or corner lot. STATE OF NEW~'OR~/ ~/ t c $ COUNTY OF ...,.~..~.~.Lr-:?~.... ........ )'~' · ........................................................................................~' bmng duly sworn, deposes and says that he ~s the apphcan (Name of indiwdual s~gning apphcat~on) above named. He ~s the .................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the smd work and to make and fil this apphcation; that all statements contained m thru apphcat~on are true to the best of his knowledge and belief; that the work wdl be performed m the manner set fo~h ~n the application filed therewith. No 52 008n~50 Qualff~ed ~ ~ulfol~ (]ounty