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Home My WebLink About5287-zNO. 4, TOWN OF SOUTHOLD BUH.IlING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No. Z,.~2c)3 ...... Date .,Tla34r. 2.~ .................. , 19.73 THIS CERTIFIES that the building located at .. 61,~. Gagena .~dlag. Rd,Street Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .Pa~y. ~,0 .............. , 19 .~.$. pursuant to which Building Pemit No. ~287Z.. dated . .14alt..3,2 .............. , 19.71., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued iAecemsoz',J. ~tox'a&e .BuLI.~ .......................................... The certificate is issued to ...E~¥a_-d. J., .Fa~zor, el~k~l. ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .............. NoR, ................. UNDERWRITERS CERTIFICATE No ....................... i,R, ................. HOUSE NUMBER ...61~ ........ Street . Building Inspector / FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5287 Z Dote .......................... .14&y.....:l~ ............ , 19....~.~. Permission is hereby granted to: .............. Rdwe~m~&..,T ..Fe,~ee ~emmk~4~ ................. ..................... ~o~xo~t ....................................... to ..... Sa~l.& ..eeeeo~e~j,..{.otel~e}.. ~tt~d~ ................................................................... at premises Iocoted at ........Q&~'~II~"I;~I~I~;"~ ........................................................................ pursuant to application dated ................................ ~ ..........~'. ....... , 19..~.$., and approved by the Building Inspector. Fee $~[e.~,O .............. Building In~l~ector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ............................. '(:";'i '~¥~'~' Inspector) / ............... APPLICATION FOR BUILDING PERMIT Date .............. INSTRUCTIONS a. This ~3pplication must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan 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 Perm t 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, hous~ode, and regulations. · 'g ~ ~p,)pi it, or n~l~ ,~orpora~l~n~ State whether applicant :s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................................................................................................. Name of of premises ~...~./~.. ............ d.-.......~..~.~....~.....~...~..~.,.~. ~ ....... owner l ............................... ~ k~at on of and on wh ch pr~d work will be done. ~p No.: ............. L~ ~ Z ................................ ................. ................... % ........ ............... ...... 2. State oxistino us~ ond occupancy o~ premises ~nd intended use ~nd ~cuponcy o{ pmpo~d construction: o. ~i~itino use ~ ~cuponcy ......... ~ ........................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Nature of work (check which applicable): New Building ......... Addition .................. Alteration .................. ~'~ Repair ..................Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............................................................ Fee .......................................................................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. Jf business, commercial or mixed occupancy, specify nature and extent of each t~pe of use ............................ ! 7. Dimensions of existing structures, if any: Front .i.....~-..../. ........... Repr ......... ~..~ .............. Depth .....~'./. ....... . Height ................ Number of Stories ................................................................................................................. Dimensions of same structure with olterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions o,~ entire new construction: Front ..... ~...~...../.. ............... Reor ....... L...0.../'.. ......... Depth .....~....: ............. Height ..~' ............... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation;~ 13. Name of Owner of premises~?.!),...~..~"~.E,~.>'.~,-~2.C~,.~..Acldress(~.,~.~.~..~...~.Z.~....~)Z~..~ ...... Phone No~...J.~.-...~..J....~..~.. Name of Architect .......................... ./..t. ........................ 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 corner lot. STATE OF NEW~OR)~/ //z [ cc ~ COUNTY OF ..,~.~. ........ J'-~ , .............. ~~.i~.~....~ ......... being duly sworn, deposes and says that he is the applicant --(Name of individual signing application) 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 ond file this application; that all statements contained in this application are trUe to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Swom to before me this , ~~~'~ ~. ...... ..... of ........... ............... . V mui~fly PU6LIC, Stye of New York No. 52-8125850, Suffolk Cou,[gy Term Expires M~rch 30, I~ 7 ?