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Home My WebLink About5301-zFORM NO. 4 TOWBI OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificnte Of Occupancy No..~.~.~.6 ..... rate Au~ ~3 ~9. ?~ THIS CERTIFIES that the building located at Goose Creek Lane (pvt Rd 1 19) ............................ Street Map No .... XX ....... Block No. ~ ...... Lot No..,, .xa~.,.,. $.o3gtho.!d.. NAY.: ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~ ..... 17, 19..7.1. pursuant to which Building Permit No. ~3.O.l.g.. dated .......... [~y .... 1.?..., 19.71.., was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... pr;].v..a.t.e..o.n..e..f..a~..~.~...d.w~.~.~. ~r~$ ..................................... The certificate is issued to ...Eleanor..I.x~e~.c.~ ...... .0~...e?. ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~.,..R.. ............................... ...... '.'.'.(.. :':7 ......... Building Inspector/ l~Ol~ 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) N? 5301 Z Permission is hereby granted to: at premises located at ............. ~"'"~"e~l~"Zll ....... (~ll~.~(~lA~) .................................. pursuarvt to application doted ......................... ~ ...........~1~ ........... , 19..~.., and approved by the Building Inspector. Building Inspector ~ OF souTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~m,~ ...... .~.~.:../..~.,......, ,gZ.(...,. ........................................ , ]~ ........ Permit No ............................ Disapproved a/c .......... ~ ............... ~ APPLICATION FOR BUILDING PIILMII' ~a~ 17 71 Date ............................................................ ,19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plat plan showing location of lot and of bu.ildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which ILpart 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 Jn 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 al.terotions or for removal or demolition, as herein d~scribed. ~j i ne applicant agrees to comply ,with all applicable laws, ord.nanc~cn~lding code,~ousing code, and regulations. ~ (Signature cf applicant, of'~6~e, If a corporation) Goose 6re~k Lane Southold,L/ N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. General Contractor Name of owner of premise~ ...,~.,]:.,?., ~a~. o.?....~.m...e.~,.c,~ ........................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) !. Location of land on which proposed work will be done. Map No.: ........................................ LatoNa.: ........................ 58~ Goose greek Lane Routhold, N.Y. Street and Number Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Private Residence a. Existing use and occupancy ........................ , .......................................................................................................... Private Residence b. Intended uSe and occupant, . ................................................................................................................................ ,3'. Nature of work (check which applicable): New Building ~ ................. Addition .......... .~. ...... Alteration ~. ......... ~.....:.v: Repair .................. Removal .................. Demolitian .................. Other Work (Describe) ........................................ 6500 4. Estimated Cost .................................................. ~ ......... tee .......................................................................................... (to be paid on fi~ing this application) 5. If dwelling, number of dwelling unit1 ............................ Number of dwelling units on each floor ............................ If garage, number of cars ........................................................... '~ ....................... .......................................................... If business, commercial or mixed occupancy~ specify nature and extent of each type of Ual ............................ Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........ i~L ........... Number of Stories ...... .(~ ............................................................................. Dimensions of same structure with alterations or additions: Front ............ ~...~ ................ Rear ..... .._4....~.. ................ Depth .......... .~.~. ................ Height ...... ~...~.. ............... Number of Stories ............./. .................. 8. Dimensions of entire new construction: Front .......... /..(~ ................... . Rear .......... ./.Gt ............. Depth ....~....~/.. .......... Height .../...~.....~ ...... Number of Stories / ! 1. Zone or use district In which premises are situated ..................................................................................................... 12. Does prapoald construction violate any zoning law, ordinance or regulation? No 13. Name of Owner of premises ~.Z..e....a.~....o.~ ~.~.e..e..e.~AddrellG...o.~se Creek Lame Phone No ..................... Name of Architect ...................................................... Addre~i ............................................ Phone No ..................... Name of Contractor Robert Ma11~raf Abe--...G...o. ose Creek Lane ~u^765 2137 ................................................................................................ Phone PLOT DIAGRAM ~ :.~l~t~te clearly and distinctly oll bulldlngl, whether ex ?tng or pra~t~ed, and indicate all alt-beck dimensions from p~lines. :Give street and block number or descrlptmn according to deed, and ~how street names and indicate whether interior or comer lot. · STATE OF NEW,_YOP~d~ , ~ · I · · COUNTY OF Robert C. Mall~raf _. ................................................. ~ ........................................ ,.....memg duly avmrn, dep~cees and ac~ ~ he la the cppllcam (Na~ o~lndlvldual ~lgnlng a~llcat~) o~e'nam~. He iS the ................................. ~ ................................ .~. ....................................................... (~nt~r, ~t, co~m~ efflcer, ~.) ~. ~ld ~r ~r .~er~t ~n~ I~ d~ly au~rl=~ to pe~rm or h~:~do~ the ~ld ~rk a~ to ~ ~d f le m app,cat~on, mar a, arateme~ conm~n~ ~n thll epp catl~ a~ ~ ~e ~ of hl~ ~l~e a~ ~li~; and ?at th~ To~ will ~erfo~d In the manner ~t fo~h In ~e'a~l~l~fl~ ~1~. ~w~m ~mre~_..~ m,, ~ay 71~~~/ / 9 ........ ......... ............. .,, ........ .............................