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Home My WebLink About5347-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z .b,3.2.8. ...... Date ........... .~...u~..S~..' .9 ...... , 19..71.. THIS CERTIFIES that the building located at .. H/S .l~l.~le. Pal .......... Street Map No. X,X .........Block No.. XX ......Lot No..XX. .... S0.u.t. h0.ld...~ ......... co~orms subst~tially to the Application for B~ldMg Permit heretofore ffl~ in this office dated ..........J~e...~.~. , 19..7~ p~su~t to which B~l~ng Permit No. ~3~.. dated .........J~e--~.~ ....., 19.?~., was issued, ~d confoms to ~1 of the r~e- ments of the applicable pro~sions of ~e law. The occup~cy for which tMs ce~ificate is ~sued is ... ~e s~ .bui.ldin~ .-. a~ce s so~.. s to~age. ~t~. ................... The certificate ~ issued to . ~,F,Y.~.er .........~r .......................... (owner, lessee or ten,t) of the Mores~d b~ld~g. S~olk Co~ty Dep~ment of He~th Approv~ .... N'.'R; ........................... House * ~62~ ,,~.,~,~ ~ I~0~t 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? 5347 Z Permission is hereby granted to: .... &, ~', ~ az,g.u~,,:...g.~:~.. ~.e ~.~l,ee.. ~Tam ........ ........... ILt.~'~'~'e--i~ ............................................... to .... J~LLL1.~.. a~m..l~l..,~ t,/.~li~ o... ~, &Il ~ ~-~ oi J .~ .. ]IalL'L~.:LI2~ .......................................................... at premises located at ............... .~3/~.....l~,j.~jeL.3.e..~t~t~j ...................................................................... ............................................................. ~ eu, t, irae3~L ......... I~.lr. ............................................................ pursuan¢ to application dated ......................... ~13~Ji ....... '~'~ ............. , 19..~:j.., and approved by the Building Inspector. Fee $...J~,4~ ........... · ' ~ Buildihg Ins'~ect~r / FOB~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. ....f. .............. Approved ........................................ , ~0....?... Pemit No....~.....~,.~,...~...,,..~.,,. ..... Application No ..... Disapproved o/c ......................................................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS This application 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 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. (Signature of applicant, or name, if a corporation) ........... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~.,~ .~,,~,... ,,~,,~,w3~,..L~,,~ ....................................................................................... ~~~_/;r~te,~of duly authorize_~ficer. ............... ....... / (Name and title of corporate officer) 1. Location of land on which proposed wo, r-I~will be done~ Map. l~.: ................. h Street and Number .................... ..~./~.......~.~.=~ ...... ~ .............. ~..~...: ............................. 2. ~tate existing use and occupancyC,~ __/~°f'~premises and intended use and~ occupancy of proposed constru~ction: b. Intended use and occupancy ...................................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. ^Iteration .................. Repair .................. Removal .................. Demolitior...L.~ ............ Other Work (Describe) ........................................ 4. Estimated Cost ....... /...~....~,....~..~... ..............Fee ................................................................................... (to he paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ................................................................................................................................... '-'"'"'~z~'~";,7".''; .... 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_/at entire new 'construction: Front ......... ~...~.. .................. Rear ........ /....O... ............ Depth ..~.....4~.. ............. 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 construct on v o ate any zonJlN3 aw, ordnance or reg~ at on? ~....:~. .................................. 13. Name o Owner of prem,se~., .~,..~/~, ~..~.Address~4,t~?x~... ~ ~.~....~Phone No. 2~.~...~ .~.~ 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~ according to deed, and show street names and indicate whether inter~~er lot. ........ ,,., .om. o., above named. He is the ....~..~..~....~e'~...~...C.~....(j~.~:.'.t:.'.~:~ ag~o..q~~.e~...c?.~.. 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 thor the work will be performed in the manner set forth in the application, filed therewith. Swam to before me this ....... ...... ........ ........... , ~ Y/'_~-~/"~ ,~'/__ '/~ · ./.~.~... : /....'..L~ .. Notary Pubh ........ County (Signature of applicant) ....................... ELIZAB£TH ANN NE~flLLE NOTARy PU~/IC, State of New York N~. $2.812,~, :$utfolk Count Term'.E~,re~'M~r¢~