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Home My WebLink About5370-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMEN~ Town Clerk's Office Southold, N. Y. Certificate Of OccupaCtcy No..Z1~26~ ..... Date ............. ~l"lalao..22 ...... , 19 .71 THIS CERTIFIES that the building located at . .N/8..14aI~l.e. 1~. (PVT. RD) Street Map No... ~ ....... Block No .... ~... Lot No. 3~ ..... lla~lTaok ·. H..~, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Jlln® .... 2~" , 19.7]. pursuant to which Building Permit No...~3gOZ dated ........ Junte ... 22., 1971.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occUt~ancy for which this certificate is issued is .. Pl~ivate-one .family. d~ell;tlag ........ ' ............................. The certificate is issued to . ,Frar~tl~ ~l~o~a ...... 9;~tel~, ............... , ........ of the aforesaid building. Suffolk County Department of Health Approval Heuse ~ (owner, lessee or tenant) · I~.~R, ........................... t·~aple La [/ , , ~ FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMEN1 TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5370 Z Permission is hereby granted to: .................... ..~,',t~l.e,...~.~ ....................... ~. ................. ~J.~tc~ ................................. to ........ :~uilct..~..,~.lt, l~:~..~,..e~l~.Ci~4~..&~l~ ...................................................... pursuon,t to application dated ................................. ~.~:~t~.....~.i....., 19...~.~., and approved by the Building Inspector. Fee $...,~. m ~ ........... FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN'r TOWN CLERK'S OFFIGE' SOUTFIOLD, N. Y. Examined . 19~-~) { Approved 19 ........Pemit No. ',..~...~ '7 o Applicution No ................................. Disapproved a/c ............ APPLICATION f:OR BUILDING PERMIT Date ........ ~.....~.~.....~.. :;...., INSTRUCTIONS a. 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, relatiqnship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn ~n 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 ~ 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 ~n 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, buildihg code, housing code, and regulations. ' ~u!e~'~'"~ '"~'of ap~ ........ ~'~"~ ............... ....... · State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ z.--r ...................................................................................... '74 ............................... Name of owner of premises ................ .~._...~.~...~...~.,~.......--~-......b.}....X ....... .....~z ........ ,,.....-~..fl .,¢C~ ......................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No.: .. ..~...~...~..'ff~.J...~...~...~... Lot No ......................... Street and Number . .L/~.~...~..~..~_. .~..~.,/6~,.~ ].?...~..q ~ ~.X~...~..I .~.,~.... ........... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................... LJ.~...~.%.i....~..~.../~....~i.C .................. b. intended use and occupancy ........................... b...~.....%cJ...~, ...... ~ .......................................................... 3. Nature of work (check which applicable): New Building .................. Addition V~ ~' .................. Alteration Repair .................. Removal .................. Demolitior .................. Other Work (Describe) ........................................ 4. Estimated Cost ............... l..,O...~...?. .............................. 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~ If business, commercial or mixed occupancy, speci_f7 nature and extent of eg~;;h type of use ............................ 7. Dimensions of existing structures, if any: Front ........ "~--~..?.......! ..... Rear ............ .~......~.. .......... Depth .... Height .. I~..~.~ Number of Stories ................ ~. ...... Z..~....~ ............................................................... Dimensions of same structure with alterations or additions: Front .......... ~..~.....'~.....,~. .......... Rear ...~....~r.. ..... Depth ........ .~..~. ................ Height ......... ~.~l..~l...~.....Number of Stories ............ ~..'tJ.....~...~... 8. Dimensions.~f entire new construction: Front ................ /...~.. ............. Rear ......... ~/..~. ............ Depth . /.. .. .~. .. ............. Height ....... :.~ ........... Number of Stories ....................... .O.....~......,~,. ............................................................................... 9. Size of lot: Front ...... ~ .~3 Rear ........... J....~...~ ............. Depth .................. ~.(~.....~... 10. Date of Purchase .............. !..~....~....~ ......................... Name of Former Owner ~'"~ ,.c...fl...~z ~c ~' 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 ....~..~..~..d.....k......&.~...tC....~.......^ddress ~ ~ ~~ne No.~.?.?..~ · . Name of Architect ...................... ~ .................. Address ............................................ Phone No ..................... Name of Contractor .................. ~ .................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, ~nd indicate oil 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 N E'¢~OI~I~, ~ ,~.O...U.~Z..~~..~...~..~OF ~........,f'--.,-~L ~-~. ....... . . . ....... being duly swam, d~oses and says that he isthe applicant above namedtName at maw.aua~ ~nm~~He s'the'h (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy 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 fo~h in the applic~ion filed therewith· Sworn to before me this ..................................... ............................... Notary Publi~~.. County ~~";'~:~ of appllcant)