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Home My WebLink About5401-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupency No..Z1~327. ..... Date ............ &g&,uz.t... 9 "" 19. '71 THIS CERTIFIES that the building located at . 'W/S'' 'lt®ut~ 'Harbez.' i~['. Street Map No..z~c~ ....... Block No ..... zX--.Lot No .... ~ .... Seuth~l~ "I¢4Y~' .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ July ..... 15' ' 19'71' pursuant to which Building Permit No.~L .~i~01E. dated .......... July .... 15' '" 19.7'1" was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thisicertificate is issued is ... ~iva.te. one. family-ch~elting ......................... ,! ........... The certificate is issued to ' 'Rl~li&/'cl' '& 'BAY15/'A' M6¢,~"~;,~,'~ ...... 0~ner.! .... ..... ~b~/f~7,'l~ssee or tenant~. of the aforesaid building. '~ Suffolk County Department of Health Approval ·.. I¢.o.R ~ ............................ House 8 '0 Building Inspectot TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMIS~ES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 540 Z Permission is hereby granted to: ...................... ~.~.~.t~.e.l~ ....................................... at premises located at .. pursuan,t to application dated ............................. ~..~. ........~.~....~....., I92~...., and approved by the Building Inspector. Fee $...-.~.?...~... ........... Examined .... ~..../....~... ......... Approved ' \ ToWN OF SOUTHOLD' <;, BUILDING DEPARTMENy TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ] 9 ........ Pemit No .............. Disapproved a/c .......................................................... Application No. '"~ ~'/ APPLICATION FOR BUILDING PERMIT Date ...Z.,,'~..../..,~., ........................ . ,9,~,,L~',.... 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 end of buildings on premises, relationship to adjoining premises or public streets or areas, end 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 l~e 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 o 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. '" i"i~'natu;e of aPl~¥~~i~;i ........ (Address OT oppdcant} State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... .......................................... : ................................................................................................................ Nome of owner of premises .~.I..C..~...~..~..~......'.'~Z'.....p.~.....~...L:~...~.,~...~.. ...... ._,~......~....4/.j~...~....a'..../~.....~.~....~...~.. .................................... If applicant is a corporate, signature of duly authorized officer. ~ .................. ......... 1 Locat on of and on wh ch proposed work w be done Map No' ' '~ Lot No ~ ~% Street and Number ...~..~...~..~...~.~..~...~.~.~:...~..~..-. .............. ...~..~. ....................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: occuponcy ~.~ ~'~-/--/'/~ ~ a. Exisiting use and ............. : ...... ... ........................ ;..~..~:~..~..~ .......................... :,' ................... b. Intended use and occupancy .................................................... ~' c*'/a~. U' r.r...4..~_! ................................................... : ....................... 3. Nature of work (check which applicable): New Building .................. Addition ...... ~ ...... Alteration .................. Repair .................. Removal .................. Derfiolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............ ~.....~:'..~...~. ..................... i ........... 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, spec~i/f7, %ature and extent of ea,ch type of use ............................ · ' n /~ ~ ~ 7. D~mens*ons of ex st g structures, ff any: Front ......... .~::..~ ............ Rear ...... ..~.. ..................... Depth .~ ........... Height ........................ Number of Stories ............... l .............................................................................................. , ..... ........... Dimensions of same structure with alterations or additions: Front ............. ..~...~.. ............... Rear Depth ......... ~..~.. .............. Height ............................ Number of Stories ........../. ................... 8. Dimensions of entire new construction: Front .............. /../~... ............... Rear ............ /.~.. ......... Depth ../...~. ............... Height Number of Stories / 9. Size~of lot: Front ....... ./.~...~.. ............ Rear .............. ./..~....~. ............. Depth ....... ..~..../...~. ............... 10. Date of Purchase ........................................................ Nome of Former Owner ~....~..~'.....~.F...~....,~......~..~-./..Y...~.. ........... 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 ~../..~.~.~...../~.f..~..~.e...~.£.~lress .~.~...~.~.~..~..~..~....~: ............. Phone No..7...~...~.Z..'~..~..~.7. 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-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior r rnrnar In+ · ~1 STATE OF NEW' Y.,ORIg..., J ...- COUNJ--Y Of ..~...}'~'~ . ~-.~~'~.....~........~ ...... : ................. being duly sworn, deposes and says that he is the applicant ~r~arne of i~fclividual sign'~g appdcation~ 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 and file this application; that all statements contoined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application, filed therewith. Swam to .,be_.~ me this Suffolk Counfy 52-0344963 No. Commission Expires