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Home My WebLink About5093-ZFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi icnte Occupnncy No...~378 ..... Date ........... Sapt.. ,~. ........ , 19. THIS CERTIFIES that the building located at ...il/. Camp. l~I~nee~.a. ~¢!..-, Street Map No..x~ ........ Block No..Xx ....... Lot No.. -xXX .... liat.t,l, tuek... N,~, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Dine .... .l~ .... , 19.70. pursuant to which Building Permit No.~)9.~Z... dated ............ Dec...be .... , 19.?0, 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 is .. Pr.:Lvate .o~e..£am~.]..y -dw®]:]./~g ...................................... The certificate is issued to ...g~..~a. ¥oung~ ~the~es-. owner ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....... I¢;B'. ......................... lieuse ~ leO~'O Ca~p P4L,~eola Rd.L/~,, , (// ./~,.,.:7'~',' , Bdilding Inspector FOih'~ NO. 2 TOWN OF $OUTHOLD 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) 5093 Z Permission is hereby granted to: ............... ~Lr,~..?,~:~.~..~,..~.tJ~.~ll. .................. ............... · ~ ~-.---~,ir.~L3,],~..lie~J ....................... .................. T,~m,m~; ..li'~l~e~ ...... .T~3, ~ .............. to ...~l~.Z:L.'-~...~:;t.~.~,J, gz~..~..~.J,~.L~'~..i~.ell~m~ ........................................................... at premises located at .......~',~..~?~,;..~,.~e...O~'~L:..*,~.~../.~4;~.,/'~J,i~:LJ..~ .................... ......................................... i~,&.t, ~I~, ....... L,~,, ~..~o:~. .................................................................. pursua:n~' to application dated ............................... ~.~4 ........~ ......... , 19.~.., and approved by the Building Inspector. JJJJ/~Jt J~l:J~J~t, J.~lJlJll~ ~13JJe~e~l~ ~ ~1~ 0~.~*0~ ~l~;h ~;F~I~,~ Fee $..~.,*.Ct~. ............ Building InspectorI TOM/N OF SOUTHOLD/~,~ BUILDING D EPARTMENT,~/~/Z//~/ TOWN CLERK'S OFFICE / APPLICATION FOR BUILDING PERMrT ~:~ ~t, ....................................... , ~9.~.. ~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot God of bu.ildings on premises, relationship to adjoining premlees or public streets or areas, aod giving a detailed description of layout at property must be drawn on the diagram whlch c. The work covered by this application may not be commenced bafore issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Su~h 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 hove 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, aod other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations or for removal or demolition, al herein de~rlbed. The applicant agrees to comply with all applicable laws, ordinances, building cede, housing code, and regulations. ........ / (~ddress of oppllcant) o,_., .... ........ ...................................................... If applicant is a corporate, signature of duly authorized officer, (Name and title 'of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ....; ................... , Street and Number '~'"~...~"~".~b/~..~'"..~'/'~'~..~.~...~..~~...~.~')~,....~...~..).~,:d.... ___ i , __ .:. , __~ ' ~" /7~/- 9o..~/~ M,,.,c,pa,,~, / /").~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construotlon: ~' ' a. ,s,,ng,,a,;occupanc ............ ............................... b. Intended use and occupant, . ..........................~..~.~.....~...f..~.~.....~.~.r~.~..~.~....~...~....~.~ 3. Nature of work (check which applicable): New Building ~ ................. Addition ~ Alteration Repair .................. Removal .................. Demolition .................. Other. Work (Describe) ...................................... 4. ,t, oted Cost ....... ............................... Fee ...... ................................................................. (to be paid on fi!lng this application) 5. If dwelllng, ........ /. ................. Number of dwelling units on each floor ...... / .................... nurTlber dwelling units If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions~of existing ~tructures; if any: Front ..... .~....~... ............ Rear .....~..-~.~... ................ Depth ....~. ~..'~.. .... 7. Height ...~-.~..~.~..~./...~-~¢Number of Stories ...... ~. ......................................................................................... Dimensions of some 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 .....J..~..~......~....~.:~ ....... 10. Date of Purchase ......... /...~.~,.~....~.. ............................. Nome of Former Owner ...~.~.o~....~..W~4f/.~. ............ ] 1. Zone or use district in which premises are situated ........ ~..~..;. 12. Does proposed construction violate any zon ng ow, ordnance or regular on? ..... [...~'....~.. ........... .L.,/~./'/E,r, ........... · ~.~/' ~ I/~ __~//~r~!~ /.~c~? //~ ~ ~ .... 13. Name of Owner of prem,ses ./.c.~.;./a....~:.../Y~..~..~..~.Address ....f~.....~....~.~r~.//.~...Z~.dZ.... Phone 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 interior or comer lot. SEE STATE OF NEWL"TORi~ .E tee COUNTY Of-;~ ........ ................... ~....~. ....... i .................................................. being duly sworn, deposes and soys that he is the applicant (Name of individual signing application). above named. He is the .............................. ....'::'=sj:~4;.k~ ................................................. jL ....................................................... ~ (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 contained in this application are true to the best of his knowledge and belief; and that the work will be perfgr.~ed in the manner set forth in the application filed therewith. Swam to before me this ( ~ ...... ~.... Cay of ...'~¢~¢~.¢~.~;1.~ ........ , 19-¢,(-.) ~-Z.~"/~~,,,~,,.,.,., ' No. 52-8125850, Suffolk Coun~ Term Expires March 30,