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TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..l~$~,:Le.~t;~..D~.l.v.e~..~e.~l.t;,..J~e,z'tQ~ Street Map No. ~l.Z'lO~DO~lock No ..... ~?...*. ............ Lot No...~. ........................................................... conforms substantially to the Al:~plication for Building Permit heretofore filed in this office dated ........................ ~J~...~ ................. , 19...~)., pursuant to which Building Permit No .......... ~L..~6,0 ...... dated ........................... ~.....8.. ............ 19~..~wa.s issued, and conforms to all of the requirements of the applicable provisions of the law. The occupa, ncy for which this certificate is issued is ................ F~ Z~.A~.. ~... ;R~I~Z.. ~.~ ~g, ...................................................... This certificate is issued to .~A:~9/,..,T~O~...~ ..................................................................... (owne,r, lessee or tenant) of the aforesaid building, Building Inspector FOI~ 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? 760' Z Date ......................................................... Permission is hereby granted to: Che%. Orl~ski A/..C. Andrew Lemon .......... .C..u. ~.e. ~.o. ~...e. ,.... ~.:~.: ...................................... Build new one family dwelling ....................................... at premises located at ..~o.~.~;.~,..~.ia~.~a~o .................................... ~il!~t..~. ~r~..v.e~ East ~arioa, ~.Y ........ pursuant to application doted ................................. ~1~.......~ ...............1~......., and approved by the Building Inspector Fee $~.,...oq.. .............. Building inspector ,/ NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .......... ~.~;, .~:~Zl'...~...Pe m',t No ..... ~--,.------~-/~-~-~ .... Approved Disapp roved a/c ~.._. ~ J~ ......... (Building Inspector) Application No .......~.~....~.. ...... APPLICATION FOR BUILDING PERMIT~ ? Date ...................... ~.~. L~.. ........... ~ ............... 19 ..~.~ ....... INSTRUCTIONS o. .This application must be c~)mple, tely 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 of property must be drown on the diagram which is port of this location. c. The work covered bv this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit shaft 'be kept on the premises available for inspection throughout the progress of the work. e. No building shell be occupied or used in whole or in p art for any puYpose whatever Until'o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end 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 ail applicable laws, ordinances and regulations. (Signature of,applicant, or name jfa corporation) (OHester 0rlows~) .. 4-..z. '.: ..................... (Address of applicant) State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. General Contractor · ANDREW M. LEMON & HAZEL B. L~MOE, his wife Name of owner of premises ........................................................................................................................................ 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:2g~..8...r...~...a..r.'.z..°R...~'..n.9..r. ....... Lot No: ~.l. ................ Street and Number ............................................. Municipality 2. State existing use and occupancy of pr, emises and intended use and occupancy of proposed construction: ,~,~H ~ - vacaut residential lot a. Existing use ...... cupuncy ..................................................................................................................................... b. Intended use end ~ccupancy..~.~.~.~....e....8.t.~9.t.~.~.?..e..~.`.1~.1..~.~...&...?.~.~.~..e...~.~.~.~.~.e...~.?..~.~.~ ........................................ 3. Nature of work (check which applicable): New Buildlng.~ ................ Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .............. /..~.'..~.~..Cc~ ........................... Fee .......... ./....~...'......~... .............................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling umts ................................ Number of dwelling units on each floor ............................ If garage, number of cars.......~...© ................................................................................................................................... 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 of entire new construction: Front.~.~.~'.*. ................. Rear 75~7" ~ "S1~6" ~ 27~ ............................ uepTn ............................ Height [6~ Number of Stories ~e 9. Size of lot: Front [00~ Rear [00~ Depth [00~ 10. Date of Purchase ....... ~..~...~ ....................... Name of Former Owner ~eCe~ B[~ ~ ~eCe= 11. Zone or use district in which premises are situated...A ...... T.....~[~E~ ......................................................... 12. Does proposed construction violate any zoning law, ordina~ m re~Jatioo?~ ................................................. 13. Name of Owner of pr~is~s.~..~z..~g~ ......... Address~.~.~.~...g.~.~Z..~...~ .......... Phone NO. Name of Architect ........................................................ Address ........................... Phone NO.~... ~'~'~ X~e~' - . . Chester 0rlowski ---- Cu~choEue, L.I.,N.Y. ~- NO pE-4-6782 PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. Zor 22 - Cook STATE OF NEW YORK. ) S S. COUNTY OF ...S..'g.Y.~.0...T~... ........... ) 0~STER 0RT.0WSKT ..................................................................................... be ng duly swqrn, deposes and says that he is the applicant (Name of individuol signing application) CONTRACTOR 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 contained in this application are true to the best of his knowledge and belief; and that the work wJJl be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ / / .-~- ,'~ /2 n . ............ of .......... ....... Notary Public, ~~.~.~~.~.~.,... .... .~ ~ ~0, ~ · FORM NO. 1 TOWH OF $OUTHOLD BUILDING D£PARTM£~T TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........... ~~.~ 9......~. Approved ........... ~....~...~9...~ermit No ........... ~....~..~.. ~/ D'sapprovedl a/c ~~')-'- ) ,~ (Building Inspector) ~' (,~7 Application No ....... ~... APPLICATION FOR BUILDING' PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and suComitted 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 of property must be drawn on the diagram which is part of this location. 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 e 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 ~u]'pose whatever until o 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 Sou'thold, Suffolk CountW 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 and regulations. (Signature of applicant, or name, if a corporation) (eheeter Orlowe~i) ?..n. ' ...C. ¥.: ........................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. General Contraator · ANDREW M. LEMON & HAZEL B. l.~O~ his w~fe Name of owner of premises .......................................................... ,;, ...................................................................................... 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. MaD No: ~..~f.....2..O.~.8....'....~..a..r..~.°..n....~....a~..?.rLot No: ..2..1. ............... Street and Number ...G..~.]:.l..e..~..~.e.....D..~.~?...e.~....¥..a..r.~.°..~...~?,.r.~..-.E.~..~.~.q~.~.~.t.~.!~.t~.t ................................................ Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ?...a..°..a..~.~..?..~.~,d..e..n..~,.~...a.l....1..9.~ .................................................................................. b. Intended use and ~ccupancy.....~....e...`~.~.q..~.....D~...e..~..1.$.n.~....a~...d...~..a..r..a.~.e....~.9..r'..~..~ ..................................... 3. Nature of work (check which applicable): New Building......~. ............. Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ............ ./...~....,~.?....~Tg.. ............................ Fee .......... /....d..:..~ .............................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling umts' ................................ one Number of dwelling units on each floor ............................ one If garage, number of cars...~9. ..................................................................................................................................... 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 of entire new construction: Fron,..?.~.'....?.'.'. .............. Rear ?:~' ?,t Depth :~1'8" & ~?~ Height ....... ]~6.! ................ Number of Stories ..o~..e. .................... 9. Size of lot: Front .......~90.! .............. Rear .......... .]:..0..0..~ ........... Depth 100' ^ Peter Blank & Peter Blank, Jr 10. Date of Purchase .....':l'..~%..9..~*...~.g.~.g. .......................... Name of Former uwner ........................................................ !1. Zone or use district in which premises are situated A * Resicl, ential 12. Does proposed construction violate any zoning law, ordinan~% gr.~zneregul, ation?~ree: ...N..0. .............................................. ]~r M , . .................... 13. Name of Owner of premises~l~W..M~,..ZD~J0~ .......... Address .G..~.~...~....0.~..~.....~.~......]~.. ......... Phone NOPI'1'26§8 Name of Architect' ........................................................ ~one Address p%'~Q'~'~B"~,9'6'~.'~'6 ................ Phone NO ..................... Chester 0rlo~eki Cut~cho2ue LI NY ~,- NO.P~.-.~.~.?..8.~ .... Name of Contractor .................................................... Address ............................................ mane 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. ~r 22 STATE OF NE'v~..,~Q,I~.,,~, ) S S. COUNTY OF ...~..uz:~:.u..%~.. ............ ) ~ST~ OR~WSKI ................................................................................................. being duJy sworn, deposes ond soys ~ha~ he Js ~he app~ican~ (Name of individual'si~ning application) ~ CO~CTOR above named. He is th~ ............................................................................................................................................................. (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 performed in the manner set forth in the appli~tion filed therewith. Sworn to ~me this~LY ~ ~at~' .............. ~ ...... .-, -, ~da~ of ...... ~ .......... ? ........ ~ ........... 19.~ ........ ,u, · .,~O~- . . I~oturv /'uI]r , State of Ne~ York Nota~