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Home My WebLink About862-zFO,R~ ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF'OCCUPANCY No ........... .Z....7..7. Z. Date ............................... ...~..~y., .,2.~. .......... , 19...6.9. THIS CERTIFIES that the building located a~ .~1.. Map No..lk~,.... Block No ....... ~*.*......Lot No3~ &.,~O~;~...:~.7 ....................................................... Parms conforms substantially to the Application for Building Permit heretofore filed in this office dated Sepl:ember 30 1959 pursuant to which Building Permit No. Z 862 BeI~%elabe~ ~{} 19.~.9..., w.as issued, and conforms to all of the requirements ~lated ............. , ................................. , of the applicable provisions of the law. The occupancy for which this certificate is issued is ................................................................. 131~I.V.A~I~ .. 0I~...F~/4 .I.L~-..I~ tJ~]l;~ ....................................... This certificate is issued to M~l~elle Del~pewolf, ow~l®r (owner, lessee or tenant) of the aforesaid building. · ! Building Inspector TOWN O~ $O~TBOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI'IOLO, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? z Permission is hereby granted to: .~./..~ Pine Tree Ro~ pursuant to opplication da~ed .................... .~pte~,~...~J ................... lg.~c~..., end opproved by the Building Inspector ' Fee Buiidinfl Inspector FOltM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined. ~-~~.~ 19~.... Approved~.f2/z'-~/ ~ 19~..5~.~..Permit No ......... '~., ..~.~.~. Disapproved a/c ...................... ~ ......... ~~--~ (Building mspecfz~r~ ,~ Application No ........ ~.~ ....... APPLICATION FOR BUILDING PERMIT 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, 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 o Building Permit to the applicant. Such permit shall be kept on the premises ova.ilabie 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, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................... .......................................................................................................................... Name of owner of premises ......... l~b~e....]~ft~O.~l~ ........................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of [and on which proposed work will be done. Mop No: ...~8.~1~.1~'~.~1 ................ Lot Street and Number ~/s.~.j~.~.e~.e..e..~R.~`a.~.~.~`~.~..~.~..~.~.e~'~.~.~." ...................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ........... ~.~..e.~.]:.J:.a..~. ...................................................................................................... b. Intended use and occupancy ......... ..~...e.~?:..~.~.~?~.~..~.~.d..~:~.~..~..e.~`-.~..~.~?.~.~..e...~.~.~.~9~9~.~.~9.? ........................ 3. Nature of work (check which applicable): New Buildimfl .................... Addition.....XZJJZ ....... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ....~....:~.O.~O.g~.,.0.g. .................................. Fee ..j...~?..0..0. ............................................................................. (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, specify nature and extent of each type of use ................................ 7. Dimensions of existing structurqs, if any: Front...~.(~!....-.~.~ ........... Rear ..$0.!..,~.79 ............ Depth ....... 2~,~". ............... 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 ...~8. ......... /..~J... Rear ...... 28..../...28... Depth ...,36/..2G. ............ Height ............................ Number of Stories.....Ol~ .................... 9. Size of lot: Front ..... ~ ................... Rear ....... ~ .............. Depth ....291.,/.2.'/2 ........ 10. Date of Purchase ......... ~.1~.~.~.t~..~1.~,~.8. .......................... Name of Former Owner ....... IB.t, mx'l$1~ ................................ 11. Zone or use district in which premises are situated ................~&~.....~t, lll~,~J,~% ........................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............. 1~ ....................................... 13. Name of Owner of premises.....l~....l~..~'~....P.i~J~.~.,C, Address .......................................... Phone NO ..................... Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor ...~.~.~.~.....~.~'~:.~1~:;$ ............. Address ......... ~l.t&;tt~c~ .............. Phone NO ..................... P.LOT 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 shew street names and indicate whether interior or corner lot. STATE OF NF_,~...,.Y...O~K ) S $ COUNTY OF ~...~...~.~,~. ............. ) ' ' .............................. ~..rh..~.k~ ......... ~..~.......(J.~.~-~,being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ...... ~.ff.~..~. .................................................................................................................... (Contractor, agent, corporate officer, etc.) af said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this epplication; that all statements contained in this application are true to the best af his knowledge and belief; and that the work will be performed in thellmanner set forth in the application filed therewith. ] DITff T. ~OKEN Sworn to before ~e this ~., 5~.03~49~3, Suffolk County Notary Public, ....w..,,r:~:~[..,~..a:~ ......... ~ ............... C~y- (Signature of applicant) ~z '~ Z = k o