HomeMy WebLinkAbout1198-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CL'ERIC'S OFFICE
SOUTHOLD. N. Y.
CERTIFICATE OF OCCUPANCY
No. Z 1026 Date April 3 1961
THIS CERTIFIES that the building located at ...Agnavlew. .Ave Ext Street
Map No. &tars Block No. .XX Lot No. xXx East Nerion,...h.Y.•
conforms substantially to the Application for Building Permit heretofore filed in this office
dated August .8 , 19.60.. pursuant to which Building Permit No. ....21193..
dated . September ,6 19.. 60., 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 private- one•••ra tily..dwelling
This certificate is issued to Don Id..11v,:r ,erntr"om Owner
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
FORM NO. 2
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? 1198 Z Date .......................September 6 19.60..
Permission is hereby granted to:
Lid...Qonstr.uation...Co A/C...D.onaid...H.ammarstrom
Roseva.1e..Ave
Ronkonkoma;....•L.I.
to .....B ilc%..new...one..ramily..dwelling.
at premises located at N/s...Aquav1.ew..AIM.•Patent iOn,
East. Marion,
pursuant to application dated Autust 30 19..&j., and approved by the
Building Inspector
Fee $.1.0..00
Building Inspector c
. 7'd&/ ,y-5" ci d 'L
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD', N. Y.
Examined S g'a r C' 19.k9. Application No. I t I t
Approved b A19.. I) Permit No. / l 7 ?'
Disapproved a/c r
C
(Building Inspecto
APPLICATION FOR BUILDING PERMIT //
Date 19..4.: s ...'
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 a 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 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 and regulations.
f
--t.l d b 04!5 7 (`0/e17 .
(Signature of applicant, or name, if (corporation)
to s !_'i1/46.Ell /y24g. 4/ix'okheo,fes.
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,.plumber or builder.
eCial.. 1 Cr7 p cc,r,4;;OP rA cr (I it' r 1 e64-f!re/e„ .
Name of owner of premises .c M/'4.44) I J.74,?'14141 freVA'0 U/ `
If applicant is a cor or e, si na ure of duly authorized officer.
I Ctf�7 'officer)
( me and i le o corporate officer) k
1. Location of land on whi h proposed work will be done. Map No: - Lot`No:
,�� way r. .. l Cra.-1 �- Tscrain
Street and Numbers e�b��� e;fCt chi✓i r'. z' v L 'oo o > p �Yv Ct�s1 s, ;a U.
Municipality
2. State existing use and occupancy of premised and intended use and occupancy of proposed construction:
a. Existing use and occupancy //I (9-ve_e ; °
/b. Intended use and occupancy 1 �u,( )L , L / �
3. Nature of work (check which applicable): New Building `Addi4'ion Alteration
Repair Removal Demolition Other Work (Describe)
4. Estimated Cost4 971" f1 Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units I Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of e ch type of use
7. Dimensions of existing structures, if any: Front /� RearWA Depth ,t/`` x/
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 ZS
Depth 2 1 '
Height /q/ Number of Stories /I,..., t
/ l /
/
9. Size of lot: Front / 0 Rear Q-� Depth ...r er 6
10. Date of Purchase oleo
Name of Former Owner ..e.B‘..ST.. 4....S7 :ig ?s..
--• 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 �at✓A44...NMI vgidress ...r!Ii...Coo, !JPhone NO.
Name of Architect,....ac•d.Mtfat2 UC4 dFpi!d. ptt ./t7„Address F e4....!. Phone NO.
Name of Contractor 4.if 11.Q...L,.ttAJSl.(Ak°kddress n`'Ci'h1",'n4 4 Phone NO. 4721U/
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.
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STATE OF NE, 0'1K ) S Sfr);?4,14/,
COUNTY.0 lot,'f/ ,� rdulyR Y
0;, ,... ‘ - . . .,... .. being sworn, de oses-,and says that he is the applicant
'(Na /bf indivi.ua si•gnin. .. • ati n)
above named. He is the .1 I/'
(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 lowledge and belief;
and that the work will be performed in the manner set forth in the application filed therewit
Sworn to b f re me this'
//_ i N DELORe$ N qq��� ir---
day of '.. .. .. ....... .. 19 wmaN Public, s[at oPNeD€E1r- 'f ap.li ant)
f �� o. 52-8286500, Suki CouYnty„
Notary Public, .gym......,.. /• County Tenn expires March 30, 1Q
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