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TOWN OF gOUTHOLD
BUll, DING DEPARTMENT
~'OWN CLERK'S OFFICE
$OUTHOLD~ N. Y.
CERTIFICATE OF OCCUPANCY
Map No ........ ~.~..~ ........ Block No ..........~..~. ....... Lot No .........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............. .~..~..r.C~h....2...~. ................. 19..6..~.. pursuant to which Building Permit No. .................... I~ 3,362
dated March Ill, 19~..~ ..... was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is PRi~ATE O~q~ FAMILY S~R COTTAG~
'/'his certificate is issued to J~.~.]]~..Q~ ~%{~.~..~g~ ...o..w~l.~..r. .............................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
TOWN O~: SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. ¥.
BUILDING PERMIT
COTTAGE #~
(TH~S FERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N.° 1362 Z
Dote ........................ Ma~ch..31 ............... 19..6.1..
Permission is hereby granted to:
~.tha..Hu~ing ...................................................
.8%-.16...P~z~k.. La~e.. S. outh, ............................
· W~ee~h.av~n-.-~t.~. -- ~ ,.-Y. · ~:..... ~:t.t .l-~ue~ ~. --N o
to ...Me,Ye. '&~d'"re'toea%e" ~n...e.~% s.~.ing.. ~o~-%age.. %0..-ne~,' .- t~¢e~-i.o~., s.i.%- e .............
at premises located at ..$/S....P.e~o~i.e...BaT...Blvd...o.n..~v%..Read ...........................................
....................................................... I~.~. ~_i.....L.I. ..........................................................................
pursuant to application dated .................................. ~Teh'"'"~8' ........ 19..6.~., and approved by the
Building Inspector
Fee $.l.O..O.O ...........
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUT,OLD, N. ¥.
Approved ........................................ 19 ........ Permit No ...............................
Disapproved a/c ................ ~ ...... ~ ......................
..................... ( ~'6'i'[~'i;" ' ;~';;;~g~sp ........ .........................
Application No. / ~' ~
· ~PPLICATION FOR BUILDING PEI~MIT
Date ........... !'.%~.z'gk... 2~$ ............................... 19...5,.Z. ......
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 shbwing 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 Certificqte 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.
...... ;.....~...~...r. ............................ ;';';... :. ..................................Z.~.
(S~gnature of applicant, ee~c~ame, .. a corp~,~rt4en)
8~-16 Park Lane South~ Woodhaven 21, N.Y.
emd Mattituck, Lon,r~ Island., N.Y.
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Owner
Martha C. Husing
Name of owner of premtses ............. , ........................................................................................................................................
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 ..... f.e.~.~.~.S..i~.b.9~9~(..~..q.d.~a..n..d.~$.~..t~z.¥).L~f.~¢~Q~~;~tz~.~.~ ..........
Municipality
2. State existing use and occupancy of premises c~nd intended use and occupancy of proposed construction:
a. Existing use and occupancy .................... ~.t!?.~.e.~..?.,.o.~.a.?;.e. ....................................................................................
Su~er cot'bage
b. Intended use and occupancy ................................................................................................................................
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....................
Repair .................... Removal ...... ~ .......Demolition .................... Other Work (Describe) ....................
~o.~ '~a00.00 Fee ..... ~]..,.0.0. ........................................................................
4. Estimated L .............. ' ............. ~. ....................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ........... 0~ ............... Number of dwelling units on each floor ....... .0.a.e ...............
If garage, number of cars ........................................................................................
6. If business, commercial er mixed occupancy, specify nature and extent of each type of use ..............................
7. Dimensions of existing structures, if any: Front ...... ~6..f.e~at ........ Rear ............................ Depth ............................
Height ......1.~..?.<.Le,~ ......... Number of Stories ..... 9..n..e...',7.fkt.b...RQ,~g,y...~,~l~,~b~.~..ft.~'.~%g ............................................
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 ............................
~ee below
9, Size of lot: Front ................... X'" ~ear ..,......~ ................. Depth
'"~le owner/. ].~ obta~_ne~ ..................... ~B~l A. Husing
10. Date of Purchase ....... ~w..,w.i.lJ...i.m.]-.9).~2. .................. Name of Former Owner ..... ~'.t}~a..G....Husing ..................
11. Zone or use district in which premises are situated....J.-r...r.¢.si.cl¢~t;L~J~ ...............................................................
12. Does proposed construction violate any zoning law, ordin~pc~or, refluLation?
13. Name of Owner of premises...Fb~a'.Lh~..g.....Hu,~inE....Address ..&,.l~.tt~,t~kr..L..Z ......... Phone NO. 1~-~.~.~-.8,~.?.1..,)
Name of Architect ........................................................ Address ............................................ Phone No.H.i..7..1.7..6..6..2..0...~.
~-,~,~+,~,-+~, Dawn House .l~gvez.s
Name of ............... ~ .............. · ......................................... !r~phank.~..Z,.Z.,.rE..%.....Phone NO .....................
( ,,~a] tar Gordon)
PLOT DIAGRAM
Locate clearly and distinctly ell 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,
................ '_ ......... .B~ulkhead ..........
---83 '
83'
cotbage {'f3
.... Driveway
STATE OF NEW YORK, ) S S,
COUNTY OF ............................ )
, .
.................................................. being duly sworn, deposes and soys that he is the applicant
(Na~ of individual si~ing application) ,' .
above named~ is the ................................................... ~.~f..~,~. ..........................................................................................
of said owner or owners, ~ authorized to perform or have performed the said work and to make and file
th~s 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~g, filed therew~
Sworn to before me this , , ~'~-
"0 p. A '/2T q
'~' O of ~//.~ '/ 1~t~ c'Staf~ NewYo~ ~gnoture at app can~) v
kl + ........................ D kl;~ d y ~ZJc/t ........................... ~ ~]~, . ~ nN°' 41-5824710Q moas Cmmty
,.O.~ .U~,.~ ....................................................... ,.
. ~ ..... ~orm Expires March 30,
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
~xam~neu ............................... :. ................. Application No .............................
Approved .......................... :.: ........... 19...l....Permit No.. ............................. 2- / ~ ~ ~
................. ,;:;~,~.:'~.,::. ...... Z::~.~.~-~- .....................
Disapproved
a/c
............. ..........................................
(Building ?pector)
APPLICATION FOR BUILDING PERMIT ~.~-~ /~ ~
Dote ........................ ~.~....~..19..~..~ ......
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and su~)mitted 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 a Iterations, 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)
.... ........
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises...~...:...~ ................................................................................................................
If applicant is a corporat.e, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Mop No: ............................................Lot No: ....................
Street and Number ..~.~..c:..~.....'~...~...':~'...~.....,~?..~..~C....B...~...~.~.~..~...c~...~...~TT· ....~.~..~.-- --'"'2 ......
/,/[ ~'Municipality
2. State existing use and occupancy of pr. emises and intended use and occupancy of proposed construction:
o Fxisting use and oceupancy.....~~ ............... ~ ...............................................................................
b. Intended use and accupancy.......~...:: ..................................... .?~..~..~ .....................................................................
. 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....................
Repair .................... Removal ......... ...,F::~........Demolition .................... Other Work (Describe) ....................
4. Estimated Cost ........... ~ ........................................ Fee ..........................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ......... .f~'...~..~ ......... 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 ............................ Depth ............................
Height ............................ Number of Stories ............................
9. Size of lot: Front ............................ Rear ............................ Depth ............................
10. Date of Purchase ......... ..................................... Name of Former Owner ~..'~.~.z,.~.'~.,..L. cM-.~ .............
Il. 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'.~ ............ Address ...f~..~..~ .............. Phone NO .....................
Name of Architect ........................................................ Address ............................................ Phone NO .....................
Name of Contractor... ,,~0.~...(.~..~;...~ ...... Address~..2~...
..... ....................... hone NO .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate alt 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.
STATE OF NEW ¥OR , ) S S.
caul'fY OE ............................
',~:~.-'Z,~,,.¢..,~..:.,,_ 7:..l.?.: .......... .~ ............. being duly sworn, deposes and says that he is the applicant
............... ' sig ning application)'?*'
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 will be performed in the manner set forth in the application fJl,~d~ th~e~ewith.
Sworn to before me this
................ ..~...O... day of ~ ..... 19 [~.f. (Signature of applicant)
Notary Public, . ........................................................... County