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Home My WebLink About2071-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. DERTIFIP. ATE OF OI-:.I3UPANDY No. Z. 2~.2,,~..~... Date ............ l~o.Vembe~..~..., 19. ~ THIS CERTIFIES that the building located at . ~e~. ~ .............. Stree~ ~t~00d .... n~o~k No ............. ~ot No. ~9,..~Ou~O~,.~..~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... ~ay .... ~ ...... , 196~. ~ursuant to which Buildin~ Permit No. ~07~. Z dated ........ ~ .... .~ ....., 1963., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ssued is . ~NlWats. O~e. f~ilF..dwel:ilnE ...................................... The certificate is issued to Ed~a~8. ~ei~e .......... 0¢~e~ ............... ,., ......... (owner, lessee or tenant~ of the aforesaid building. Suffolk County Department of Health Approval .. ,De¢~..~. Xg~'...by. ?;~ .V~la... FOI~ 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) No. 2071' Z Dote .......................... ~,~ ....... ~3 ............. 19.6.~.. Permission is hereby granted to: Ed.~m~.d...Hain~ ................................................... ........... · ~eu.~.het~ ................................................. to ....... D~.i~.. ~ew · .cme..-f a~i.13~ · .dwst.~lr~g .......................... ..................................................... at premises located at .....'tOt,..~t,9.~ .......... J~l~t~J~1~/-OO~- ........................................................................ ............................................... · g~l.tten...I~e.~ ....... ~.outhet~l. ....................................................... pursuant to application dated ............................ ~ ....... ~..~ ........ i ........ 19.6.~.., and approved, by the Building Inspector F~ $.....10.00 ....... ~ui ding inspector FORM NO. 4 TOWN OF BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, CERTIFICATE OF OC:CUPANCY No..Z...;~O.~'O ........... Date ......................... ~e~gi~,be~......9...., 19.0.~... THIS CERTIFIES that the building located at '~'J~'""(~;~0~D.'"~t~ ............................ Street Map N~.O..~,..tth~,°..°.d..... Block No ....................... Lot No. "'~9 .............. ~"0~:~'t'"~i"~i' ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................... tV'I~J~' .......... ~-'S .............. , 19.~.~.. pursuant to which Building Permit No...~,(~....~ dated ..................... ~Z/' ......... 2~ ............. , 19..~,.S., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued' is ........ ......... ~.~ .i~ a.~ ~., ~ ~ ·, .~.~mi ,1.~ · · ~.~ .1.~.n~ ....................................................................................... The certificate is issued to ...E~W~Pt~...~e.~ ................ ., ....... /¢)~e~. ................................................ ~owner, ~essee ar tena.nt) of the aforesaid building. H,D. ~pprov~l Dee 196% by SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at ' (Give deed loc~iidn) / ~ ' have been inspected by this Department and found to be satisfactory. District E~ineer TOWN OF $OUTHOLD TO~N CLERK'S OFFICE SOOTfiOLD, N. Y. Examined ........ ¢...~ ........ Approved ........................................ , 19 ........ Permit No ................................. (~ild~ Inspector) Application No ............................. APPLICATION FOR BUILDING PER/vtlT Dote .......................... ];~!i~;~ ....... 23 ........... , 1963 ........... INSTRUCTIONS o. 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 odioining premises or public streets or areas, and giving o detailed description of layout of property must bedrawn on thediogram which is part of this application. 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 pa rt 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. .................................................................... (Sign.oture of applicant, or name, if o corporation) ......... I{umme.Z...Ave.,...~u. th.'l.od ........................................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, e~ectricion, plumber or builder. .............. owt~e~...- -bui. lde~ ............................................................................... Nome of owner of premises ..... Ed. wa.l~.d.-.li~m ................................................................................................................... if applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ..... ~Oll.t, hWO0~ ................. Lot No: .}+¢~ ............. Municipality State existing use and occupahcy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... .~.&oa~.t..~o~ ..................................................................................................... b. Intended use and occupancy ...... ~e..~e~j~t:~..8~e]:~.~ ............................... ,.; .......................................... 3. Nature of work (check which applicable): New Building ~ Addition Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ,.~...000..~./M ............................... Fee ·.·1.0.. (to be paid on filing this application) 5, If dwelling, number of dwelling units ....... OJ~J ................ Number of dwelling units on each floor If g,arage, 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 Neight ............................ Number of Stories Dimensions of same structure with alterations or additions: Front ................................ Rear Depth ,...'....;i .................. Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front.....~.O. ...................... Rear .... .~.0 ................... Depth .... ~.~'.~ ........ Hei~iht ............................ Number of Stories....~l:~lt ....................... 9. Siz~ of lot: Front ..... ;~.00. ................... Rear ......... ~00 ............ Depth ...~J~0. ............................. 10. Date of Purchase ............. '19.6~ ................................. Name of Former Owner I1. Zone or use district ,in Which premises are s~tuated.....~.....~[~.~..~ ............... 12. Does proposed construction violate any zoning law, ordinance or regu at an~ ............. ~. Nome a~ Owner of premises ..~.~..~.~.~.~. ................ Address ......... ~.o.~.~b..q~.,a. ................ ~hone No. II Nar~e of Architect ......................................................Address ............................................ Phone No. tl Name of Contractor .................................................... Address ............................................ Phone Ne. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fn property lines. Give street and blocI,L numbers or description according to deed, and show street names and whether interior or corner lat. STATE O1: NEW YORK, ) COUNTY OF ~..~'O.'1~ .......... ) S.S. ................. l.....~.t~.~...['z~:~l~ .................................................. being duly sworn, deposes and says that he is the (Nome of individual signing application) above named. He is the ...... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to Derform or have performed the said work and to make and ~jiJe this application; that oil statements contoir~lfr~Ir,inrtt~j~[Igppiication ore true to the best of his knowledge and beli~ef; and that the war( will be performed i~t~e~['/t~',~',~'~fo, rctrb in the application filed therewith. Sworn to before me this - ........ .~ ,,~ J ..., 19, ....; ........................ J. .... , ......... , ............. ..... · . : .