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Home My WebLink About2100-z, FOI~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...F~..~,..J~al~.e, toc~a~..P,/L ............................ Street Map No...,~:~ .............. Block No .....~, ............. Lot No. ~ J/~.$;~.g,~. ~'.,~.t .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................................... · T.g, Ti~....,o~ ......... , ]~J~3 ..... pursuant to which Building Permit No.~-.;.40.....~.... dated .............................. .~t.l,~e..,..2!'J: ...... , 19~...., was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ..P.r.i.v~t,~...~e...£amil~...d~.ellir~ ............................................................................................... The certificate is issued to .~..!~r~t~f~Z'...].~][~)~:~}~,],...~...~.~.~ ............................. .0...~(~t..e..1T.,~.. ...................... (owner, lessee or tenant) of the aforesaid~building. H.D.Approvai Oct. 28, 196~ by H.Villa Building Inspector FOI~M 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? 21oo Z Dote ........................ Z~e ....... ~.~ ............ ~96.3.... Permission is hereby granted to: .~.~z~t,e~'..&..G~e~a.~c~.e~e;], ....................... ..................... ~:ve~,~ee¢l ......... . .............................. to at premises located at ..... ]~/S--"~,-a%eu]~a"R~ .............................................................................. ........................................................ }~e~.~..~te~.~ ....N~..~. ................................................................ pursuant to application dated .......................... J~-T~ ....... .~ ............... 19~:~-.., and approved by the Building Inspector Fee $.1J0.00~ .......... TOWN O,F SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SGUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ................................. Application No. ~ I 0 0 APPLICATION FOR BUILDING PERMIT Dote ........................... ~tttll..... :>~ .......... , 19.63 .......... 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 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 g~onted 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. G'an~.er...&..G:Lse't a...l,{or, che:L ........................................... (Signcture of applicant, or name, if a corporation) .......... J~JrJlt]L..b~:~181t...Ri.v. erhea4 .................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................. e~,~el~ ................................................................................................................................................. Name of owner of premises ...l~tll~te~...&..~:~l!ljJ,&..,.J~o~,~hel. ....................................................................................... If applicant is o 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 ...~&~k&..~.d~ ........ ~&'l;.'J;&'t;.ltO]~ ....................................................................................... Municipality : 2. State existing use and occupancy of premises and imended use and occupancy of proposed construction: a. Existing use and occupancy ....... .~.8~..,~,O.~ ..................................................... .......... b. intended use and occupancy '. ......... 0~...~&~L~..¢I.~/~.~.~ ......................................................................... 3. Nature of work (check which applicable): New Building ..~ ..... Addition .................. Alteration .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ............ 3.~/,~.(X)0...p/f,~ ........................ Fee .......... 1~0.00 ................................................................ ~ (to be paid on filing this application) 5 If d~elling, number of dwelling units ..... On~l .................. Number of dwelling units on each floor ......................... If garage, number of cars ......................... ~...~3a3?..$~..~3~]~L&~' ............................................................................. 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 ............................. Depih ............................ Height ................................ Number of Stories B. Dimbnsions of entire new construction: Front ......... .~.8 .................. Rear .....~.~ ................... Depth ......~,~ .............. Heiflht ............................ Number of Stories ......... ~e .................. 9. Size of lot: Front ....... 310.0 ................. Rear ....... 'IQ0 .............. Depth ............. 'I~.O .................... 10. Date of Purchase ....................... ~13'11~...'1.9.63 ............ Name of Former Owner ............. ~'l~t3...~,l~,~l. ............... 11. Zon{~ or use district in which premises are situated......~.~A~...d~.t, .................................................................... 12. Doe~ proposed construction violate .any zoning law, ordinance or regulation? ........... ~ ................................. 13. Nar~e of Owner of premises ....t~...&..O...]~C~.e~e3,....Address ........... ~.l/'e~ea~, ........... Phone No ................ Name of Architect .......................... ~ .......................... Address ............................................ Phone No ................. Name of Contractor II .................................................... Address ............................................ Phone No ................. PLOT DIAGRAM L.ocat~ clearly and distinctly oil buildings, whether existing er proposed, and indicate all set-back dimensions fn property li(~es. Give street and block numbers or description according to deed, and show street names and indic whether interior or corner lot. STATE OF, NEW YORK, ) COUNTY 'OF ........ ~.1,1~..O~C...) S,S. ............................ (~.lla~.l~..~OZhl3.~l~,~ ................................... being duly sworn, deposes and says that he is the applicc (Name of individual signing application) above named. He is the ..................... 0~e~..~...~ae~ ............................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to oerform or have performed the said work and to make and this applicbtion; that all statements co~l~d, i~s application are true to the best of h~s know~edge and bell and that t~e work will be performe~ i~z~k~e~e~o*~orth in the application filed therewith. Sworn to b~fore me th~s ss~o~ ExpJres March 30 (Signoture of s-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Building Permit TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at e deed location) have been inspected by this Department and found to be satisfactory. District Engineer