HomeMy WebLinkAbout2117-zFO~FI NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No....Z..1~.78 .......... Date ............ Ho.v. emher.....lO ................ 1~)...6.3.
THIS CERTIFIES that the building located at ...Ql.d..~.'0,~..~e .................................... Street
Map No...~ ............ Block No....~ ........... Lot No...:X,~ .......... .~.~,.~.~.:~.~.~ ...........................
conforms substantially to the Applicotion for Building Permit heretofore filed in this office dated
................................ ~L~. ....... 8 .............. , 19.6.3... pursuant to which Building Permit No.
dated ......................... ~.~1.t:~ ......... '9 ......... , 19..0.~.., 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 ........
.................... /~.tv~t e...owe..£amily... ~w~lling ............................................................................
The certificete is issued to .....~.b, il,li~..P~.o,~.er, es. ....................................... 0wp. cZ' .......................
(owner, lessee or tenant)
of the aforesaid building.
H.H. approval Oct. 30, 1963
FORM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS I~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°, 2117 Z
Date ................ ~ll~:~t ....... ~ ....................... 1963...
Permission is hereby granted to:
Quak,'r ~idg ~..Bu~Id~r. ¢....~.C.....P,~tllip..I~.o~s.
.............. Aquebogue ............................................
to ....Bui4.d...ne~¢..~ne.. ~a~i.'tF.. ~-we& .~i, ng ........................................................ · .........................
at premises located at ......... O~...~..]..e,,. ,~[:~e .....................................................................................
...................................................... Yla.t,~$.~uek~. · .~7~.~.,. ......................................................................
pursuant to application dated ............................ ~.~ ....... 9"'"" ........... 19.6~.., and approved by the
Building Inspector
Fee $...1. O. ...............
Building Inspector 1 '
S-9
SUFFOLK COUNTY ~PARTMENT OF HEALTH
Date , ,10/3 0/,,6~
Building Permit No.
TO WHOM IT MAY CONCERN:
The sewage disposal facilities for a structure located
Old J~le Lane,~,
(Give deed ~oc~t~'~')
at
have been inspected by this Department and found to be satisfactory.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
.......... , gCJ
Examined ....... ii ........
Approved ........................................ , 19...:,J..,Permit No.....~....,.~....L[..?. .........
Application No. ~'o~,......J...~ ............
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 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 part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS FtEREBY 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.
(Signature of applicant, or name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumSer or builder.
Contraotor
Name of owner of premises ..... ~..~..]:..~..?......J~....O.~'~..~.~...~. .........................................................................................................
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 ..... .0..]:..d:.....~..~..l_.~.....~..~...~.,~. ............ ~.~...~..~..$..~..0...~. .................................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
vaeant land
o. Existing use and occupancy
b. Intended use and occupancy one .~'atiEJ.].~t
3. Nature of work (check which applicable): New Building ....~. ..... Addition .................. Alteration
Repa r .................... Removal .................... Demolition .................... Other Work (Describe) ........................
4. Estimated Cost ..... ];~.i.8~O.....p./M ............................ Eeo ....'!.~
(to be paid on filing this application)
5. If dwelling, number of dwelling units ...13I~il .................... 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 '-'~8
Height ............................ Number of Stories...~,~ ..........................
9. Size of lot: Front ......... 3;03' ................ Rear .'J:~' .................... Depth ....... 1.~)/L.l.tl~ ................
10. Date of Purchase ........................................................ Name of Former Owner
11. Zone or use district in which premises are situated ......... 4~.~,ii...{]~I.S~,
12. Do~s proposed construction violate any zoning law, ordinance or regulation? .......
13. Name of Owner of premises ..... .~....~[~2'.~3.~'~'~1 ........ Address ............................................ Phone No.
Name of Architect ...................................................... Address ............................................ Phone No ................
Name of Contractor ........ ~...R~lg~ ............... Address ...i~q.~e.~O~.lZ~ .................... Phone No ................
PLOT DIAGRA.M
Locate clear y and distinctly a buildings, whether existing or proposed, and indicate all set-back dimensions
property lines. Gwe street and block numbers or description according to deed, and show street names and
whether idterior or corner lot.
STATE OF NEW YORK, ) S.S.
COUNTY OF ..~,~1~;,,¢O.-t.t[. ........ )
.............................. :1.O~...}][~._]~1 ............................................. being duly sworn, deposes and says that he is the applic
(Name (~ ~¢¢a?vi~c~l~a~ ~igning application)
abow~ named. He is the .................. ~Z~'~¥;;~'f~'~, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work end to make and
this a.pplidation; that all statem~l~l~cRnt~kLa~d in this application are true to the best of his knowledge and bel
and that fha work will be ~t~d ,~tetl~e~c~at~er set forth in the appUcation filed therewith.
~ , Nn ~4Y 4,1983 Suffolk County
Sworn to Before me th~s ~',o~n~',~,' ;~o .... '~
· u n Ex~@~res Ma c 30, 19~& /-~ ') ~ ~,
........ . .~.¢~...~' day of ................. (,~'~,,..~.~,,~,-" ' .......... 19,~X'.~-~' (,_ /~,.,,~. /',,f'/. "~:_ J
.,- ........................................... . . ..............