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Home My WebLink About2133-zFOR~VI NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...Z...lJ~.0?. .......... Date ...................~'4~h..2 .................... , 19...~...~.. THIS CERTIFIES that the building located at ..~./J~.....~,~..]~O/~.~ .................................. Street Map No...~ ........ Block No ...... ~ ....... Lot No..~X~.~ .......... 0r.~..e. tl.~.t,.....]~.,.~[, ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. ~.~L~ ....... 2~. .......... , 196,~... pursuant to which Building Permit No....J~3.~. dated ............................. ~.1~'......29 ........ 19.~.., 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 ........ ........ Pr.l~rat;~.. ~ne...fam,tl~..d~ge.ll.~ ag ......................................................................................... The certificate is issued to ..~e.te~...~led~sl~:L....~D,e~ .............................................................. (owner, lessee or tenant) of the aforesaid building. H.D.Approval Feb. 28, 1965 by R,Villa .......................... 1 ................... FOI~M NO. 2 TOWN OF $OUTHOLD 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? 2133' Z Date ..................... ,~. ....... ~,9 ............... 19..~3.. Permission is hereby granted to: Chest, er ~.:Le~mkt..... ~/¢..:P~t~e~.. ~ [ed.~Ce~i .......... ............... Cu~;e-h~ae ........................................... to ..... Bui&d...n~.. ~ne..~i.~.~..d~.m.l. li-~g ............................................................. ~. ................... at premises Jocated at -....~'~--...]~-~.~...~RI].~. .................................................................................... ........................................ .O~.i.e~t.~...~,..~.,. .......................................................................................... pursuant to application dated ..................... ~l"~,l~' ......... .~t. .................. 19.~3,., and approved by the Building Inspector Fee $10.,.0.0. ........... Building Inspect~ir SUffFOLK COUNTY DEPA~,~Ti~ENT OF HEALTH Date F.ebruary~28 Building Permit No.__ 213~.Z. TO ~0M IT MAY CONCERN: The sewage disposal facilities for a structure located at N/S_Main R0~, Orientoi~{~ have been inspected by this Department and found to be satisfactory. District Engineer ~ NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~r,~,~ ~ CJ 19 (O~ Approved ......................................... 19 ........ Permit No. Application No. C~/ 3 3 Disapproved a/c .................................................................... ................................. ........... ........ ................ (BUilding inspector) APPLICATION FOR BUILDING PERMIT Date ~ 2. .............. , 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 applica- tion. 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 H.EREBY 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances~and regulations.~ ~ t~gnaTure of applicant, or name, if ~ corporation) ................... ................... (Addres~s of applicant) / State whether applicant is owner, lessee, agent, architect, engfneer, general contractor, electrician, plumber or builder. Nome of owner of premises ......... ~~ ........................................................................... If applicant is a corporate, signature of duly authorized of Yicer. / J (Name and title of corporate officer) 1. Location of land an which proposed work will be done. Map No.: .:...~ ......... Lot No.: ......... ~. ............ Street and Number .... ~ ....... ~. ................................. t. ..................... Mun c pal ty / 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. ~xisting use and occupancy ,~::~..~.~ ................................................. ~~ b. Intended use and occupancy .................................... 3. Nature of work (check which applicable): New Building ....... ~x~ ......... Addition .................. Alteration ............. Repo~ir .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estin~ated Cost ......... ~.~,~.~....(4TT/cC-L~ ........................... Fee ....... /~...,...(-~'~ .......................................................... i (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ~=..~ ......... Number of dwelling units on each floor ....................... If garage, number of cars ...............~ .................................................................................................................... 6. If business, commercial or mixed occupa,ncy, 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 ........ .,~.'~....C~.~.. .......... Rear ......... ~'~...~..'~. .......... Depth .....~....~,. ............. Height ....... ~...~.....(. .......... Number of Stories ....... ~ ....... 9. Size of lot: Front .......,./...~..~.. .......... Rear ........ '"~"/'~"¢'7' ......Depth .....~..../.....C~.,_, ......... , rx ,~ ^ J 10. Date of Purchase ....~ .......... ~....~'....~.....~. ............ Na,m~ of Former Owner 11. Zonei or use district in which premises are situated ..... ~"¢~.~....c~.:...~,~.,,~..., ........................... ~ ............ 1... 12. Does :.proposed construction vi~l.ote any~;~onin?, law, ordinance or j:,egulation~',m- ~ ,,---- / ....................... 13. Nam~ of Owner of prem ses j'~..~~. Address .~..):'7...!..t~..!.... Phone No ................ Name of Architect .................................................. Address ................................................ Phone No ................ Name of Contractor . . ' t ......Address ...... ' Phone No ............... PLOT DIAGRAM L.ocaCe, clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions fro property li~es. Give street and block numbers or description .according to deed, and show street names and indict whether erior or corner lot. ~ ./( / STATE OF NEW YORK, ) c c COU N-['Y DF ............................ ) ..... . ..~...~,_~.....~~.......~: ........................... being duly sworn, deposes and says that he is the applicar (N~me of individuo! sig~ applic~io~ above named. He is the .............. ~~......N~..~..~ ............................................................................................... (Contractor, agent, corporate officer, etc.) of said owner ar owners, and is duly authorized to perform or have performed the said work and to make and file thi~ application; ithat all statements contained in this application are true to the best of his knowledge a,nd belief; one that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ....... ..f~....~'....C~....... day of ................. Notary ' ...... .......... . . Cou~nty,~,,. ~2.~t'~?~;~ ~u(~]'~noture of apphcant)