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Home My WebLink About2155-zFOEM NO. 4 TOWN OF$OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ~Z~. L~..?c..l;;~f~..~.~.~....R. 9.a.(],.. ................... Street Map No....~.~ ........... Block No ......~ ....... Lot No. ~.~.. ........ .~.~.~.~.~.O.~.~..~..~. N,~, ............ conforms substantially to the Application for Building Permit heretofore filed in this office doted ...................... ~..~g.~..l; ........ 2~ ................. , 19~... pursuant to which Building Permit No.....~."...~..~.~.~ dated ................. ~.~.~..8..~......~.]:. ............... , 19..~.~.., was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ..~.~.~.v..a~.e. 9.~..zT...m..~.~.~ dw.~lZ~g The certifica:te is issued to ..~,~,~.....0,~.Jl~..~ .................................. 0I~O~.... .............. (owner, lessee or tenant) of the aforesa'id building. H.D. Approval Dec. 11, 1963 ......................... ............ FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLDi N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 2155 Z Date ....... AI~tt~"~ '~ ............................. 1963 .... Permission is hereby granted to: Edwa~ ..A.b.~.~.....~, .g-..J~l. te~,.....O~.i ~-~.a~t~ ....... ............. Fm 'c.t ~.-t,ae~ ............................................. to .BuiTd..,a..n~w..one...f~i.l~.,dwet.ting ................................................................................ at premises located at ...]~./~....,~i~j-]~aj~..~jd ............................................................................ · -: ........................................... Out,~heg~e.~...N.,.~S, ............................................................................... pursuant to application do~ed .................................. ,~[t~...-;~(}.....]96L~..., and approved by the Building Inspector Fee $'il~& ................ S-9 SUFFOLK COUNTY ~EPARTMENT OF HEALTH Building Permit No. .... 2155Z TO WHOM IT MAY CONCERN: The sewage dispesal facilities for a structure located at ,, 1!J~2,~6' ,,~ ~genes Rd. E/S L~ttle Neck Rd~ Cutchogue ~ (GiVe de~d"~ation) .... have-Q~en inspected by this Department and found to be satisfactory. DiStrict Engin-ee~ - FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... k.~Z....¥'..¥..~.....~...( ...... , Approved ......................... ~.,t ............. , 19 ........ Permit No ................................. ................................... ;~,,;-. .......................... ~: ,~. ,,.~,,~.~ ........ (Building Inspector) ~/~ Application No ............................. APPLICATION FOR BUILDING PERMIT ate .......... ................... , ..... 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 Ioco¢ion 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 bedrawn on thediagram which is port 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 o Certificate of Occupancy shall have been gr.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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinan,~_s,~and,~, ,~ regulations. ..... .................... (Sign.oture of applicant, or name:if a corporation) ..... ........... (Address o¥ '~'~'l'i'~ti ..................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................ ....... ................................................................................... Name of owner of premises ........... Z~...~....~....(~Z:(.~.. ...... ...~....N~/....~...~..!../.:: ................................................................................. If applicant is .~ corporate, signature of duly authorized officer. ................... i'~;~;';~;~i"fi~i~" ~' '~'~'~p;~'~¥;"~;f~i~ ~'>i ................... 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ................................ ~... ............. ~:~'i~'i~ii~ ........ :;" ................................................................ 2. State existing use end occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ................... l~:~./,~.~-"Z,..~.z~_ .......................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .............. Repair .................... R~... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ........~ ..................... Fee ...................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...........~:~..: .......Number of dwelling units on each floor ........................ If garage, Humber 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 ............ X.6..L ....... Number of Stories......~...~..~ .................... 11. Zone or use district in ~,nich/,7: ~/~"~zg'.premises~¥~are/c situated ........................................... )/~/,~ ........................................... . 12. Does proposed construction violate any zoning law, ord'r~r~'~'~f~c~/eg~ation;~A ..~-~.. 13. Name of Owner of p~,~"t'ni,~es ....... ~ ........ ~ .................. Address ............................................ Phone No .................. Flame of Architect ................................................. ~...Address ...... '/~',~w'~';-"~>,,,~ .......... Phone Na. Flame of Contractor .................................................... Address ............................................ Phone l",la .................. Locate property lines. whether interior o~ street and block :orner lot. PLOT DIAGRAM existir or proposed, and indicate all set-back dimensions ftc to deed, and show street names and indic~ STATE O~,~,£W YORK,/ .. ) S S . ................... ' ......................................... ~ .................................. being duly sworn, deposes and says that he is ~he applica~ (Name of individual signing 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 fi this a)plication; that all statements contained in t~ s gpp~J cation are true to the best of his knowledge and belie and that the work w~ll be ~ rfo reed ~n the man~?rsti~t~l~ the app~on filed therew th Sworn to b~fore me this '. ,~l:l~ · 'day of ............ , .................................... .. -~ , . _/ .~h~'~ . ~:~..~..~..~, .................................................. . . ~ot,~y p~,c, ....c.~:~.::,~.e,,:......z.,.:dJ....:.~,,.~. ~ ¢S,g~,t~r. of ~pp~,c,~t~ TOWN OF SOUTHOLD BUILDING DEPARTMElqT TOWN CLERK'S OFFICE SOUTHOLD, lq. Y. Application No ............................. Date ........................................................ , 19 ................ 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 hove 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, ordmance~a'nd,regulat~on,~. /~ . -- ,.1 -- n (Signature of applicant, o~r. nam~, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ C*,"~ Name of owner of premises If applicant is a corporate, signature of duly,authorized officer· f f, /.t:,,. (. ,' ! ..... './ (t - ~, (Name and title of corporate officer) 1. Location of land on which proposed work ~will be. done. Map No' ~ ................................... : ........ Lot No: ....,~ .............. Street and Number .......... /...~...'~:..~..:.~........ ~/~: :(~: ~...~?!(:( ...... :2::i~...~. ~....~... ! ./.~i:../.~. {.~....~i.'.ii. .......... I Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ,/c' ~.,~ ~,. /1)~.~--~'~' 3. Nature of work (check which applicable): New'l~'uilding .................. Addition .................. Alteration ............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. !:sti~nated Cost ........................................................ Fee ..................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............~.~2.~...C..: ....... Number of dwelling units on each floor ........................ If garage, number of cars ........................... ~..~... ........................................................................................................ 6. If business, commercial or mixed occupancy, specify natu, re 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 ~_ ~z ~D /f Height .......... ../..~:..~. ........ Number of Stories...4f;-_~.~. .................... 9. Size oF lot: Front ........ /..~..(? ............... Rear ........ .~..¢..~..'. ........ Depth / 6-'c~ J of Purchase .....~¢..~...~..~.~ ....................... Name of Former Owner ....... .~,..?........~..../.~.,,~....z~...~...,~.../.: ..... 10. Date 11. Zon? or use district in which premises are situated ............ ~.: ............................. 12. Doei proposed construction violate any zoning law, ordinance or regulation? ..... ..~....O. ......... ~ .......... 13. Name of Owner of premises ~.......~..~/.~.~4.(~ ....... Address ...~...~.~../..~....~. ~..,~..~.~. ~h~'~ ~*~ Name of Architect ...................................................... Address ............................................ Phone No .................. Name of Contractor ....... ~.~-~....~..:../~...'~......./..~....~...~...'~../Add~ess ............... .~..~.~....~......~".~x.. Phone No .................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions ftc property lines. Give street and block numbers or description according to deed, and show street names and indic~ whether interior or corner lot. ./~O ~ STATE OF NEW)~OR~/ ~/7 ) ~ COUNTY ,,G~~..) ~.o. .......... .~.~~.~.~....~~ ............................ being duly sworn, deposes and says that he is the applica, (Name of individual signin~appl]cation) above named, ke s 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 this applicafion; that all statements contained in this application are true to the best of his knowledge and belie' and that th~ work will be performed in tb~ ~r~s~.rth in the application filed therewith. Sworn to before me this ~r~?lm~lq.., ~ ~? ~ .............................. ~' ...... x. . -