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Home My WebLink About2171-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...~/~.....]{~o~ll~.oo~!...~a~e ..................... Street Map No ...... ~ ......... Block No .......~ ........ Lot No...~ ......... ~,~A:~t,i.t~:~/.....]~,.~, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................ .Aug~t~t,.....3.O ......... , 19.63_ pursuant to which Building Permit No.....~.~..],....~ dated .............................. ~I,~g.14EL...3~., 19...~.3., 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 ........ ............. 2~i.~at, e...o~e...f~il~...dw.e ~ll~ ................................................................................... The certificate is issued to .....~,~"tO.,~..}~,1:J~7~.~.0.~$~ .......................... (owner, lessee or tena,nt) of the aforesaid building. HoD. Approval November 1963 by R. Villa · I....'Y~...~..V.~ .................... : ............. Building InspectS:' t TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLEP,.K'S aFl:iCE SOUTHOLD, N. Y. BUILDII~IG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2171, Z Dote .. ........... ~ ............. A~4r~,~ll~t~.....3 0 ...... ~ 9~... Permission is hereby granted to: ~.w,....A~.~,....~/~.....B~un~.....B~au~er ........ ............. ~t ,~1 ~UC~ ............................................ -'-'~'~ld...ne~..e~e-.F~,mi.~ · .d~e '1-~ ~r~g .................................................................................. to of premises located at ...j~l~]~.~.W~d...l',~trl~ ....................................................................................... ............................................ · ~4a.~i.~uek.t*.:~,.~-~ ................................................................................ pursuant to application dated .............................. A~g'~t;.*..*~O* ......... 19..~.~., and approved by the Building Inspector Fee $....lOtO0 ....... Building Inspector L SUFFOLK COUNTY DEPARTMENT OF ~EALTH Date ......November ,2~? ~963 ~uilding Penuit No.__ 2171Z TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at ,,,4o0', E/Grand ~Xv, enue Matti?u.9,,k,~ N/S T(nollwood Lane (Give deed loc&tion) ...... have been inspected by this Department and found to be satisfactory. DiStrict Engineer FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .......................... t..: .......... ,19 ........ Permit 'No.....~.....!..ii~...!...~. Disapproved a/c ............................. ~ ............ ................... ......... ,..;:..: ............ g ........................................ (Buffding ~nslbector) APPLICATION FOR BUILDING PERMIT 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 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 granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buitding 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ............. Ei~.d.....~,~t~z .................................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................... .¢I .¢. ..................................... ......................................................................................... Nome of owner of premises ..... ]~.~O..~'.&l~e~. ................................................................................................................ If applicant is o corporate, signature of duly authorized officer. ................. iName and title of corporate officer) ............ 1. Location of land on which proposed work will be done. Map No: ....... ,1OfX ............................. Lot No: .................... Street and Number ...Kl'~.3.].~/~l]....]~Ile,~ ........ }itt¢'~,~-t~..~.-k.;:: ......................... ~ ..................................................... ~wumc~pa,ry 2. State existing use and qccupancy of premises and ir~tended use and occupancy of proposed construction: Existing use and occupancy ............V~oa.~'li~...Itfi. Ild. ............................................................................................ Intended 3. Nature of work (check which applicable): New Building ... '~lf.~.~... Addition .................. Alteration .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cast .........~..~..!.~..0...0...?../..~.. .......................... Fee ..................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... O~I~ ................ 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 ........ ~9 ........... Hei§ht ............................ Number of Stories...~lrl~ ....................... 9. Size of lot: Front ......... ~,.0.CI ................ Rear ............... ,],OID ..... Depth .....%~'0 ............................ 10. Date of Purchase ........................................................ Name of Former Owner .................................................... 11. Zone or use district in which premises are situated ......... .l.l~.l.l...d,l,a~. ................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... nO. ................................... 13. Name of Owner of premises ...])~'.lg~Q..]l~&lg'~l~' ...... Address ............................................ Phone No ................. Name of Architect ...................................................... Address ............................................ Phone No ................. Na~ne of Contractor ..... ~,1'/.~_..~1~..~,~ ....................... Address ............ ]~.~G~.~. .......... Phor~e No ................. PLOT DIAGRA,M Locate clearly and distinctly all buJldin§s, whether existing or proposed, and indicate all set-back dimensions fn property lines. Give street and block numbers or description according to deed, and show street names and indic~ whether interior or corner lot. , /~ STATE OF NE~._~)RIf~ ) COUNTY OF .m...~...~.'.0..-~1~ ............ ) S.S. ......... .~.~..~.~.......~..~..~..~..~ ..................................... be ng lduly sworn, deposes and says that he is the applice (Name of individual signing application) above named. He is the ....... ~.Q~!~&¢~.~' ............................... i..~,i. .................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or 'have performed the said wdrk and to make and f this a.pplication; that all statements contained in t~is application are true to the best of his knowledge and bell and that the work will be performed in the maDDer E~x~,forth in the application filed therewith. Sworn to before me this ~°~?J'u~;~{,.auwa~N ~