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Home My WebLink About2216-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ......... .~.....~.~..~. ...... Date J(a~eh 3, THIS CERTIFIES that the building located at ]~/J~ ~:,'ashin~ton Art ...................................................................... Street Map No ..... 1~%1 ....... Block No ....................... Lot No. conforms substantially to the Applicatio? for Building Permit heretofore filed in this office dated ........................ .O~..t,..cber ~.~....., ig.......~.'~pursuant to which Building Permit No. dated ()O tahiti' ~, , · 9 63 issued, and conforms to oil of the requirements ......................................... I ........ · was of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ Private one fe~'~, dwelling . The certificate is issued to ..... ..i~..:R..r.~......~ster & Wif~ O'~lere (owner, lessee or tenant) of the aforesaid building. H.D.approval Feburary 7, 1964 by R. Villa .......................... ............... FOEM NO. 2 TOWH 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) Permission is hereby granted to: ~l~¢~¢l..~omem.....A/.C.....Ha-~.~.~...F.m~er...&.~.. ..... ........................................................... ............. .~..e.3,~..e.~ ..................................................... to .~.t..z...a...~?.~...o. ~.e.....t. ~..z.~.....a.~.e..z...z..t...~. ..................................................................................... at premises located at ...~/~......~.~:~D~.~D.I:I..2..V..~ ............................................................................ ................................................ .~..~..e. ~p..o~.f, .......................................................................................... pursuant to application dated ...................... ~).~.~.O.b..~;~.....],~, ............... 19..~,,~., and approved by the Building Inspector Fee $.~,..0. .................. Building Inspector SUFFOLK COUNTY DEPARTMENT OF REALTH Date .~ ~ebruarz 7, ~.96h Building Permit No.., ,2216Z, TO WHOM IT MAY CONCERN: The sewage dispesat facilities for a structure located at .... N/S Washington,?v~nue,.Greenport ~ ~ ....... ) .................... ..... (Give e location have ~oeen .;inspected ~ this Department and found to be satisfactory. District E~ ..... FOEi~I NO. 1 TOWN OF SOUTHOLD EUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..................... .~...~...~, ·.././....., 19..~....~.. 19 ~Permit IXlo/ / Disapproved a/c ................................ ;~ .................. (Building' Inspector) Application No.......c~...~../....~'. .... APPLICATION FOR BUILDING PERMIT Date ....................... _..~........~,,,. ...... ./.~......,' 9......~..~.. 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 ureas, 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 gr.anted 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 Cuur~ty, 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,,~nces0 - ~ %-~~and regulations, f ~ r-~(Sign.ature 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. Name of owner of premises .....".i~..?/.....~.?C4.. ....... ~.....~.' .~...~.q .................................................. // 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: ...... 1...'.~...~.../ ..................... Lot No: .................... Street and Number .........~....~.~..~m..~'~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................. :~ ........................ ~N .................................................................................. b. ntended use amd occupancy ....... . .................. 3. Nature of work (check which applicable): New Building .................. ddition .................. Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ (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 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 ....... ]....~ .............. Number of Stories ......../.. ........................ 10. Date of Purchase ..................... /...~...~...3 ................ Name of Former Owner ..........--~ 11. Zone or use district in which premises are situated. 12. Does proposed construct on v o ate any zon na aw ord nonce ~ reaulation~ 13. No,ne of Owner of p~mises ..._.~;...~..~..~.Address .~ .......... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property lines. Give street and block numbers or description according to deed, and show street names and indi~ whether interior or corner lot. STATE OF NEW, ~/OP,~/ ,~,,~ ) S S COUNTY OF ~:...) ' ' ......................................................................... being duly sworn~ deposes ond soys thor he is the opplic, (Name of individ(mi' signing oppl obove homed 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 th s cppli~ation that all statemept~u~,~E~f~'rt~J~.~i.n,, tkJis application are true to the best of his knowledge and and that the work will be per~dl3i~,'~,~/~i~set forth ~e application filed erewith. Comn~ss~otl ~xp~res March 30 19~-- Sworn to b. efo.r~ me this ' ~ .............. day of ........ Notary Public, (Signatureapplicant)