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Home My WebLink About2259-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIF~CATIE OF OCC:UPANCY No..~..18.~.9 ............ Date .............................. ~Lll~e.....~,~ ....... , 19.6.~... THIS CERTIFIES that the building located at l~/J].....I/~t~l.~L~..J~oJ~[ ................................. Street Map No, ..~..*...~..'..~..~.].:.~.~ Block No ....... ~ ........ Lot No..~..ik. .............. ~.O...~.~.~...q.]'.~l:....~..'..¥.~ ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................................. ]~V~]~e~..~g.~).63.. pursuant to which Building Permit No. -...~'.9~ dated ....................... .~.~..v..~..l~..sq..e..~......~6....., l C~..~...., 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 ........ ......... l~.i.v.~.e..~e...£a~L.lE..d.w, elli~g ........................................................................................ The certJficote is issued to ~)I~.~...~I~,~.~.O~..$~..~..~.U~.~..'~;' ................ .0.L,~A.e.~. ................................ (owner, lessee or reno.hr) of the aforesaid building. ~{.D.Approval June 11, 196~+ by R. V/~la ~ .......................... ....... i ................. TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING ~ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2259 Z Date ................... ~o~v. ell~e~. ......... 26. ...... , 19.~3.. Permission is hereby granted to: to ~..~...~.e. ~.. m,~.e....~'.e~3,~...~.~e~;L~,~ ...................................................................................... at premises located at ~,,~.~..,..~......(t~[,...~.~e..:T~. .................................................................... ......................................... l~Z~.....~e.;~,~.,.&v.e., .......... ~.o.~.~.~. ....................................................... pursuanf to application dated ..............,~o.~.em~,~.....~(~ .................. 19.~,~..., and approved by the Building Inspector Fee $...1.Q, .0.0 ......... SUFFOLK COUNTY DEPARTME~ OF HEALTH Date Jm%e ].1~ 196~ Building Permit No.. .... 2259Z TO~OM IT MAY CONCERN: The sewage disposal facilities for a structure located at e/s Wells Avenu~ Lot #1~1~ Southold~ (Dr. Dougherty) '(Give deed loca~{~n) have been inspected by this Department and found to be satisfactory, District Engineer FORM NO. 1 TOWN OF SOUTHOLD BUILDING I~EPART~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ ~...~.....~.. ........ , 19...~...~.. Approved ........................................ , 19 ........ Permit No .............................. Disapproved o/c ~~ .................... ~ (Building Ilnspector) APPLICATION FOR BUILDING FERMIT Date ....... 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 o 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 m~y 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 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, alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ..... ................................. (Signature of applicant, or name, if a, corporation) · -- (Addr~ t ~ ~'~i~ f '~'~ii~ ~¢i' ' ' ' '/'' ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. tf applicant is a, corporate, signature of duly authorized officer. (Name and title of corporate officer) If' 1. Locotion of land on which proposed work will be done. Map No.: ...... .r::...t ............................ ~.or No.: ......"wt.. ........... .~..,e'/ Street and Number ..~...S ...... '-~!~C...~.~. ............ ~..~---~?~..~.' ~'~....J.....b.......c~.......=, ............................ Municipa ity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. ...................... b. Intended use and occupancy ~.. ~.~.'..gC~.~. ~/~.¢~.~. 3. Nature of work (check which applicable): New Building ....A ........... Addition .................. Alteration Repair .................. Remova! .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ........¢~...]~o~..~....L.~...~.. .................... Fee ...... .~.~.?....~...~.. ....... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ~ ........ Number of dwelling units on each floor .....-..-~-.. ............... If gqrage, number of cars 6. If bus/ness, 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 :~-~...7.. ' Height ........ ~...~...! ............ Number of Stories ..... ]....~.. .............. 9. Size 'of lot: Front ....... /.~..'~.. .............. Rear ...... /....{..4...'.5 .............. Depth ...~...:~..~..G.. ........... 10. Date of Purchase ...t~4,~...~...[.~.~'~:~ ........ Nam~ of Former Owner 11. Zone or use district in which premises are situated. 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... }¢~¢ct.......~7. .......... 13. Name of Owner of premises~'~::.~.,...~... Address ...t~..~~.....J2.....~..., ...... Phone No. Name of Architect .................................................... Address ................................................ Phone No. Name of Contractor~.~ ..~..G ............... Address ..~.~...~...:...~..:... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing ar proposed, and indicate all ,set-back c 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; NEW ,Y~),RJ~,~.~ ,~,~ ) c c COUNTY,~DF ..~.) '~"~' (Name or inaiviaua~ signing app~atJom a.bove named. He is the ....... ~~...~..x.. (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 file application; that all statements contained in this application are true to the best of his knowledge a:nd: belief; that the work will be performed in the manner set forth in the application filed therewith. Sworn to ~efore me this , . ..... ............. ' Notary Publ'c ~~...~..:~'~t~.0C~y~. ( 'g tue of app 'ca.hr)