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Home My WebLink About2434-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. U P - D A T E D 1984 CerfJ[icafe O~ Occupancy No. Z12930 Date ...... Oc~:ober. 24 ........................................... 19...84 THIS CERTIFIES that the building . ~J, 8. ~:~..n.q..O.n.a..F..a.m.~.%y. p.w.e..1.!.~.n.q. ,w/../~..cgZ...' Location of Property 240 sumrait Rd. 8outhold House No. Street ~'lam~et County Tax Map No. 1000 Section ,,..07.8 ...... Block .... .0 .9 .........Lot .... .0 .2.7 .......... Subdivision..B,a,y Side Te.r.r~co. .Filed Map No. 2. q.3,4 Lot No. 30 conforms substantiallY2t~ th~gA6P4Plication for Building Pemlit heretofor~g~gi[ .tohi.s)o~e4dgated ,June October 17 19 .8.4. ursuaz!t39.which Buildin Permit No (Z12902..C.O.) 13472Z ............ fi66~6~' l~ ~ g .................... dated ....... O.c..tp.b.o.r. ...... .1.8 .....19 .8.4., 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 ......... ...~. y.~..~-.~.~.t.~., 9.~.~., ?¢.m.~.%y. p~..~.~5.~.~, M .% ?.6.s..?.~.%h..%~. &o.~?.~.o.~. ¥..~.~., .~?.~).,. EDWARD & PAMELA MICHAELIS The certificate is issued to ........................................................... (owner, of the aforesaid building. Suffolk County Department of Health Approval . .N./A ....................... N/A ~ UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 Building Inspector FOI~M NO. 2 TOWN 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) 1~? 2Z]3Z] Z Date ............................... e~llJe....~ ......... , 19.(~.. Permission is hereby granted to: lilt.. &. grin .. ll~be~.t.. ~V~ehaelZa ................... t o ....2~.td...ne~r. ~ne" fa~ fy" d~']:llTlg .................................................................................. ct premises located at ....t~...~0 ....... ]~y$~.~"T~l'l~ ............................................................... .................................................. S/.S.....$~ t..Road~ .......... 8euth~ld .......................................... pursuant to application dated ................................ ~TIII~II.....~L~ ......... 19.~,., and approved by the Building Inspector Fee $.---]-OeO0 ....... Building Inspector TOWN OF$OUTHOLD BUILDING DEPARTMENT TOWN CEERK'$ OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY No..7~..P-~t9 ............ Date ............................. ~.f~.O.~mb.e.~.......~,O 19....~,~. THiS CERTIFIES that the building located at ...~t/~.t,..~.(}~.,....Q,~'~...~..~...(~.~.~..~....~..~...~ Street Bay S~de Te~u'aoe Map No ....................... Block No ....... ~ ........... Lot No. -3.0, .......... ~.Qt-~.I~h.Q~..t....~..*..~.~. ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................... ~.%1Z~....~ ............ , 19.6.~... pursuant to which Building Permit No..~J~.~....~ doted .............................. ~.t~%e.....2.] ....... , l C~.~...., was issued, and conforms tcuaii, of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ........ .~.ri~a~e...one...£ ~milY....d~.e lli~g ........................................................................................ The certificate is issued to (owner, lessee or tena:nt) of the aforesaid building. NO'. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Aa~roved ........................................ , ........ ................................. Disapproved a/c ............................................. ' ................. ...... ................................ 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 propertymust 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 o 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 granted by the Building Inspector. APPLICATION tS HEREBY MADE to the Building Deportment 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, as heroin described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. ....g.$;I,.b.~..¢.. ~£~b~s ..................................................... (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner,, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................... o. wne~....-....buil~e~. ...................................................................................................................... Mic~lis Nome of owner of premises ...... l~...&..~.S...GJ~b~.t...~=~ .................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No: ...~..~.~....~..~.d...~...~.e.~.l~.f~.~.~.... Lot No: ...3.0. ............ Street and Number ....... S~JI;..~Jo&d ............... l~.O.l~t]l~.~ ........ ~ .......... 7............L..7. ............................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .V.~,g.c~t'l.t,..l&l~d ............................................................................................... o e ami b. Intended use and occupancy ..... 1~.......~. ....... .~Y....(lw~llSn~ ................................................................ 3. Not(Jre of work (check which applicable): New Building ....~.. Addition .................. Alteration ............... Repair .................... Remora .................... Demolition .................... Other Work (Describe) .................................. 4. Estimated Cast ..... .~...0~0..~./M .............................. Fee ......... '1~1 ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....~.~.Q .................. Number of dwelling units on each' floor ......................... If g~rage, 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 .............................. I[eight .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...... ~.~ ................. Rear ........ ~ ............... Depth .......~ ............. Height ............................ Number of Stories ..0~ .................... 9. Sizeof lot: Front ,..9.~ .................... Rear ......... 9~ .............. Depth .....9.8 ....................... 10. Date of Purchase 1~.6l+ "o e of Former Owner ...... ~.~...t~...~.. ................................. 11. Zone or use district in which premises are situated ...... .t~..A.!~...~.J-..~.t'.. ................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ........... ,.11.?. .................................. 13. Name of Owner of premises ..(~.......~...~.~...~..8,..e...~.~.~. ...... Address ......... ~..~..~.~.~.Q.~,.~.. ............... Phone No ................. Name of Architect ...................................................... Address ............................................ Phone No ................. Nature of Contractor ..~..~..~.~l/f~.~,~. ......................... Address ........... ~JO.g.I;I~C~]~Cl ............. Phone No ................. I propel wheth PLOT DIAGRAM ocate clearly and distinctly all buildings, whether existing or proposed, and dicate a ty lines. Give street and block numbers or description according to deed, ~d show ;r interior or corner lot. set-back dimensions fr~ ,treet names and indic¢ STATE OF NEW YORK, ~ COUNTY OF .,~t~.~],l~, ............. [ S.S. ~':J-l~e~'t; ...J~,.O~ ~l~'l ~.1~. be n duly sworn, deposes and says that he is the apptic~ (Name of individual signing application) above ~med. He is the ....................... ~ .................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owper er owners, andis duly authorized to perform or have performed the said work and to make and ~ this application; that a~l statements contained in this application are true to the best of his knowledge and bali and that the work will be performed in the manner set forth Jn the application filed therewith. .................... ~3.. day of ............. ~e ................ '......, 19.~.. ~ ' _ ~'_~ Notary Public ..~~County.~ ,_'~ (Signature oFapplicant) ~o. o Suit0 k Coun ~