HomeMy WebLinkAbout2502-zFOP~I~ NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at ....1~//.~;.....~.~cozlf~....L.e.~e ......................... Street
Map No.......lf.~. ........... Block No ......~:X .......... Lot No. ~ ....... .p. ee~)12.~;~.t...~,..~., ......................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
...................................... .At~.~.~; ....... ~.0., 1~)..64.. pursuant to which Building Permit No...2.~02..Z
dated .......................... Att,~.tt~[.....~,7......, 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 ........
..... P.~lv. ate ..en~ ..~: e.~i. ty...~].~e t.1. ~.ng ............................................................................................
The certificate is issued to ...~t,~l~l.]..~.~....~.:[e.~.~h.....&..W.~ .......................................................
(owner, lessee or tenant)
of the aforesaid building.
by R.Vitla
........ .....................
Building Inspector
FOP~M NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEpT ON THE PREMISES UNTIL F:ULL
COMPLETION OF THE WORK AUTHORIZED)
N? 2502 Z
Date ...................... &V~U~t .....~.~. ............. , 19..6~..
Permission is hereby granted to:
Four 5 t,~,...~es ...Y, ne· .A/C.. ~ ta~e~..C~er, aeh
.......... .~7.~..~t~.aw/ .................................
.................. Sh~t®y~.-.l~,,¥~. ...............................
to ...... B~.~t&..~e~..o~e'"famt'X'Y"~l~ett'~t'~ .................................................................................
ct premises Iocoted at ..~/J~.....J~etl~l...]C,~"~e ..................................................................................
.......................................... Peeea~ey ....... .N,-g, ....................................................................................
pursuant to application dated .............................. A~.~,.....~0 ....... 19.6¥., and approved by the
Building Inspector
Fee $..]:.(~,.00 ..........
FORNI NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N, Y.
Approved ~ ~' ~ .~...~ O ~=~ ~
19 ........ Perm t No .............................
(Building Inspector)
Application No..~.....~...(~..~ .......
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 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 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, ordinances, building code and regulations.
(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.
Oon~0r ~ c±,oz
Name of owner of prem'ses ,'¢.i',¢z;lu;r Gi~:~l~ .........................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on ~v_h, jch/~z/¢ proposed work will be d~ Map ,N,~o: ............................................ Lot No:
gf .....n~ k,._ker'.~...'.Peconic I,a~.a o_ '.' -.'.~" , ~' Routc 2~ & 2]A~ .... ~..
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy //A ~L A ~ ~
b. Intended use and occupancy .............................................................................................................................
3. Nature of work (check which applicable): New Building ..... lJ .......... Addition .................. Alteration ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ......................................
4. Estimated Cost ........... JJ3.gagg~. .................................. Fee ..........................................................................................
(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 ...~..<~.l~..gll~jpl ...............................................................................................................
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 ...3,.~.~J,J~r..hoJl ................................ ....~ ........ .....................................
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 df Stories
9. Size of lot: Front ....... (j~ ............... Rear .................... Depth ................................
10. Date of Purchase ...................................................... Name of Former.~:A/~ner ........ , .................................
1 1. Zone or use district in which premises are situated ....................................................... L....t ...................................
12. Does proposed construction violate any zoning law, ordinance or regulation.;> ......................................................
13. Nam~ Of Owner of premises ~ ....................................... Address ................ i... ................... Phone No .....................
Stan~oy (3~eraeh _.. ~'elton~.~ Lonj Box 120R
Name of Contractor .~,]~ld..iiJ~A~l:l.&. .................... Address ............................................ Phone No .....................
F6~r J%al-H~r~ Zn~l. 77~; l~ontauk Hgt~ [3h.~.~y 2~o7600
PLOT DIAGRAM
Locate': clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lin~es, Give street and block numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW./~.O.P,I~,,~ ,, ~, ~.
COUNTY OF s.s.
.....~'"'?~'~J~'''""iJ~'r:n-~'~f i~'~i~i~'L;ol s:g ' g app' ' i'""'--'" .......... being duly sworn, deposes and sa~;t that he is the applicant
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 file
this application; that all statements contained in this application are true to the best of his knowledge and belief;
and that th'e work will be performed.in the manner set forth in the application filed therewith.
Sworn to before me this .~ --
......
Notary Publi~, .~/.~....~:.~e~ICou~,/~f/'(Signature of applicant)
/ia, 52-3~331.20 Sulfol/( C0mlt~ .~ ~/
MAP OF PROPERTY
RICHARD WILHELM '~I~I I . [ L, S,
CONSULTANTS
CENTER MORI~:HES & PATCHOGUE
NE'~N YORK
MAP OF PROPERTY
TOWN
SUFFOLK COUNTY,
GUARANTEED
RICHARD WILHELM,~ L.
CONSULTANTS
CENTER MORICHES 8c PATCHOGUE
NEYV 'YORK
$-9
~
TO WHOM IT MAY CONCERN:
/
SUFFOLK COUNTY DEPARTMENT OF HEALTH
Date ,/~/~/
Building Permit ~o.
Th~ sewage disposal facilities for a struct~ve located at
(Give deed locatfon)
have been inspected by this Department and found to be satisfactory.
District Engineer
MAR 2 5 1965