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Home My WebLink About2962-zFOF, M NO. 4 TOWN OF SOUTHOLD BuH,r~IN(~ DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupnncy NoZ~72~ ....... Date .........J.a~ ..... 7 ......... , 19.73 THIS CERTIFIES that the building located at .~./8 .Rob,in,on .~,~. ta~e... Street Map No.l:~.comtc .~&~Blo~c SNo ........... Lot No.. ~ .... P~¢onle... ~,Y, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........Dec ..... 21, 196~. pursuant to which Building Permit No. 2.962Z. · dated ..........D~c ... ~.1 ..., 19.6 ~., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ...Pr~v.a~e..one. Tzmt~. Awalling ..................................... The certificate is issued to . C,~rl. ~ .Thexe~&..Ekb~rg ..... '.OWner.,, ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · Dec...PS ....~ 973 ................. UNDERWRITERS CERTIFICATE No. ~.r.~-...e.~$o.t.~.n.g ............................ HOUSE NUMBER .. A~ ........ Street .. ~Aohin~on .La~ ~ ...... ~oc.onia .......... Building Inspecto~ 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 FULL COMPLETION OF THE WORK AUTHORIZED) N? 2962 z Permission is hereby granted to: ............................ ~ ...... Z ...... 7.":'" ..... ' .............. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~EC 2~ ~3 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. Chief of General Engineering Services DEC 9 8 ~973 FO~ NO.I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~ 19 ........ Approved ........................ (.? ............. , 19 ........ Permit No..............c~ C/ ....... ~__........~ Disapproved a/c ................ ,~,~.-w. ..................................................................... ~l' /) ' ~ APPLICATION FOR BUILDING PERMIT Date I~ Q..~ ~ I 19.,~...)...~'~... 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 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 throughou~ the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a 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. ....... ..J... .......................... (Signature of applicant, or name, if a corporation) ...... .................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. and on ~ch ro osed work w be done Ma No ~-~'~ 1. Location of I .~p' n p p ' -...~- P ,' ....... ~ .......... :..l ............ Lot No.: Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use ond occupancy ...... ~ ~ ~.~ ........................................................................... b. Intended use ondoccuponcy....~.....~.~ ....... ~ ......................................................... 3. Nature of work (check which applicable): New Buildi~ ..i.. · Addition .................. Alteration ............... ~... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..... ---.~.....(e../...O.T.~ ............................. Fee ....(....O...' ............................................................................... (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 a.lterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ z,~ ~,_Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ~....~..~.....~.... ........... Rear (~ ~:- ~ Depth ,/--~/./..0.~..~-~' / Height .................... Number of Stories ~ 9. Size of lot: Front ............................ Rear .................................... Depth ................. ~...~__ ,~. /~ 11.10'~,~ee ~fr uPsUerCdhi~:~ic;"i'~"~;;l~';;';~:~';~"~;;'~i;~]~;~' .y,~,a,~rmer Owner..~..~.~..~ ................. 12. Does proposed construction violate, r~ ,~ ;, ,~ ~-any zoning law, ordinance or,,.~u~,~ ,~ ,~ ,~re ulation? .....~ ................................................ 13. Name of Owner of premises~.~ ....... Address ..~..'~....~.~ ...... Phone No ..................... Name of Architect ............. . ....................................... Address Phone No ..................... Name of Contractor- '~ ~--.~.z.~~.¢-'~.~. ........... Address iii~i~i Phone No ..................... PLOT DIAGRAM L.ocQte clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether i.nterior or corner lot. STATE OF NEWc-¥OI~K~,, /),~ ~ ~ S ................... duly sworn, deposes and says that he is the applicant (~h~ of indivFdual signi,~p.plic~~ above named, He is the ................~...-m-~...~..:~..:,~-:..~ ............................................................................................. (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 the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this /'~ ,~ , Notary Public,~ ......... -, :...~ount~~¢ (Signature of applicant) ~OTARY' pUBLIC, .,ate oi~T,~cw Yor