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Home My WebLink About2759-zFOR~ NO. 4 TOWN OF SOU?HOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z...2~. ............. Date ........................... ~e.l~. ......... 9. ...... , 19..6.~... THIS CERTIFIES that the building located at ....J41)~/l~..~.~.~..~b[ ........................................ Street Ma~p°h~c?.e.....C..°...~..e.. ........ Block No ........ ~ .......... Lot No. ~. ........... Cll,[CJ~qg.~t.,...~.,.~., ............... conforms substantially to the Application for Building Permit heretofore filed in this office doted .................................. ~. .......... 1.~. .......... , 19..6~. pursuant to which Building Permit No...~.~..~....~. dated ............................. ~.~..,...~-.~. .......... , 19,,,~.~, was issued, and conforms to ell of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ....... .~J,~t~....o~e,..,.~m~...dw..~...1,!,'.~tl~ .......................................................................................... The certificate is issued to ..,,1D~.:[/~....~.:J.~(te]g.~ ...................... 0,1~t~e~. ................................................ (owner, lessee or tenont) of the aforesaid building. H.D.Approv~I ~e~t 7~ 1965 By R. Villa ...... .................. Building Inspector k 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) Ne 2759 z Permission is hereby gronted to: ·..tt.:l..1.1.:l:am · · ..~!~ ........................................... ............ C. mf~ehog~u~ ............................................. at premises located at ...... .~O~,...3~,jC....~IiOIi~..Gx01/~ ................................................................... ..................................................... l(ooee..t'~,~ ....... O~t~ohol~e ................................ · ................ pursuant to application dated ............................. 1/~, ......... .'1.(} .......... 196~..., and approved by the Building Inspector Fee $ '~'O,.00 ........... Building Ir~pector! ~ S-9 sC~D SUFFOLK COUNTY DEPAR2MENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at have been inspected by this Department amd found to be satisfactory. District Engineer' FOKM TOWN OF SOUTHOLD .BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exom ned ............... ApproYed ........................................ , ]9....I... ~ermit ~o ............................ No. ? APPLICATION FOR BUILDING PERMIT Date ................................ .Ma~......19 ........... , 19...6.~ .... 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 thb 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 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. (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. owner - builder Name of owner of premises ..... .~.~i~t.~...~.~.~).~ .................................................................................................................... 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..Mop No.' ......M..o..9..s..f~...C..o..¥.~ ............ Lot No.: . 3LF Street and Number ~qQ.$fl .g~:~.~$~ ~..u..t...e~.Og.~.e~ N.Y. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy V~Q~.~t ta~d b. Intended use and occupancy ........... OD,~....~ftD, c.~-y...~W..e.~,~,~.~.~ ........................................................................ 3. Nat~re of work (check which applicable): New Building .iX. XZa:~XX.. Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost ......... ~,.O.~...O.O.O .................................. Fee ........ I,D.., ....................................................................... ' (to be paid on filing this application) ,5. If d?elling, number of dwelling units ....... OD.e .............. Number of dwelling units on each floor ....................... If g~rage, number of cars ..... OZle ............................................................................................................................ 6. If ~usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dirrjensions 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 ....... ,5'.~. ........................ Rear ........ ~.~. ............... Depth ......... 2.~ ..... Height .................... Number of Stories ...one ...................................................................................................... 9. Size,Jar lot: Front ....... iD.0 .............. Rear ............. 10.C) ................ Depth ...21.7.../....2,1..9 ....... 10. Data of Purchase ........................................................ Nome of Former Owner .......... aa.ne 11. Zon'e~ or use district in which premises are situated ....... ?.~.l)...~.:~,.~ ...................................................................... 12. Doeb proposed construction violate any zoning law, ordinance or regulation? ........... ..r!..o. ....................................... 13. Name of Owner of premises ....~i~..~..:....~...e..e.-.~.e., ............... Address ........ .C..lfLt..o..139~,.~.9 ............... Phone No ................ Name of Architect ...................................................... Address ............................................ Phone No ................ Nanhe of Contractor ...........same ................................ Address ............... lJ ........................... Phone No I PLOT DIAGRAM [_ocat~ dearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fi property I~nes. Give street and block number or description according to deed, and show street names and indic whether i.nterior or corner lot. m i~ TRA I £ STATE OE NEW YORK ~ c c COUNTY; :OF ,EiI,I, ZII;'~llC. ............ ,f""~' ................. ' ........... .l/~J~.],,'[-.i,a. IIl..Z~.9. e.tl6 ................ ~ .................... being duly sworn, deposes and says that he is the appli~ (Name of individual signing application) above nar~ed. He is the ................... O~Ile.~--...b~.ii..Zt.~e.~. .... (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work end to make and this applidation; that all statements contained in this application are true to the best of his knowledge and belief; that the work will be performed in the manner set forth in the application filed therewith. Sworn to 15efore me this /,~ ~,~~ ................ i.~L<~, day of .......................... mia.y: .......... , 19..~.~. l~'~' ' ~ ~o5 ...... ~4AR ON '~" '~ [[~1 Ne~v Yor~ .............. ~" ""': ...................................................... Notary Public, ~'""~': ............ 'N'QTA~C~ItY sialo o'Ill- (Signature of applicant)