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Home My WebLink About2798-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. of the aforesaid building. H.D.Approval 8ept 7, 196~ CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ........ l~'8...$em~l..V, le~..Ave ................ St!iet Map No ...... 113[3[ ......... Block No..3131~ ............. Lot No .......... Ilia[ ......... ~[OIA~JM)~;[t.....][~][~..! conforms substantially to the Application for Building Permit heretofore filed in this office ~atec~,~ dated ................................... ~t1~.~.....~,-.~ 19..6,~., was issued~ and conforms to oll of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued i~~ ...,,.. (owner, lessee or tenant) Building Inspector[ FOItM ]qO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2798 z Dote ........................... ~1'~11~ ....... ~ ........... , 19.6~.. Permission is hereby granted to: .......... It~l...aQ~ ........................................... ................. g$~ge¥ ....... t~.-:I.~. ............................... to.. ~1,~..m~w.. ~ne.. Z'aad,~... 4~e~..l&~g ..................................................................................... at premises located at ...... .JJ/('l~....~OJl~J...~.le~/..~.~J'~ ......................................................................... ....................................................... · ~o~t~o]At ....... ~I.~o .................................................................... pursuant to application dated ...................................... ~lJli~....~,m~.., 19~..., and approved by the Building Inspector Fee $~].0.1~0 ............ Building Inspector/ FORMNO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~x/ Approved ........................................ , 19 ........Permit No ............................. Disapproved a/c ..~,~?~...././. ............. ~...'?~.i.....~ .................... .,~:.....J..f.~. ........ ................................................................................... ~.;~':zz:',~' ~-' ......................... (Building I~;;;;~¥~;i ................................. Application No ............................. APPLICATION FOR BUILDING PERMIT Date .......... :JtZ..:?/...~. ............. .~.. ,~., ............. , 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 drown 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 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 Lows, 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, ordinan, q.es, building code and regulations. (Signature af applicant, or name, if a corporation) (Address of applicant) State whether a~plicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. Name of owner of premises .................................... ' L..L ............................................................. If af~p~cclnt is a corporgte, signatur~ of duly authorizp(J officer. / (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No.: ........................ Street and Number Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ...... .~'.?.~.~:..: .................................................................. b. Intended use and occupancy .....(,.)..'~.f..~..~ ........ ~.~...~.¢.:..ff..T::'.'. ...... ~./,.<~..~.~.;/-..~:-(..¢,~ ................................................ 3. Nature of work (check which applicable): New Building .................. Addition .................. Altera.tion .............. Repgir .................. Removal .................. Demolition.; ................ Other Work (Describe) .................................... (to be paid on filing this application) 5. If d elling, number of dwelling units ............................ Number of dwelling units on each floor ........................ If g0rage, number of cars ........... ~ ............................................................... ; ........................................................ 6. If business, commercial or mixed occupancy, ~pecify nature and extent of each type of use ....................... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................Depth ................... Height ........................ Number of Stories ............................................................................................................. Dim~ensions of same structure with alterations or additions: Front .................................... Rear ....................... Depth ................................Height ............................Number of Stories ................................ 8. Dimensions ore, re new construction: Front .............. ............ Rear .............~......~.. ....... Depth ......... Hei~lht" ........./..~(- ....... Number of Stories ........... ~. ..................................................................................................... 9. Sizeiof lot: Front ............ ..~...~. ......... Rear ............./.'.~ ............ Depth ...... 1 1. Zonb-- or use district in which premises are situated .......... ~ .................................................................................. 12. Doe~proposed construction violate any zoning law, ordinance or regulationP ............. Nan~e of PLOT DIAGRAM L.ocat.~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property lines. Give street and block number or description according to deed, and show street names and indic, whether interior or corner lot. STATE OF! NEW,'"A/O~I~, .,~ t ¢ ( COUNTY OF~.,f '~'''' ................. of individual signing appli~tion) being(Nome duly sworn, deposes and soys that he is the applic above nar~ed. He is the .................................................................................................................................................... I (Contractor, agent, corporate officer, etc.) of said owher or owners, and is duly authorized to perform or have performed the said work and to make and this applicgtion; that all statements contained in this application are true to the best of his knowledge and belief; that the w(~rk will be performed in the manner set forth in the application filed therewith. Sworn to bbfore me this C'~ ~ ,,~ .~ z,.~,~, i J-, ,. ~, .......of ............ _.-- .2 _. ' ' Notary Pu )lic, f¢~'..~../-.~......~.~~.. Cou~)~"~' B[~E;l'~i"'"~,"r'~'"'iSignat~'~ of apphcan~) ........................ /' / NOTARY PUBLIC, State o~ ~,ew ~o ~ No 52-3233120 Suliolk County S-9 SCRD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at ' ' (Give deed location) ' %.:~'0~,~.. /~.~-.. ,~'~' have been inspected by this Department and found to be satisfactory. ' ' I District Engineer FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined .............................., 19 ........ Approved ........................................ , 1c) ........ Permit No ............................. Disapproved a/c ..... (Building Inspector) Application No. ~' ''~ ? ac;''' APPLICATION FOR BUILDING PERMIT Date ........... ....................... ........... , ]966 -~J,~//L ............ 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 pa. rt 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 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. ............. .............. i Name of owner of premises 511~ [~O ..... ~ ~-~ C~' ~i'~i ........................................................... If ap~:agt is a corporate, signaturq,~of duly authoriz,~officer. .... ......... (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ...... ..~...?...U...~......~.. ......... .~.(.~ ........ ..~._....~.~.~.. ............................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~.../~....Cc..' ... . b. Intended use and occupancy . .~.?~...,~... ...~...'/~....~(..~ ~J~' /~b~4/,~'L~ 3. Nature of work (check which applicable): New Building ........ ~ Addition .................. Alteration Re.plir .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estir~ated Cost ........ .'~.~./...O.~..~. ............................... Fee (to be paid on filing this application) 5. If d~velling, number of dwelling units ............................ Number of dwelling units on each floor If gqrage, number of cars ........... 6. If bvsiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dim.ensions of existing structures, if any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories Dim~.nsions of same structure with a.lterations or odditions~ Front .................................... Rear Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of ~?.tJre new construction: Front .............. ~...~ ............ Rear ............ .~....~.. ....... Depth ......... ~..~.... Height ......... ./ .......... Number of Stories ........... 9. Sizejof lot: Front ........................... ~'~.. Rear .............. ~ ................ _~..'~ Depth ............................... 10. Doti of Purchase ............../...~..~....."~..; ............................ Name of Former Owner ...... ..~....:....(~... ..... J?~.7~./.~ ....... 11. Zon~ or use district in which premises are situated .......... /~ ............................................. 12. Doe~proposed construction violate any zoning Iow, ordina.nce or regulation? ............. 13. Name of Owner of premises ~,../~.l~....o......4/~.-~..~.l~(/J~dress ...~."~. ('¢'. ...... ~./.). ........Phone No. Name of Architect ...~.~.~..~.¢'.~'~.~'. ....... ,~.'].Jr..(~.~.~.~....Address .....~..~...~..c(.~,,-..~.....~.~..m-:.' .~.. ....... Phone No. Narbe of Contractor .J.~/../~..r/,.../~':'~/~..*~.....~./..~Z~..[.(A, ddress ...... .J. 2f/..:~.'.r~.~. ................... Phone No.~ PLOT DIAGRAM Locat~cleorly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property lihes. Give street and block number or description according to deed, and show street names and indic whether injerior or corner lot. STATE O~ NEW ~OR~,~ /) ~ ¢ = COUNT_~ 'OF ~~'~' ...... Y..~.~...(.~....../..~......~.r. ............. being duly sworn, deposes and says that he is the applic .(Name of individual sig~ing ap~iJcation) above nar~ed. He is the ................................................................................................................................................... j (Contractor, agent, corporate officer, etc.) of said o~(ner or owners, and is duly authorized to perform or have performed the said work and to make and this applidation; that all statements contained in this application are true to the best of his knowledge and belief; that the w~ork will be performed in the manner set forth in the application' filed therewith. Sworn to Before me this ~ . .- /~2~ I..) ~,~ A"/~/' ~q.. /~/-~,~-,~ >- ..... of ...................... , ',_", , ..... - II ........... .... Notary Pqblic~..~....J.~ ........ ~~/,¢:f~ounty RtON A RCC~[NT (Signature of apprJca~}) ,// ~ MA . o ' ~o, 52-3233120 Suffolk uoun~y // ,Term Expires Nt~rch 30, 19.,~-7 ,// ,,I '";I U L- ,4 F F P J .7 J 'V L .m 6 J, !,,,,I, I I N;,v Y~rk