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Home My WebLink About2811-zFOP~M NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. "Z,~'""229'~ ......... Date ......................... Nove~e~.....~0.., 19...6.% THIS CERTIFIES that the building located at .S'/~.....P.~Tte..[~e(~.~...R. oa~[ ....................... Street Mop No....'31b~'~ ........... Block No .......... ~ ...... Lot No ......~.~ ......... ~l~hOt~l...~..-...}[,.~, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......................................... ~r~t~ ............... ~ , 19....~.~ pursuant to which Building Permit No...2~....~ dated ................................. ~..~.~.~.....$....., 19../O.~., 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 ........ .... .P~lva. t e...ome.-.f, am~.~,y.. ~wet.l.t.~:~g ............................................................................................ The certificate is issued to '"~'l't, irlll~"i~arlTl .................. ;'""~e~' .......... : ......... : .............................. ~owner, lessee or tena:nt) of the aforesaid building. H.D,Approval Nov 18, 196~ Building, Inspector · FORM NO. 2 TOWN 0F $OOTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BI~,K~p¥ ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2811 Z Permission is hereby granted to: (teo~'ge.. ~3,e~.~.....~.¢I ....... ~t':t~,~x .. ~mna .......... ............. ........................ .................... to. ~,ltl...r~.. ,or~.. ~am~ ii.F,. ~* .~.~,r~ .................................. ; .................................................. .................................... ;..'. .............. : ..................... ~ ............................................. ; ......................... ,~ ......... at premises located at ..... ~J/,~,....J~J3/~..~l~O]¢..]~,Ot~ .......................................................................... .......................................... ~o~a~l~o:l.~,.......,.~...~*, ................................. : ....................................... '. ....... pursuant to application dated ................................ ~1~.....~. ...........19..6~..,. and approved by the Building Inspector Fee $....~10.,,OQ ....... · - muilding inspector j s-9 SUFFOLK COUNTY DEPARTMENT OF H~LTH Date November 18, 1965 Bldge Permit Nee 2811Z TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at Pine Neck Road, Southold (~d~d location) have been inspected by this Department avM found to be satisfactory. Distri'ct Engi~leel, FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE .~ SOUTHOLD, N. Y. .......... Approved .....~.. ............ : ........ .~.! ........ , 1~." ....... Permit No..~.....~....../...!........~---' Disapproved a/c ....~._.;.~ ........................ ................................. APPLIGATION FOR BUILDING PERMIT Date ........................................................... 19 ............ INSTRUCTIONS o. This applicolion 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 throughout the progress of the work. e. No building shall be occupied or used in whole or in port 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 lhe 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 -R~geuI~?~t~incsan~ra~rheee~stcro~r~cynw~fthbuaiI~dionpgps~caadbd~itei~r~s~r~ra~enra~t~b~i~gr~v.~n~r red~u~~erein described. (Address of applicant) State whether applicant is owner, lessee, agent, architect,~e~lgine~r, general contractor, electrician, plumber or builder. Name of owner of premises ............................ .~...~ ........ ~ .......................................................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed wor~,ill be do~,~M~'qo.: ~~,]~/~2~2y ...................... Street and Number ............. ~.-~ ......... ,...:~.~..,'~ ............ ~.....~...'c...~.m.~:...'~..m: ................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .........................................................////,~,~,7/'~ ................................................................. b. Intended use and occupancy ................................... ~~ 3. Nat6re of work (check which applicable): New Buildihg .................. Addition .................. Alteration ............... Rep6ir .................. Removal .................. Demolitian .................. Other Work (Describe) .................................... 4. Estimated Cost .......... ./.~..~ .................................... Fee ...................................................................................... (to be paid on filing this application) 5. If d~el[ing, number of dwelling units ........... .~.'~.. ............ Number of dwelling units on each floor ..... .s'..'7.. .............. / If gerage, number of cars ......................................................................................................................................... 6. If biusiness, 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 ........................ Deplh ................................ Height ............................ Number of Stories ................................ 8. Dim.bnsions of entire new construction: Front .............. ..~..~ ............... Rear ......... ~i:.,~. ........... Depth ..~..O. ........... Hei~lht ........ ./...~. ...... Number of Stories ................... ?.. ........................................................................................... 9. Size~of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner .................................................... 11. Zone or use district in which premises are situated ......................................... ~.. ................................................... 12. Doe~ proposed construction violate any zoning law, ordinance or regulation? ......~.~. ............................................. 13. NQ~e of Owner of premises ..~..~..~..~.....~...q. tt~.....Address ..~--)-~...~...~...~.~..~..~.~.~'J(.~l~one No ................ Nar~e of Architect ...................................................... Address ...... i ..................................... Phone No ................ Name of Contractor ....~...~.~.r~..¢ ....... ~...~ ./.~2~ ............ Address ..l~..¢~.*.im¢.~.~...~.....~..~.~.:. Phone No..?..~..~..~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fn property li~es. Give street and block number or description according to deed, and show street names and indic( whether in~erior or corner lot. ~6 STATE OF NEW YORK, COUNTY ~O~ ........ 'O .................... ................. i .......... '~ ........ ~ ........................... being duly sworn, deposes and says that he is the applicCmt above narged. 'He is the ...................................................... .~,~...-¢~,a~-r~¢..~ ...................................................................... ~ .... (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 this appliqation; 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 b~f. ore me this .......... ....... .............. Notary Publi~.~...~,~c~,,.....~.,...~"~'.¢~.... County of applicant) / // MARION A REGPN~ / (~/ NOTARY PUBLIC, State er I]~w Yor~ Term Exmres March 30. 19~".~