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Home My WebLink About2902-zFOEM NO. 4 TOWN OFSOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY No..~..;~380. ............ Dote .......................... A[0~:J.~L.....~J .......... , 19..6.~t. THIS CERTIFIES that the building Iocoted at ..W/B....(~a.l.~r~.~...~e~t.~l..~d .................. Street Map No ..... ~ .......... Block No. ~ .............. Lot No..,I~T, ......... S. Otl, t, JtOl~t..~,~, .................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................................... 0G.t~O~O~...~, 19...6~ pursuant to which Building Permit No....~.90~...~ dated ................................ OG~.....~,.~'...-., ] 9.6~.., was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ · . · P'~.i.va te. · one .. f.~m.:t,l.7..d.we.ll.~ng .............................................................................................. The certificate is issued to .......]~.,.&..~.9..j~,~.t~ol~..j/~,~/,...~.~........~.....~._fl~0nO~l~~bT~B~ / see ° te a~f~'' .................... of the aforesaid building. H.D.Approval April 1966 by R. Villa Building Inspecto[~ FOP~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 GOMPLETION OF THE WORK AUTHORIZED) Permission is hereby gronted to: ~e3,a~t~.~l,a~..i~..C~,'~.,,....~:C....~.ta~ea~ ~ ~ W~e ............ ,.~a~l~3~ ........................................ ...., to. L~t~,~d.. ~w.. one ..~'~,I~ ..(l~e.Z.;~$.~...-, .......... ~ ........................ , ......... ~ ................................ at premises located at ...... ~.~.e~.l....~'g~.~...~. ............................................................................... .............................................. ~ou,~h~3~,.:.~,~,. ......................................... ; ........................ .. ................ pursuant tc~ ~pplic~ltiondated ,i .......... , ........ :..,.....,~'; ...... ]J,-~ ........ , 19.~., and approved by the ,Building Inspecfor Fee $~O...OJ) ............ SUFFOLK COUNTY DEPAR~I~ENT OF HEALTH A P ~ - ? 1966 Date TO WHOM IT MAY CONCE~: The sewage disposal facilities for a structure located at - ' . ~/ ~ " (Gi~e deed loc~io~) have been inspected by this Dep~tment a~d found to be satisfactory. Distriot Engineer District Engineer FOI~M NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined C~' , ....... , 19., Approved ........................................ , 19..:! .... Permit No. · [ Disapproved a/c ............................. ~..7 ............................................................... ................................ :..::'..~ ............. ~-,~r.,',;:.~ .................. :;[[ ................................. (Building Inspectbr) Application No. APPLICATION FOR BUILDING PERMIT ote ...................... '. ..... ............... , 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 premi.ses 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 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. ............................ Nome of owner of premises .....~..,~.,.~-,.....~.]....~..~.. .......... J/~/Z~'~L~......~,~ ...................................................... If applicant is a corporate, signature of du[~. a~uthorized 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: a. Existing use and occupancy ................................................................................................................................... b. Untended use ond occupancy ....... ~. ............................................................................................. 3. NatUre of work (check which applicable): New Building ....~... ......... Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cast .................. ~',~.,~ ........................ Fee ..... ,/,.~.-..~ ................................................................. (to be paid on filing this application) 5. If d~wel[ing, number of dwelling units ............................ Number of dwelling units on each floor ....................... If g~rage, number of cars ............ '. ........................................................................................................................... 6, If JJus/ness, commercial or mixed occupancy, specify nature and extent of each type of use ....................... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................Depth ................... Hat,iht ........................Number of Stories ............................................................................................................ Dim,ensions of same structure with alterations or additions: Front .................................... Rear ....................... Depth ................................Height ............................Number of Stories ................................ 8. Dimensions~ of entire new construction: Front ........ .'..~.,...~.~-.~ .............. Rear......~.L....~.~.: .........Depth ...--~....~.~..~...: ..... Height .,..~..~,..'~..'.. Number of Stories ..,~r~..:: .................................................................................................... 9. Size of lot: Front ...... ,Z.Z.,~....T .......... Rear ............/.,~..~.,..~. ............ Depth .....z'~'~..~...~Z.U/F~../~,~c~, ' 10. Date of Purchase ......~. ................................................. Name of Former Owner ...Z~.,...~.......~..'..zr..~. ........................ 1 1, Zone or use district in which premises are situated ..~..~/..~2,,~g-Z~.g ................................................... 12, Doe~ proposed construction violate any zoning law, ordinance or regulation? ..~..~. ................................................ 13. Nar~e of Owner of premises ~,g~....~.~.'~.....~.'..,J]/J~7'2~......Address ..,~....rC4..gTg'~..(.,.z.~,.: ................. Phone No Narhe of Architect ......................................................Address ............................................ Phone No ................. Name of Contractor ~".d.~.'2~../:??./~....~.¢('/Y~-/~/$j/Address ....~.~.~/~.?-~..~ ........... Phone PLOT DIAGRAM L_ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fn 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 YORK, ~ ~¢ ~(~me of individuol,sionin~ opplication) obove homed. He is the ~~~ ............................................................................................................. (Controctor, oOent, corporote officer, etc.) of sold owner or owners, *nd is du~y ouIhoHzed ~o per{otto or have porformed the s~d work *nd to m~ke ~nd this ~ppli~ation~ that ~11 stmements contained in this ~pplic~tion ~re true to the best of his know odoe ond that the w~rk will be performed in tho mon~or sot {orth in the opplicoHon filod therewith. Sworn to b~o{oro me this Notary Public ..... o~, A. R~,~,,,v - (Signature of applicon1 / (/ ~0TARY PUBLIC ~f ~e~,~ ]~rm Expires ~srch 30, ~9~