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Home My WebLink About2907-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .l~IT-.R..0.,.~[,.....E/~...l~c~...,l~;...l~d,.. Street M Rlehard son conforms substantially to the Application for Building Permit heretofore flied in this office dated .............................................. 0~.~.....~',~ ..... 19..6~.. pursuant to which Building Permit No. ~..0.~.....Z.. dated ................................. .(~.~,....23 ....... 19.~'..., 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 ........ ....... l~.i.v.a.te., on~..£amil~...~welling ................. : ........................................................................ The certi:ficate is issued to ..Edna..~Benn~/c.t.&..Mar.;Le..~hmele~ ........... '. ........ 0'~ae~.s ............ (owner, lessee or tenant) of the aforesaid building. H.D.Approval May 23. 1966 by R. Villa ~_~ Building Inspector FORM NO. 2 TOWN OF $OIJTHOLD 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? 2907 z Date ....................... O~.tO~l)eF..... ~_~ .......... , 19...6~[ Permission is hereby granted to: Jlld ~-o~t ..& · ~eo.....A~C-..F4i~a...~en~e~,t · .& .-M~.~.e %i~eeler ......... 6~.....B~o~wey .......................................... ................ S~tthto.~n~....?l~. ~. ......................... to ...~t~l,l~,..New..e~e...fasa!.l.¥..~e~.l.~.~, ................................................................................... ct premises located at ...~t~..l~ead-...-e£.~..W/8...l~ock)--.Pt.-~o~d..~...I~;T;~o~d .................. ......................... Let,.~ .............................. Mat~..o.~ ................................................................................. .................................................... ~:es4~"Me~.l.o~r.....~'*-*.~.~ ................................................................... pursucnt to application dated ................................ O~.te.....~ ..........19.(~.., and approved by the Building Inspector Fee $.10,.00 .......... Building Inspector S~TOLK 00~T~ DEPArtmeNT OF HEALTH Date Bldgo Pez~i% No. TO ~ON IT ~A! The sewage disposal facilities for a structure located at (Give deed locat~fah) have been inspected by this Department and fouad to be satisfactory. District Engineer District Engineer FOBM~ 'NO~ 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ ......... ,,9..0.] " ' ~. ?.. ~.'Z ....~-.. Approved ........................................ , 19 ........ Permit No .......... ...................... ......................................... (Building APPLICATION FOR BUILDING PERMIT 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 o detailed description of layout of property muSt be drawn on the diagram which is port 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 o 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. ........... ...................................... (S'g atu e of app~ii~ant, or name, if a corporation) ...................... i~'g~"~i"~'~'~ii~;~ii ............... State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. .................................................... ~:~. .......... .~..,.~.~....~ ............................................................................................ Name of owner of premises ............. ~ .............................................. ~ ...................... ~..~r~.~ ........................... If applicant is a c,~rporate, si~lnature of duly authorized officer. (Name and title ~6f corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ...... .~.'.. ................ ~ ............................................................. 2~./~.., ......... ./. ................... Municipality 2. State existi,ng use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ~. /~..~'~.~...~... /.~.~.'.~.d ............................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ........ 2..."... Other Work (Describe) ........................................ 4. Estimated Cost .................... L~'....~....~.. ................. Fee .......................................................................................... (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 olterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ~..~...i .................. Rear ....... .~...~.. ............. Depth ...... ..~'..~.. .......... Height ....../...~. .......... Number of Stories .................. ..~.. ................................................................................................ 9. Size of lot: Front ....... .~....~T¢... ............. Rear ............... ~....6'~L2.. .......... Depth ...~ ................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation:~ /~/O 13. Name of Owner of ~,remises/~'J~'~ /:-'~,v,~ ~.~.~.,~.,/~.Addre~* ,,;70.~ ~'/' ~'! ~' ,.~,'/Phone kl.-,~/~, ~.~-~/~y ~' ....... '/~-~;~"' ll;,'/~-~,',l~Z ................................................... · ....................... Name of Architect ..?..~....../f'~?.. .............................. Address .~.~..~.!..~.~ ......../?..,~.~..~. Phone ~'~o ..................... Name of Contractor~Y.~?~....~..,~..~.~......~.~.~..~.?. ............. Address .&..[..... ~.?....~. .. ...... ?...~...(,~,~..... Phone No. ,~......'~..;...~.../..~?. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oll set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~/~ 'STATE OF NEW y,~j~, ~ ~1¢~ .......... ~.C~r~.~_~..~~ ..................................... bein0 duly sworn, deposes ~nd soys thor he is tho opplicant obove named. He is the ..... ~.~.~.~ ............................................................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements conta:ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fa~h in the application filed therewith. Sworn to bef~r~ me this .~ ,~ ~-, ........ ....... ............ ......................... Moro, Public, ~.~..-,.~ou~,, ~ a0~[~ (Si~notur~o{ opplicont) No. 52 0344963~ Suffolk County ~ Com~ ss'h Expr~s Ma ch 30, 19~