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Home My WebLink About2630-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~. ~'~T] F~ ~AT~' OF' No. Z .2(~ .... Date ................ THIS CERTIFIES that the building located at 'N/~} '(~'1~ '1~O~(1 ............ Street ~ap ~o. W..~.~..C~..~.k~.S ........... ~ot ~o..~ ....... ~out~o~., · · ~.z. ..... conforms substantially to the Application for Building Permit heretofo.re filed in this office dated ............... ~D-..28, 19.6~ pursuant to which Building Permit No.. dated .............. ]~eb" 2&'" 19'65' was issued, and conforms to all of the require- ments .of the .applicable prov, sions of the law. Thc occupancy for which this certificate is issued is . P~.lvate. ~n~ f.~ii.y, d~el~i~ ............................. The certificate is issued t.o . .]~. ~:.]~ .W~.%SbeZ,~ .............. OWllel*S ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... FOI~,H 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) N? 2630 z Permission is hereby granted to: Oh. et ~lo~ct.. ~. 0..;E o..&,.Z o...~l.s:bez'~; ......... to .. ;~-,A1,1d,.. me,~..se...f, am~iy'.. ~,,~e 1.1.~, r~ .................................................................................... ct premises located at .... ~t...~]~ ..... ~ut..~]~..F~t.~ ...................................................... ............................................... .l~lm~a .Roadt ....... Smu~;hol~ .......................................................... pursuant to application dated ........................ ~e~a~ ...~ .......... 19...~, and approved by the Building Inspector Fee $3.0..0EI ........... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date April 14, 1967 Bldg. Permit No. . ~29QZ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at w/s Glenn Road off Bayview Road, Southold (Give deed location) have been inspected by this department and found to be satisfactory. ! ~ ~ , · ~ fl. · LY~Cz~t~ District Engineer District Engineer Builder - Chet Orlowskt Owner - H. & S. Wllberg FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .... ..~..~.~... ~ ............ ,19.~.~7 Approved ........................................ , 19..~....Permit No.~....~..~......~......~... ................................. ................................. APPLICATION FOR BUILDING PERMIT ~ / Date ......... .;..~..~-......: ...... ~......~ ........................ , 19...~..X~.. INSTRUCTIONS a. Th~s application must be completely filled m by typewriter or in ink and submitted in duplicate to the Buildin Inspector. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets c areas, and gw~ng o detailed description of layout of propertymust be drawn on the diagram which is part of th~s applicatior c. The work covered by this applicabon may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Budding Inspector will issue a Budding Permit to the applicant. Suc permit shall be kept on the premises available for inspection throughout the progress of the work. e No budding shall be occupied or used in whole or ~n port for any purpose whatever untda Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuonce of o Budding Permit pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances · Regulations, for the construction of buddings, additions or alterobons, or for removal or demolition, as herein describe, The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. ..... ................................... .............. ........................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncian, plumber or builde Name of owner of premises ...................................... :~ ...................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) 1 Location of land on which proposed work will be done. Map No: ............................................ Lot No: .. :~.... ./. ...... Street and Number ......... .~,:-~...'~t.~.,~'~.~....~,..k.~. .......... ~.-~....':~...~,.~k~¢... ........................................................... Mumcipality 2 State exzst~ng use and occupancy of premises and intended use and occupancy of proposed construction: Ex,stin se an' occu anc ~ a. g u a p y ........... ~.~ .................................................................. ~ ...................................... b. Intended use and occupancy ............ ~ ~.....~.~f .....%J..¢.~..~.:bf....2~.% ..................... 3. Nature of work (check which applicable): New Building ..... /..x, ......... Addition .................. Alteration ................ Repair .................... Removal .................... Demolition .................... Other Wark (Describe) .................................... 4. Estimated Cost ....... /.....~..t...(~ ............................... Fee ....... ~...(.'...:......~.. ............................................................... (to be pad on filing this application) 5. If dwelhng, number of dwelling units ....... ../. .................. Number of dwelling umts 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 D~mensions of ex~st~ng structures, if any: Front .......................... Rear .......................... Depth .......................... Height ........................... Number of Stones ............................................................................................................. Dimensions of same structure with alterations or aad't'ons. Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stones ........................................ 8. Dimensions of enhre new construction: Front .......... .~.~. ... //. ......... Rear ......... ?.?....(. .......... Depth ...~....~.. .............. Height ....... ('..~'. ............... Number of Stories .... ~ ......... 9. Size of lot: Front .......~.~..¢~ ............ Rear ....... ~...~...q.:..~...~.. Depth/.,.~.',~.,,..'~.,(,....~../..~..'~., F~"3 10. Date of Purchase ..........-----/....~....~...~ .............................. Name of Former Owner .J'~r~.,.~..'..q.../.../~....¢~..... 1 1 Zone or use d~strict m which premises are s~tuated .......... ~... 12. Does proposed construction violate any zoning law, ordinOhce or regulationP ...~...~.....~ ..................................... 13. Name of Owner of premises ..:.ff...~,., .... Address ...... Jn.: .. Phone No. /g...~....~.'.~ Name of Architect ........................... ~ .......................... Address ............................................ Phone No ................... Name of Contractor G..~.....~t'~w.,~.~: ........... Address ..~..~,-.-~.'m-,~..J2...~'... Phone No..¢~.,~'.7.¢..~..~ PLOT DIAGRAM Loc, ate clearly and d]st,nctly all buddings, whether ex~sting or proposed, and indicate all set-back dimensions frof property hnes. Give street and block numbers or descriphon according to deed, and show street names and ind~cat whether interior or corner lot. STATE OF NEW YORK, ~, ~ ~ COUNTY.OF ....................,- .......... ~ ~ ~ ........-- ................... (Name of individual s'g g pp' ' n) above named. He ~s the .............................. ~.%...: ................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and th~s apphcation; that all statements contained in this application are true to the best of his knowledge and beliei and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... ~ .......... day of .~~~ ............ , ~9 ..... ' ...... ........... .../7... tlO¥~;~u~!s~,~s~'-.~t i::,'~ ~'~ ~ .... Pk' ....... ' ,Terr~ Expires March