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Home My WebLink About2633-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. ~155 .. Da~e ..... z.~y 1.1 196~ THIS CERTIFIES that the building located at E/S Pine' Tree. Road Street Map N~].aqeau z?armsBlock No. Lot No..21A to & includiug 2k, Outehogu~ conforms substantially to the Application for Building Permit heretofore filed in this office dated Feb 9 ' , 19.6~ pursuant to which Building Permit No. 263~Z dated .. Feb 9 , 19..6~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Private. one The certificate is issued to . of the aforesaid building. £amil~' dwelling A .W.. DeClerque Suffolk County Department of Health Approval UNDFRWRITERS CERTIFICATE No. N~R, · · [{OUS[:NUMBER ~93~ Street Pine (owner, lessee or ~ena~t) Tree Road Braiding Inspector FORM 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? 2633 z Permission is hereby granted to' ................. ~g~ateheju~ ........................................ to llu. t.~.,idtd~t:to~..&.~ke...a~ce~a~!u~...ol~.,a~r.e~Tat~.~tlg..d~eT~:L~t~ .................. at premises Iocat,ed at ?l~.t..~a/~2~i,.. "N~t'Ss~t' '[a't~L~uz~ ............................................................ ............... ; ............................. l~e"T~ee"l~oad i ....... Ct~te~o~te'; .................................................. pursuant to application dated ........................... ]j~l~"'~ .................... 19~1~..., and approved by the Budding Inspector " Fee $.~i~1~ ............. Bu,ld,ng Insp-ec~,o~] TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE CERTIFICATE OF OCCUPANCY No...7~ ..... ~;L~. ........ Date .... /. .................. ~.....~.:L ............. , ~9.~.~... THIS CERTIFIES that the building located at ...,~/.~./.. ~.$;~...~',IZ. DL~...~Qf~. .................... Street M~p rqo ...................... ~oc~ No ...... ~ ............ kot ..... FJ.u.~.~.l%o. glg~. .............. conforms substantially to the Apphcation for Budding Pe~etofore filed in th~s office dated .......................................... .,~..e.~. ....... 9 ..... , 19 ..~.~.. pursuant to which Building Permit No ..... ..~..~.~,~...Z dated ................................. ~..~.~ ....... .9. .....19...~..~.., was issued, and conforms to ell of the requirements of the applicable provisions of the law. The occupancy for which th~s certificate ~s issued ~s ........ ....... P. niv.~t e...o~e.. ~.amlLy... ~we.1 Ling ....................................................................................... The certificate is issued to ...... ~..W.....D.eCZeD.qBe ........................... Om~E. .................................... (owner, lessee or tenant) of the aforesaid building FORM NO. 4~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...~.J~ ..... ~.~..~.9,.fL~f~.l~J ..................... Street Map ~o~..~.?.....~....1~..?.? Block No ..... ~ ............. Lot No. ~].A..&.2~. ........... .C~t~]L%~UJ~ ............... conforms substantially to the Apphcatzon for Building Permit heretofore filed ~n this office dated ........................................... ~.~ ....... .9. ...... , 19..~.~.. pursuant to which Building Permit No ..... dated ................................. ~J~. ....... ~. ...... , 19...~..~, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which th~s certificate ~s issued is ....... ....... L~.i~a t~e .. ~n~..famil¥...d~e/lil~ .......................................................................................... The certificate is issued to ..... A,~[~..T~eC, Ii~.CI.%le ........................... ~rD, el'. ................................... (owner, lessee or tenant) of the aforesaid building FOR~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~N CLERK'S OFFICE SOUTHO~.D, N. Y. Examined .......~..~....~. ............... 19..~...~.~'- Approved ....................................... 19 ........ Permit No .............................. .... ..................... ~.~ ................................ (Buildinfl Inspe~or) Application No ....~....~..?..~.. ......... INSTRUCTIONS a This application must be completely filled in by typewriter or ~n ink and submitted in duplicate to the Buildin Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adlommg premises or public stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this Iocatio~ c. The work covered by this application may not be commenced before issuance of Budding Permit d. Upon approval of th~s application, the Building Inspector will issue a Building Permit to the applicant Suc 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 unhl a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulations, for the construction of buffdings, additions or a Iterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable laws, ordinances and regulations. ..... ........................ (Signature of applicant, or name, ~f a corporation) (Address of ~Dplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde ............................................................................. ............................................................................................. Name of owner of premises .................. ~,..~.~....~...~....~..~.:'..~.~ ................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which' proposed work will be done ~Map No.' ...~..c~¢ ~- ~..¢~-~ ................. Lot No ....... D/4../..,.~..~... Munio, i~pality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construchon. a. Existing use and occupancy ............... ~..~..:,.'¢~.?~ ........................................................................................ b. Intended use ond occupancy ................................................................................................... 3. Nature of work (check which applicable)' New Building .................... Addition ..... ~ ......... Alteration ..... ~ ......... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4 Estimated Cost ................. ~. ¢.. ~TD..~..'~.. ...................... Fee ............. . .z2..:....ct~.. ................................................................ (to be pa~d on filing this application) 5 If dwelling, number of dwelling umts ........... .~. ................ 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 existing structures, if any. Front ............................ Rear ...................... Depth ........................... Height ............ /..=c....~. ...... Number of Stories .............. /.. ......................................................................................... D~mens~ons of same structure with alterations or additions. Front .............................. Rear ................. .,: ........... , / Depth ............................ Height ............. /..~ ........... Number of Stories ...... ./. ...................... / / / f 8. Dimensions of entire new construction. Front .............~.. ............ Rear ....~..~/. .................. Depth .....~.~ ................. Height ............... ~ ......... Number of Stories ...... .~.. .................. 9. Size of lot' Front . ..~..¢..P.../../-./ ...... Rear .......~...~..=.../..Y-../ ..... Depth .......?..~:~...:.~...(... 10 Date of Purchase ....................................................... Name of Former Owner ..................................................... 11 Zone or use d~stnct m which premises are situated ........................ ..'~..: ............................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation2 13 Name of Owner of premises.f--~Jfz,.~..'.C~,~.,/~ef¢~ ...... Address .~'.'.~r.~.~z~r..."~,..~"...'~.....,~'."./x.~.....Phone NO Name of Architect ....... .~ ............................................... Address .......................... ¢ .............. Phone NO .................... Name of Cantract~'/~...L/"'.~.'.~.~.~.~.~~.~.....Address .~..~.< .~..~.~-~..~.'.~...~...~'¢.....~.~.~..~.21~hone ~..~..':~.~....~!.~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back d~mens~ons trot. property hnes Give street and block numbers or description according to deed, and show street names and ind~cat whether interior or corner lot. (Name of individual signing application) duly sworn, deposes and says that he is the applicon above 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 make and ill, this apphcatlon; that oil statements contained in this applicahon are true to the best of his knowledge and behef and that the work will be performed in the manner set forth in the apphcat~c)n, filed therewith<___ Sworn to before me this ~ da of ~,~z~~/ 19 ~ ~gz~y ~us~lc s .... '(~ign~ure of applicant) ~' ....... ~ Y ' ~ ...... '~ ...... ~1 ................. ~.~-s~s3~0 s~,,;~, ~ ;" .......... 1'