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Home My WebLink About2638-zFOll~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...~..~.~.~.~ ........... Date ............................ O~P.~t~l~...~k ...... , 19.6~... THIS CERTIFIES that the building located at ...~/.~ ..... gr. at~e..~oa~ ........................... Street · South Harbor, Homes Mop INo ...................... m,OCK ,xlO ...................... Lot No. -~ ........~..q).~.~hg.~-.¢l,,...~.,..~.~ ...................... conforms substantially to the Apphcatlon for Building Permit heretofore filed in th~s office dated .............................. ~t'b, ........ 'l~ ...... , 196~.... pursuant to which Building Permit No. 2~38..Z.. dated .......................... ~L~e.~ ......... ~ ....., 19~.~..., was ~ssued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which thru certificate ~s msued is ....... ........ ~i¥~t e...oz~e.. J~amiI~...dwe. Ilin~ ....................................................................................... The cerhficate is issued to ...J~.s.~...AnTJ~..~,..~JB, T,I~D,h ................... ~aez~. ................................... (owner, lessee or tenant) of the aforesaid building H. D. Approva~ April 7t 196~ by R. Ville .h ....................... 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°. 2638 z Permission is hereby granted to: at premises located at .... ~t~t '~'1~ ..... JJgU~;J~J~OF...HJ~melI ......................................................... pursuant to apphcation dated ............................. F~h....'lll~ ............... 19..J~.~., and approved by the Building Inspector Fee $~LO~J~O ........... s-9 SUFFOLK COUNTY DEPARTMENT OF HEALTH The sewage disposal facilities for a structure located at have been inspected by this Department and found to be satisfactory. District Engineer FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ~ (~) ~'' ........................................ 19 ........ Permit No ................................. Disapproved a/c ........................................ ............................. ................................. APPLICATION FOR BUILDING PERMIT Date ..................... Eeb.z~s~.;f...,.:L6 .......... ,19...6[~... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildln~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relat,onship to adjo,ning premises or public streets o, areas, and g,ving a detailed description of layout of propertymust be drawn on the diagram which is part of this application c The work covered by this application may nat be commenced before issuance of Buildmg Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Sud permit shall be kept on the premises available for ,nspechon throughout the progress of the work. e. No bu~ldmg shall be occup,ed or used in whole or ,n part t~or any purpose whatever until a Certificate of Occupanc} shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buddmg Department for the ~ssuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply with all apphcable laws, ordnances, building code and regulations. R. Gend~.on..~,/C,..~.s ..... -~n,..G,....l~a~s,e.h ............ : ..... ~ ......... (Signature of applicant, or name, it a corporation/ .............. J. smempor..t .............................................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................. g.o.~.~r.~c ~om. ............................................................................................................................ Name of owner of premises .... ~L~,S.....~.D,Z).~..~L...~g.s~,h .................................................................................................. 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~t~.~.]~.qz:..~ome,sLot No: .~ ............... Street and Number ...... Gz:a,s-~[~,..~c)~ ................. ~Qu,.e,,Jn_~],c]. ................................................................................. Munmipality 2. State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy ..... .¥..~..¢.~.~...~Q.~. .................................................................................................... b intended use and occupancy · ..c~['t.~..~'~Ji;L~],~...~/~.'J,.q,.:[,~. .............................................................................. 3 Nature of work (check which applicable). New Budding .... .x...:K4g%.. .... Addition .................. Alteration ................. Repair .................... Removal .................... Demol,hon .................... Other Work (Describe) ..................................... 4. Estimated Cost ..... i~.~,O0...P/.~ .............................. Fee .....1..O..: ............................................................................... (to be paid on fihng this application) 5 If dwelhng, number of dwelling units ..... D.g.~. ............... Number of dwelling units on each floor ........................... If garage, number of cars ........ .Qtg.e. .......................................................................................................................... 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 ............................ Number of Stones .............................................................................................................. D~mensions of same structure w~th alterations or additions: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ........................................ 8 D~mens~ons of entire new construction: Front ........ ~. ............... Rear ....... .5'~ ................ Depth ..2kk/...~A. .......... Height ............................ Number of Stories ...~ .................... 9 S~ze of lot: Front ..1OD. .................. Rear ........ ;LOG ............ Depth ....1.8.~...P./~ ........... 10. Date of Purchase ..... ~.e~h ......... 196.~ ........................ Name of Former Owner ..... ~ .... G~nd~og ......................... 11. Zone or use d~strict in which prem,ses are s~tuated ..... ;:.A:: .................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ~1:). ..................................... 13 Name of Owner of premises .Ag;Ge ..... P~e. lZS. c:~ ......... Address .B.r.c].~tz'...R~l,..C.l~¢,,~ ...... Phone No .................... Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor .]B.,..~ez~8;~4~ .......................... Address ........ J~.m~s~mz'.t .............. Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fron property lines. Give street and block numbers or description according to deed and show street names and indicat: whether interior or corner lot. STATE OF NEW YORK, '~ COUNTY OF ..... ~.~ut~:Qlk .......... ~ S.S. ............................ ~..e.p..e....QC.~Ct.:E.o&G ........................................ being duly sworn, deposes and says that he is the appllcan (Name of individual s~gning apphcation) above named. He is the ................ g.o~.t,~c, to.r. .................................................................................................................. (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 ill, this apphcahon, that all statements contained ,i.n th}§~pJ, icgtion are true to the best of his knowledge and belief and that the work wdl be performed in the mal~/~t~.? rsetc,f~3~t.~l'C~he application filed therewith. Sworn to before me this ~,. ~q~3 e.~ ~?w Yor~. Notary Pu ...