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Home My WebLink About2658-zFORUM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No 'Z '2'29] ............ Date .......................... l~c~v, emb.~r..lf~ ]9.6.5_ THIS CERTIFIES that the building located at . . .[~/~....~]..t~,.~O.~ ............................ Street Map No ..... ~l[~c~ ...... Block No ,.;;l~c ............ Lot No ,X3C~,, . l~Q1~t,,h~.]L.~J,...~..~.t] .... conforms substantially to the Apphcahon for Building Permit heretofore filed ~n this offic~ dated ................................... jl~t..~O~ ..... ~' .... , 19 0.~. pursuant to which Bu,ldmg Permit No ..~.~.~....~...~ dated ....................... J~'~'<~Jl ....... (J ...... , 19 6.~.., was ~ssued, and conforms to all of the requirements of the ~pphcable provisions of the law. The occupancy for which this cerhficate ~s ~ssued i~b .~ ...... · . Priv~te...oae.. £amily...d~.e ] ~ ing ............................................................................. , ........... The certifmate is issued to '-'(~ori~e"l~'¢fla~(ie ...................... (~wrte~ ........................ i ........ ~" (owner, lessee or tenant) of the aforesaid building H.D. Approval Nov, 3, 196% Building inspector FO]~ NOo ~ 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? 2658 Z Date ........................ ~e~ ......... 8 ............ , 196.2.. Permission is hereby granted to: ~Tae~ ~ILe~ _~_?~s .....A/~:.. Cm~.~.ne..t~i~t~t ~ ....... .... 3,,~6.... l~outl~de~r~....t~ ................................ ....... k4~or~ ..... ~.~¥~ ................................ to ..~t~..~e,,~..one...fm~il~r..<l~ret.~:~: .................................................................................... at premises located at ...~/.~.....]j~lhl. l~...Re~.~. ......... '(.l~'l.~d-~- ~)~I).,..A-,--) ........................................ ..................................... .l~a:l...~ew...t..~ut~olds...l~,.~, ............................................................. pursuant to application dated ................................. ~L~(~ .......... ~' ....19..~r~., and approved by the Building Inspector Fee $..]L~.O0 .......... S-9 SUFFOLK COUNTI DEPARTMENT OF TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at U (Give deed location) have been ins d by this Department and found %o ~e satisfactory. Distri6t Engineer TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, hi. Y. Approved ........................................ , 19 ........ Permit No ................................. (Building Inspector) Application No ........................... APPLIGATION FOR BUILDING PERMIT Date INSTRUCTIONS a. Th~s opplicahon must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildint Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o, areas, and g~wng 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 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. Suck permit shall be kept on the premises available for inspection throughout the progress of the work. e. No buddmg shall be occupied or used Jn whole or m 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 ~ssuance of a Building Permit pursuant to the Buildmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply with all applicable laws, ordmances, building code and regulations. (S:gnature of appli~c~nt, or name, if a corporation) 126 BOUTHDO~IN RD. HUNTIR GTO~ N,Y.. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engmeer, general contractor, electrician, plumber or builder. OWNER, BUILDER Name of owner of premises ...... ~..0.~.t~.~..*~....~.1.?.~.~,. ........................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Locohon of land on which proposed work will be done. Map No' . ........................................... Lot No: .................... Street and Number ...................................................................................................................... SOL~fH SIDe, EDtS .RD. 215' EY'.c~ CF V!G:OAI$. RD. B~VI~L~.,...~] ...................... Municipali~ IC%.N DF SOUTHOLD 2. State exmtmg use and occupancy of premises and mtended use and ~cupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b Intended use and occupancy ......... ~.~ ................................................................................................. 3. Nature of work (check which apphcable): New Budding ..... ~ .......... Addihon .................. Alteration ................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..................................... 4. Estimated Cost ..~.i...0.~.O..~C~...,.~.Q. .................................. Fee ...~,.Q^.QQ ........................................................................ (to be pa~d on fihng th~s application) 5. If dwelhng, number of dwelhng umts ............................Number of dwelling umts on each floor ........................... If garage, number of cars 6 If business, commercial or m~xed occupancy, specdy nature and extent of each type of use ............................... 7 D~mens~ons of ex~stmg structures, if any: Front ..........................Rear .......................... Depth ........................... Height ........................... Number of Stones ............................................................................................................. D~mens~ons of same structure with alterations or additions: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stones ........................................ 8. D,mens,ons of ent,re new construction: Front .4..4..L~..1..U..~....1.]..~...6~ear%.°..%..~..1.....~.~'.~.(~.~.~ ..... Depth Height 12~ Number of Stor~es 1 9. Size of lot. Front 110 ~ Rear ll0t Depth . 166 ~ 10 Date of Purchase ..... .1...9..6...1.. ......................................... Name of Former Owner ..... ~.I..D...D.~ ...................................... 11 Zone or use d~stnct m which premises ore s~tuated ................................................................................................ 12 Does proposed construction violate any zoning law, ordinance or regulahon? ........ .~..0.. ........................................ 13 Name of Owner of prem~sesq.~.~.I.~.!.~..~.~.H..~.B..~Addres~..2.~...~.~...U..T.~.D..Q}?.~..~.~...D......~[r~.~.~.~. .... Name of Architect ...................................................... Address....... ...... HA...? ....... 085~i'. ..... ............... Phone No .................... Name of Contractor ..J...A..q.~....~..I.~.H..~.~. .................... Address ...~J%l~,~ ............................... Phone No .................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~stmg or proposed, and indicate all set-back dimensions from property hnes. G~ve street and black numbers or description according to deed, and show street names and indicate whether mter~or or corner lot. STATE OF NEW YORK, / S S. COUNTY OF .............................. ................ ..~....~...Cr..J...~. ....... ~.~./...~.,/'..~..~....~ ..................... being duly sworn, deposes and says that he ~s the applican~ (Name of individual s~gnmg apphcation) above named He is the ........................O..%.~.R.....B..~I~,q~.~. .................................................................................................. (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 th~s application, that all statements contained in this application are true to the best of his knowledge and belief; and that the work w~ll be performed in the manner set forth Jn the apphcahon filed therewith. Sworn to before me th,s ~~ 19.(ft...~......~X~_ /~ ~ 0 _ ~,x..~ .~-..~ ..] ............. .~....... day of .......................................... , Notary Pubhc, . .................... T.ra'.~.~..]..~.'~... County/ J (Si'gnature of applicant) .... -. Il