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Home My WebLink About3069-zFORM I~0. 4 SOUTHOLD,. N. Y. r. EI~TIFll]ATE OI~- IDI]I]UPANI]¥ No. Z. ~.~ .... Date .................... 0e.~. · L~ .... 1966. THIS CERTIFIES that the building located at . .E./$. 8gi.l-lwaqe~ .Ave ..... Street Map No.. ~ ....... Block No...X~ ...... Lot No..~ ..... gntehogue ,. ]{,Z, ..... conforms substantially to the Applicat~on for Building Permit hereto~o~'e filed in this office dated ........... A~...~.., 19~. pursuant to which Building Permit No. ~... dated .............. Ap~...2.~ 19.6~, was issued, and conforms to all of the require- ments .of the .applicable provisions of the law. The .occupancy ~or which this certificate is issued is . P.~ivate..one .fa~il.y. ~,t~e~i~g .......................................... The certificate is ~ssued to ... ~. RObo~t~ .......... ~,~e~ ...................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval 0e~..~'~' '1966'' 'bY 'R~' 'Vi~la ....... ............. .... " ....... FOR~/I NO. 2 TOWN OF $OUTHOLD ~UILD~NG DEPARTMENT TOWN CL£Rg'S OFF~CE SOUTHOLD, N, Y. BUILDING PrRMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3069 z Dote ............................................................ , 19 ........ Permission is hereby granted to: Gee, Ahler~ ~...~..q ...... ~[~t~:~.~.~q.. ~q .o:[q Oh~ ......... ...~.~.¢.c. hag~e ....................................................... t~.~$~.c~..~:~...P~Le...f~mfZ~...d.~.e~-].i~g ......................................................................................... at premises located at ..f~..~..~:f~t.~f~2...~e .......................................................................................... ................................................. .C.~zt~h~ue.,**.. N ~ ~o .............................................................................. pursuant to application dated ......... i ................... ~,~.~],.....~. ....... ~., 19~..., o~d approved by the. Building Inspector Fee $iO.,.O.Q ........... s-R SUFFOLK COUNTY DEPArtMENT OF HEALTH OCT ~ I 19~ Date TO WHOM IT NAY C0~CERN: The sewage disposal facilities for a structure located at (dive deed location) have been inspected by this Depax~ment and found to be satisfactory, , D%s~$~,t En~fneem District Engineer FO~M ~0, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~-/~'~" '~'~ ~ 19 ~ ~ Approved ........................................ , 19 ........ Permit No ............................. Disapproved a/c ............ ~ .............. ~..~ ........ ~.~ ........................... .......... ............ (Building I n~l~ector) APPLICATION FOR BUILDING PERMIT Date ....................... g.~.. ................ , 19.~...~~. .... INSTRUCTIONS a. This application must be compJetely filled in by typewriter or in ink and submitted in dupJicote to the Buildlng Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving 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. 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 a 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. ....... .............. ~~'~ess of appl'i~nt) '"~ ................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) i. Location of land on which propos~ft~ work,~will be done. Map No: ............. ,..../~ ............ , ............. ' 'Lot No: .................... Street and Number ....... ~...~...~.&~. ........ ...~...~ .................. .~..~.~.....~..Z.~....~., ................................................. Municipality ~] 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................... ~',' ~ '.~7"' ................................................................................... b. Intended use and occupancy ................... ~...~.~.~ .................................................................................. 3. NatUre of work (check which applicable): New Building ...... ~ ..... Addition .................. Alteration ............... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................. i (to be paid on filing this application) 4. Esti, ated Cost ............... C) ..................................... 000 ....................................................................................... Z...., Fee 5. If d~velling, number of dwelling units ......... I....~.... ......... Number of dwelling units on each floor ..... ..~.....~. ......... If g~rage, number of cars ........................................................................................................................................ 6. If blusiness, commercial or mixed occupancy, specify nature and extent of each type of use ............................. 7. Dimensions of existing structures, if any: Front .......................... Reor .......................... Depth ........................ Height ............................ Number of Stories ............................................................................................................ Dimensions of same structure with alterations or additions: Front ................................ Rear ............................ Dep!h .............................. Height .............................. Number of Stories ......................................... ' " '.'.. ~v' ~" ' ~ ' . .... ~ ~. ~ Depth ........................ 8. D~mpns~ons of entire new construction: Front ~.~,.,....~.. .......... Rear ................ Height .......... ./.~ .............. Number of Stories .......... /. ................ ' . ......... &,o.,o .4...o.~ 9. S,ze of lot: Front ............. Rear ........................... Depth ............ ..~ ................. 10. Dat~ of Purchase ........................................................ Name of Former Owner ....~Z.......~.. ................................... ]1. Zon~ or use district in which premises are situated ............................................................................................. 12. Doe~ proposed construction wolate any zonLng law, ordinance or regulation ......................................... , ......... 13. Nan?e of Owner of premises .,/~.~,':~........~......Address ..~, ....... f:......~;..'f/./~.~. ....... ~... Ph ne No ....... ! ......... Nam[e of Architect ...................................................... Address ............................................ Phone No .......: ......... - Nor6e. of Contractor .(~ ..................... Address .~..I/..~.¢. .............................. Phone No. PLOT DIAGRAM L.ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr( property liges. Give street and block numbers or description according to deed, and show street names and indic( whether int~erior or corner lot. OO I .{. STATE OF{ NEW Y{DRKJ/ .,/- ) ~ ~ j~ .~ ................................. being duly sworn d~oses and says that he is the apptic .............. ~;~';~n~ividual signing application) above na~ed He is the ....................................................................................... ~-~.~.~ ....................... j (Contractor, agent, corporate officer, etc.) o~ sa 4 o,*,ker or owners and is du v authorized to perform or have performed the said work and to make, and this applicption; that all statements contained in th~s applicat~on are true to the best of Is nowledge and be and that t~e work will be performed in the manner set forth in the application filed therewith. Sworn t~ef~,me this ~ ., . .... , ...................... ~ . ,/ ~ ~ ..~,. ...... ~..~~....~'.~.~ ....... , . v ~ ' r,, Pui>~ c state of N · i