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Home My WebLink About3124-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OI:FICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at]~/~.,.~,.'~..~....~..~..~.~..~. ...................... Street Map No. ~ .... Block No. . ~ ......... Lot No. ~ (~hO~e ~*Ye conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................... ~..~.~...~ .......... .~..~. ...... , 19..~.. pursuant to which Building Permit No...~..]....2..~....~. dated ............................... ~,~li~.....~......, 19...~.$., was issued, and conforms to oil of the requirements of the applicoble provisions of the law. The occupancy for which this certificate is issued is ........ ..~.l.v.a.t.e ~z~e. ~amily. ~t~¢tlling ............................................... The certificate is issued to ~.~.]-~I]. ~O~g~ ~ ~'~'1,~ (owner, lessee or tenant) of the aforesaid building. ~.D.App~oval Jtm. e 20~ 1967 Villa ......... ................. Building Inspector { FOItlW NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING P~=RMiT (THIS PERMIT MUST BE KEPT ON ,THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 31~4 Z Permission is hereby granted to: .... · ....... · ................. ........ .b~¢...;.~.~9. ........ : ......................... : ................ .......... ~e~..t,.~.~..l~.~.,.....~.~.~'~ ........... ~ ........... at premises located at ..........]~/-~.....~.¢~al~..Rea~,. ................................................................... ............................... ~tehog~ ..... ~.,.'Lr, ................................................................... pursuant to 'application dated ................................ J.~le. ..... ]..1~. ....... 19.~.~.., and approved by the Building Inspector Fee $....~,.Q ~..O~. ........ s-9 SUFFOLK COUNTY DEPARTMENT OF HEALTH JUN 2 0 1967 Date TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at ,~6, ~,',~/= /v~K Po,~ (~' ' ' (Give deed ......... £~sr ~ve been inspected by this D~p~ment and fo~d to ~ satisfacto~. ~)istrio~ Engineer District Engineer NO. I · TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×amined ..... -- ................... Approved ........................................ , Disapproved ~ .......................... APPLICATION FOR BUILDING PERMIT Date ....~...~....~]......../.....~.. ......................... , 19.~...~..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building 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 descriptioi~ of layout of property must 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. ..:_?...s....c...~..w...~.....~..~.~.~.z~,.....,..~..~ (Signature of applicant, or name, if a corpor~'t'ion)' ........ x.. ....... & (Address of~6pplicant) State whether applicant is owner, lessee, agent, arch tect, engi'neer, general contractor, electrician, plumber or builder. .......... b.....w..~..~. .......... h.~ ........... ~..~.~..~,e.~ .......... ~../.~.~..~...:..~......,~_. .................................................. Name of owner of premises ............................................................................................................................................ If applican~~e, signa~r~e~J~ uly outh~zeO officer. ............. ~....'.~ ....... :..~..:...~..,..,...../..~,. (Name and title of corporate officer) 1. Location of land on which proposed wo'rk will be done· Map No.: ........................................ Lot No.: "' Street and Number ............ .~..(.'....~.../...~.......~...~...~....~.......~x~ .................... .~...~.~..?........~/II~..?..~/.~.:~,4¢~...w..'.~....)/, Municipality d -- 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructi(~n: a. Existing use and occupancy ................................. ; ................................................................................................. b. Intended use and occupancy ....'..~...L4~..~'..~.."~ ..~...-,~..~..~..~" .................................................................................................. 3. Nat re of work (check which applicable): New Building .................. Addition .................. Alteration ............... Repc~ir .................. -,~_./,,,~-'P~em°val .................. Demolition .................. Other Work (Describe) ..................................... (to be paid on filing this application) 5. If d,~eIling, number of dwelling units ...... ~...~...~.,~.. ........ Number oi~ dwelling units on each floor .....:'. ....... :', ........ If g4rage, number of cars ................ &~:~,'~....~:/.'~.. .............................................................................................. ........... / 6. If bpsiness, commercial or mixed occupancy, specify nature and extent of each type of use ....' ........... i ......... 7. Dimensions of existing structures, if any: Front ............................ Rear ...... ; ...... £ ................. Depth ..: ........ ......... Height'J'' ..... ~ ............ Number of Stories .....: ........... .-. .......................................................................................... Dimensions of same structure with alterations or additions: F~ont ........ '.'.; ......................... Rear ...... : ........ : ......... Death '-"--' .. Height .......... ~ .......... Number of Star es ' ~ 8. Dim,bnsions of entire new construction: Front ....... .................... Rear ........ ........... Depth ........ ..... Height ...... /..',~.. ...... Number of Stories ...................................................................................................../.... ! , · 9. Sizelof lot: Front ........./~..~...~ ........ Rear /O~ Depth 12. Doe~ proposed construction violate any zoning law, ordinance or re. gulation? ........... .~'....~....: ................................. Narhe of Architect .............. ~....~'.. ........................ Address ................ !,.~ ......................... Phone No ......./.! ....... Na4e of Contractor ~../~.. ...................... Address ~" Phone No. / ~ PLOT DIAGRAM : I , Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate oll set-b~ck dimensions property lilies. Give street and block number or description according to deed, and show street names and indic( whether interior or corner lot. I STATE OFI NEW¥OR~ ,q / e e ...... , .......... !.'~.~ ........ ~ ....................... being duly sworn, deposes and soys that he is the appJic( j(Name of individual signing al~/plication) . .~ above na4ed. He is the ....... ...~..~..., ....... .~¢'!Z:~.Y~..., .......................................................................... , ......... (Contractor, agent, corporate officer, etc.) of said o?lner or owners and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this application are true to the ~;~t of his knowledge and belief; that the w~rk will be performed in the manner set forth in the opplicatio,~,filed thFfe~ith. / Sworn to before me this ,,~ ............ /:~... ~ay of '"~*;9";*t ......... , 19...~ Notary Public0 ..B~~ount~ (Signature of applicant) I ~o, .~. -~o~ ~-' // '~ // Z I'rl 0 N. 89° 59'$0"E Z 0 Mary' Zeneski S. 89°5~ 30"w. E ' Stepnoski 150.00' 150.00' NOTE: I= MONUMENT SURVEY FOR ROBERT P. DE MOTT 8~ MARION R, DE MOTT EAST CUTCHOGUE TOWN OF SOUTHOLD SUFF. CO., N.Y. GUARANTEED TO= $OUTHOLD .SAVINGS BANK THE TITLE GUARANTEE CO. SCALE: I" = 40' APR. 18, 1967 PROFESSIO~ ENGIly,]EER AND ~ LAND SURVEYOR~N.Y.~. LIC. NO. 12845 RIVERHEAD., N.Y.