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Home My WebLink About4098-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy NoZ~932 ....... Date ........... &l~.... 7- ...... , 19 .~0. THIS CERTIFIES that the building located at . 01® .~l~ll~ .~ ........... Street Map No. ~1~ ......... Block No. ~ ...... Lot No..~1~ -..l~tt~;~l~k. - 1~.][. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 08~;. · · ~.., 19 ~. pursuant to which Building Permit No. 1~4)~[~.. dated ........ I}e~;. .... ~4~ ' ' ' , 19.68', 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 .... P~.l~;e .~..£~11~.1.y. d~l:L~ .................................... The certificate is issued to ...l~s.o..¥11~.~eld. t~ebbs1, ..... On~l'l' .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~T~I~®. [}.-]~ · .b~r..R.. ~.t-11~ ....... Hou~e I~ 2280 FORM NO. ~ TOWN OF SOUTltOLD 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) 4098 Z at premises located at ........................................................................................................................... .............................................................................................. .................. pursuar~t to application dated .... 2 ...~.... ~CT 10~B and approved by the Building Insl~c~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. Z .351~3... Date ........... ~tm~... ~o ....... , 1965.. THIS CERTIFIES that the building located at . .Ole. ~3,e. ~ ......... Street Map No ............. Block No ........... Lot No.. ~/~ttl~l:~,lco. lle~..York ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .Q~ol~r.. 23,.., 19 f~8. pursuant to which Building Permit No. 4028. ~-.. dated ..... [~tolaer.. 2~o..., 19.68., 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 ........ px:L.v.&te. ~me. ~a~lll~..d~eelllng ................................ The certificate is issued to . ~£l~ld. W~er ...................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Jurm .&,. 3,~,. Iobezt.~/lll~ .... ,/ {f RECEI SCHD DEPARTI,~,E~J[ Of: I1~ ~ ih RI/E~HEAD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ~Cive 'daSd locat~on~ ' ' ~' V' v ~,~ have been inspected by this department and found to be satisfactory. Histrict Engineer JUN 9 1969 District Engineer 'tOWN OF SOUTHOLD ' BUILDING DEFARTMENT T~N CLERK'S OFFICE. ~THOLD, N. Y. ~/~ ~amined A~mved ................. ~.~...~., ,9~.~ermit No. ~'~:'"~/~0 ~is~r~ed e/c .............. ~ ...................... ................................................. (Buildin~ Insp~tor) APPLICATION FOR BUILDING PERMIT 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 ad oining premises or public streets or areas, and g ring a deta led description 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 $outhold, 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, housing code, z~nd regulations. ~ca~tion) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................... ~.~..t..~.~..~.~ ......................................................................................................... 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.: ............................. ........ Lot No.: ........................ Street and Number~1' ~80 ..~/L. ~L.~-- ~LE I_,~NI~ Z Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ................................. ..V...~.....~....~....~.)..-~.. ......................................................................... b. Intended use and occupancy .................. .~. ...... ...~...~.....~..../..../~.....¥. ......... ..~.....~.....~.~..~.../T../....~...~ ................................ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal ........~.~... Demolition ......... :/~.... Other Work (Describe) ........................................ 4. Estimated Cost .................... !.?...) ........... .O.. .................. Fee ....... ~.....~. ............................................................................ (to be paid on filing this application) S. If dwelling, number of dwelling units ........ ..0....1~.....~.'~.. ...... Number of dwelling units on each floor ............................ If garage, number of cars .~ C~k'l~/~ ~- ~.. ~ 1~/1)/~ ....'~. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories .............................................................. : .................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number qf Stories ................................. ;.; .................................................................................. 9. Size of lot: Front ............. ..~....~..../.~.~'l~;ar .......... ~....~...!.(..~...?~...... Depth ..... ,~..~...I..(.~.l./.~..i.~... 10. Date of Purchase ..~..7.-.~..~....~......../..~.....~...~ ........... Name of Former Owner ~...~...C....~..~..Z~... ...... 11. Zone or use district in which premises are situated ..~..~.~...~...~..~..Ib~-/¥ 12. Does proposed construction violate any zoning law, ordinance or regulation? ...'~.....~. ............... 13. Name of Owner of premises .~..!.N....P../....~....~.........J~....~...~..~.'~ddress lC ............. 7~'/~'tY'/'m'~'~'- Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....~.~..~....~.~..L.~. .......................... Address...~...~...~...../~.....~..Z....~.. ................ Phone No.Z..~....~...Z...~.~'~..~b- PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF N~ YORK, ~ OLEJUL E _ COUN~ OF ......................~.....¢~ ¢¢'~ .~ . -~ . ....................................................................... ~ ........................ ' g au~y sw~r~ d~ses aha says t~t he is the (Name of individual signing application) ~ [ bov,H, ............................. L ........ ............................................................................. (Contractor, agent, corporate officer, etc.) ' of said owner or owners, and is duly authorized to perform or have performed the soid work and to ~:ke and file this application; that all statements contoined in this applicotion are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ..... ................... ........................ ot ' 'i~ ................... ~ ...... ~-~ ....... ~'" .......... NOTA~ ~LJC, State of New York No. 52-3233120 Suffolk County Term Expires March 30, 19~