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Home My WebLink About4110-zFO~M NO.~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z .3637. ..... Date ........... Oat ..... 31 ...... , lg.-69 THIS CERTIFIES that the building located at .. Pwt' Road' S~S ' 0rTenta*l ~?e~et Map No. F.I..Ezt.... Block No..20 ....... Lot No. 7 "' F-ishe.r.s .Is.land .... N.~.... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... @c ~;. · · · 30., 19.65 pursuant to which Building Permit No..1~ 1 .] O -~ - dated ....... 0~t....31 ...... , 19./~8, 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 . ?r. lva.t.e.., ac.c.e $ so.r.y, b~il~; ;tr~ ...................................... The certificate is issued to ...... Thomas ~ ho~b$nz ...... Ow~eI~ ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval '" 'N ~R~ ............................ ........ ...... .............. Building Inspector FOR~I NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMEN' TOWN CLERK'S OFFICE: SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL Permission is hereby granted to: .... to }~...~...~.~.~..~~..~..~o~.~g. ~ .~..~g...~.~.) ..... at premises located at ........... ......... ~g..~ ......... .~.~g~...~.a,~ ..~.~,~ ~ ................................. pursuon¢ to application doted .......................... t~. ....... ~) ......... ;....., 19..~JJ., and approved by the Building Inspector. ....... Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILI~ING DEPARTMENT! TOWN CLERK'S OFFICE Examined ......................................... 19 ........ Approved ........................................ , ~9 ........ ~rmit N~ .............................. ~,. Disapproved a/c .%~ . ....................................................... .... · .'~ ~" .......................... (~U dinO Inspect° ~" .......................... "" ................. ' ........ Application No ....... /..~'../...0 .......... APFLICATION FOR BUILDING PERMIT .i Oetol~ 30 Date ...:, ........................................................ , INSTRUCTIONS a. This application must be completely filled in by typewriter or in i~k and submitted ia duplicate to the Building Inspector. b. Plot plan show ng location of lot and of buildings on premises, relati~onship to adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust be drawn ~n the diagram which is part of this application. c. The work covered by this application may not be commenced befor~e issuance of Building Permit. d. Upon approval of this application, the Building Inspector will ~ss~e o Building Permit to the applicant. Such ermit shall be kept on the premises ava able. for inspection throughouf the progress of the work. e. No building shall be occupied or used in whole or n 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 theI issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Sou,hold, Suffolk County, New ~rk, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or ~or removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buiJ~ing code and regulations· Fisher~ (.l~nd ~ility Co. Inc. (5ignatqre of appli~nt, or name, Jf Q corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gene[~al contractor, electrician, plumber or builder. Name of owner of premises ........... .~.~.~...~.~J.~ ....................... ~ ................................................................................ If appHc~'i'~ c~po/at~, si~ure ~ly au~orized officer. V (Nam~ ahd title o~rporat o ~r) 1. Location of land on which proposea wor~ will De ~on , p ~ :., .~ .............................. Lot No: .................... Fishers I~land Ne~ Yo~k Street and Number ......... : ...................... ~ .................................. ~ ....................................................................... Municipality 2. State ex st ng use and occupancy of premises and intended use 8nd. occupancy of proposed construction: a. Ex~shnfl use and ~cupancy ................................................... ,~.E:,.-~,,z.~...~.~ .................................................. b. Intended use one occupancy ........................................... t ...... :-F:':*' ....... :";"','"'"' ................................................. 3. Nature of work (check which applicable): New Building X Addition Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4.Estimated Cost . . .0. ,. . .0. .0. . .0. .,. .0. . .0. ................................. Fee ............................................................................. (to be paid on filing this' application) I ~oom $. If dwelling, number of dwelling unifs ............................ N~mber of dwelling units an each fleer ............................ If garage, number of cars ......... .i....~?..,~...~.e.?...~.~l~ ..................................................................................................... 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 .............................. FI,eight .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...... .I..4..~. ............... Rear............................20' Depth .4..6.~..'..~..". .............. Height 14' Number of Stories 9. Size of lot: Front ..... .3.?.~7.....A. ........ Rear ............................ Depth ................................ 10. Date of Purchase 1965 .................................. Name of Former Owner · ~ ,~ Re~ident; tal 11. Zone or use district in which premises are s~ue .................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...N.~ ................................................ 13. Name of Owner of premises .T,,h.,O.l~...e..~....~.o..l~..J.~ ......... Address .....D...e.~..i.~.~...~.~.., ................ Phone No ..................... Name of Architect .~.:..~.....~.?,o..~..~.?..e.~....?.!..e...~..~. ....... Address !.!..O....?...~..~..k....,A.,.~.,e...,....N..~.... Phone No ..................... Name of Contractor F......,..I..,....~i..!.j..~..~..,..~..o,.? ............ Address F...i..~...h..e.~.~.....I.,~,.!.e..l~..d....~.... Phone No.~..~.~..~.~.! ..... PLOT DtAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW "~olk 1 S,S. COUNTY OF ................................ Robe~'~ .~., E,~elho..~.~. be ng duly sworn, deposes and says that he is the applicant (Name of Jndividua signing app ication) above nome& He is the .......... ......................................................................................... (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 file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the~x~pl~ication filed therewith. Sworn to before me this ............................ ~ . ~ n I . ~ , ~ ~ j~rquahf,ed in Suffolk Count~o /~ ~ m Expires March 30, / / / ,/ / ? I i; / /I I / / / / / / / J / '~ I '1 I PLoT PLAN HOUSE FOR MR. & MRS. THOMAS ROBINS FISHERS ISLAND, NEW YORK p'L ~.T'r