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Home My WebLink About3983-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTM~.NT Town Clerk's Office $outhol~ N. Y. Certificste Of Occupancy ~.W Road THIS CERTIFIES that the building located at .. S~.. O~len. tal. ~ve .... Street MapNo.F'I*Est BlockNo. ll ...Lot No.~ Fishers Island N.~. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... A..ug. .... 3.., 19..~.~. pursuant to which Building Permit No..~9.83..Z.. dated ............ .~g .... ~., 1968., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...P.r.~..v.a.t.~...o.n.e.. f..~..$.1.~,..d.w.q .1.1~.ng ..................................... The certificate is issued to .M..o.r.g..~....R.? .~.c.~..~.r. ...... .~..np.r. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....... .N...R... ........................ FOKM NO. Z TOWN OF SOUTHOLD BUILDING DEFARTMENT 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? 3983 Permission is hereby granted to: .............. ~g..~....~.:~.,....~....s.~. .................. at premises located at ...~.a[~f~.~U..~lll~.~,~P~il~ll.~..m~'.~l~t*...~*~e~ .................................. ...................... 31a~.l,~l..l~o~d..@..aaate~tl~..~..af..l~ ............................................. pursuan¢ to application dated .............................. ~lg ....... ~ ............. , 19..~.., and approved by the Building Inspector. Fee $..5.~'~) ............ Building Inspector / TOWN OF SOUTHOLD BUILDING I~PARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........ ~ ............................... , lC~...,...Permit No ............... £ (Building Ins~ector~' . APPLICATION FOR BUILDING PERMIT Application No...."~....~....~...~.... .......... 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 description of layout of property must be drawn on the diagram which is part of thi.~ applica- tion. c. The work coyered,,by ~'l]i§ '~oplic~t~n rr~y,~n0t' be:c~r0rne~ttd before issuance of Building Permit. d. Upon appi~c~'e~ ofithJs appliCdtib~, the~ Buflding 'lnsl~'eLeco~ill i!L~eE-a B~ilding Permit to the applicant. Such permit shall be kept on the premises available for inspectlo~ thl~6ugl~at~h~:~l~i'°gtess of the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS H.EREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk £our~ty,. 'Blew Y~rk, and other applicable Laws, Ordinances or Regulations for the construction of buildings, additions;, q!terqtjzgt~ or f~r removal or demolition, as herein described. The applicant agrees to comply with all applicable laws,?rdinc~hc~nd _regulations._ ,,// ~ ; ' ( 'g /, ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~alz'&l~ll~.~t,.A~.J~l~,glalll~. ..................................................................................................... If applicant is o 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.: ~a~g~l.. ~'~.~'~lJl~l~R..~e. Lot No.: ...~'....~.. ............. Street and Number ..... .~Zlk ~ .¢1~.~.~111~11..~,1~1~1. ~ : · . ................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ..~111.~!1~I~1/ ........... b. Intended use and occupancy ..~e~del!ee.~ .......... ' " 3. Nature of work (check, ,,,which,,, applicable): New B~i~lding .....?.<.~ ....... Addition .~ .............. Alteration .................. Repair ................. : ,Removb! .................. Demolition .................. 'Other Work (Describe) .................. 4. Estimated Cost .~16,Ol~)n.{~ ........................................ '. Fee .~.~..~..0~... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....(~.e ....................... Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupc~ncy, specify nature <~nd extent of each type of use .................................... 7. HeDimensi°nSght 2[l°f existing structureS,urnbe f any.,. Front "i~ 'b'01 ...................... Rear .)4(]1 ...................... Depth .3..0..I. ........................ ............................ N r of Stories .............................................................................................. Dimensions of same strdcture with ~131aalt:l~:~cXm~additions: Front ...0. ......................... Rear ...6..0.I Depth ~.01 ~.~..~.(aCo Height 211 Number of Stor es .1} pl..~.~ add. I st, oz3r 8. Dimensions of entire new construct on: Front .~,Q.I ......... Rear .................. 2.9 ...................... Depth ~..0..I. .................. Height ...... ~.3~! .............. Number of Stories ...... ~. ...................... 9. Size of lot: ~ ...2.,~.a~z~ ....... ~ .................................. ~ .............................. 10. Date of Purchase ~i'..3.2.s..*l~tl .................................. Nome of Former Owner ~.l~.p.~,~ .O.p..q~.'b~'...~..e~..~..~...q.z.. ........ 11. Zone or use district in which premises are Situated. !!~.a.~k..Az'~m.".s..F~h.e~..s.~8'l_.n__~._rt_e.~{...~'. ................................ 12. Does proposed construction violate any zoning law, ordinance or regulation;> 13. Name of Owner of prem se~l~,~.~ehne~ .......... Address ~.0]~:ac.jl,~b~.~a~;t'~B~ Phone No. ,~..2. j ........... Name of Architect ~ame ~ame ' ' ' ~" ;~ "~ "~f~'~r~'~'~ ' '13~ ........ Address ................................................ Phone No ................... Name of Contractor ........................ Address .~.0.~..~....~.0.~..~..~..~...Z..?.~dphone No .................. PLOT DIAGRAM Locate clearly and distinctly a]J buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description ~ccording to deed, and show street names and indicate whether interior or corner lot. At.abed ~S photost~t-of F~s~s'[sland"U~t~l.t. ieS Hap Sbee% 't~J ~n which 'existing house~ drive~ay a~d proposed addi%ima az~ dra~ Tax bill deseribes property %hus~ N - Private Road E - Private Road S - Alice Milliken W - Reichner. Millikem STATE OF NEW ,YORI~',./ ) COUNTY OF .../~..~....~C...~......~.: ....... }S.S. .............. --'V~o~an..Se-.Ae..]~j-~hn'~; ............... being du v sworn, deposes and says that he is the applicant (Name of individual signing application) ........... ' above named. He is the .gCfO,~ .................................. (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; th~ all statements contained in this application are true to the best of his know/edge end belief; and that the work will be performed in the manner set forth in the app~c~ation filed therewith. ~ , Sworn to before me this ~? ,~ /~ ,, I/I // / .................. · "'"' . Notary Public ...... c'/*~'"'~'".'f..~l~i~ll~..,~~.... County ........... ......................... MOORE 12-1 C. CHENE¥ IO-B I0 -I 10-2 II-aA II-aB I1-1 I O-TA :)WNING 10-TB 11-30