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Home My WebLink About4157-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTME~IT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...~,. 35.07. -. Date ........ 3une ..... 18~ ...... ,19..69 THIS CERTIFIES that the building located at ..Da;~n. Df. rYe ............. Street Map No..Daw-n ...... Block No ........... Lot No..7.~, ·. ~.ee~t~I~;,. lqew. Yolk .... ~:s rates conforms substantially to the Application for Building Permit heretofore filed in this office dated .... December .... 25.,., 19.68. pursuant to which Building Permit No..4157.2;. dated .... December .... 25.,.., 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~iva~.e, one ·fam. t.J;y, d~eJ. Kinq .................................... The certificate is issued to .. -~la.~-~y~ a.~nmt~q (Owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval June. ,i7,. J,96~,. lto]~e~t:. Villa .... Building Inspector Underwriters Certificate ~ 736638 TOWN OF SOUTHOLD 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) N? 4157 Z Permission is hereby granted to: ......... I,~..l~,e~t~l~e.....~t~.....l~,rzl,.. J~'~e.t,~ ......... .b3....ll.....~em,.A~m ................................ ......... ~....~,e.~...... .......... ~.:.~.: .................. to ~tX~l ~ ~a~ realty. ~z,.Z.....~ ..................... at premises located at ...~Jd~..~.J ....... ~l~,lr.elll..~..o;~13~..~Jl~e,.],~X ................................................ ............................. ])mm..~ ......... o,~aenpoz~ ......... ll,Zo .......................................................... pursuant to application dated .............................. ~1~111~11~.....~,~., 19..~., and approved by the Building Inspector. Fee $.....!.~.*.~. ....... 8-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date_ ~_ ~ ~ /~'~ Bldg. Permit No.~_~ ~_.. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located - ' ~ (Give deed f n) have been inspected by this department and found to be satisfactory. Dis~ ¢~ Enginee~ District Engineer GULL PO~-4 L') TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................................ ,, /:/..../.../.. Approved ........................................ , 19 ........ Permit No ..... Disapproved a/c ........................ ................. I ........... iBuTl'~n~ In§i;~&';;';i ................................. Application No ............................. ^PPLI¢^TION FO. BUILDING :PE.MI? Date ............................................................ · ]9 ............ 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 o detailed 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 befo~'e 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 i:ssuance 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, ordlnances, b~il~n~l code and regulations. .... :' ';~;;'i'/';"~;'r'~';;¥i;';'> ....... .... ~ .~....~ :.(..~.C~ ~ _q~ ....... ~ ;: :./..~/-f~ ~ :~ ~. :%.. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pi'~mber o~-~ / If applicant is a corporate, signature o¥ duly authorized officer. 1. Location of land on whic~kproposed wo,~k will be done. Map No ..... t ............ Street and Number ,.,.~?~...~....~.......~...~.. ................ ~..L...~..~..~.....~. ..................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy /~/r'~,~-J~ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair ............. t~" Removal ..................Demolition .................. Other Work (Describe) ........................................ 4. L-'stimated Cost ..L~'.....~..,.,q.,,~,,...,.."~... .......................... Fee ..... ./....u...f....-~7..'.'.' ................................................................... (to be paid on filing this application) / 5. I~ dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ........../.. ................................................................................................................................ 5. 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 ....w~....~.T. ................... Rear..~.'.i ............. Depth .~.?.~.~.~.?.~ ...... Height ...../...~... ....... Nu~mber of Stories ...../.. ............................................................................. ~'I .......... ~"~'"'"~'"" 9.Size of lot' Front ....7..~ .... Rear /~..Z Depth / ''~ ? ~' jr"%' ~ 12~ Does proposed construction violate any zoning_llt.w, ordinonce or regulotion? ....~....~. ............. ~ ............... m ............. 13. ,Name or uwner o p .~...:..--~.z.':::. ............. jr. ~ ............................................ Phone No.'.,,¢. ................. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~..~...~..~...~..~./ ........ Address~...~.~..~...~..(../..~... hone No .. 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 ar description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, 1. c c CO~JNTY OF ............................. ~..~ ~"~' ................................................................................................. being duly sworn, deposes and soys that he is the applicant (Name of individual signing application) above named. 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 conta,ined in this application are true t,9 the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application fiJ~'d,/~erewith. Sworn to before me this ,-, ' ' ~.---~/~/' ....... o, ..... ............ , Notary Pub'~~...~..~.~... County ...... A'-'~-("'~-/~;';¥~;;-;~'~;'~;;~;;'i ............................. ........................................ ' .......................... ~'X~ a.~ v~, ~ j~.~ ~ ............................... i'~u'~;;,~"i;.,~;,:.'~;,:i .......... ~' ........ ~," ,~ ' ~ ~,~,~ APPLICATION FOR BUILDING PERMIT , '~u_~/.S'- c:~ 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 description of layout of property must be drawn on the diagram which is port 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, o.r for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordina~atians. ......... ~~;:,;,i-;'~,; ',;;;;;'i¥';';;',~'~i';;,'~' ........ .... ~..~:...~r:....~.~...~...¢'....,..~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber o~ - Name of owner of premis .... ..~.~....~...~ ........................................................................... If opplicont is a corporate, signature of duly authorized officer. (Name and title of corporate officer) /~ ,. _..~' ,:' ,'o,o,,,o,,.~n~o,~,,~.~_ ~o.,wo~w,,,~.~o...,~o~, wr~- ?,o.~.:.:.,o.~~.~.'.-..'.C.I,"~,~o.~.;. . ,o,,o 2~ ............. .. Street and Number ....~.J~...¢~.. ....... .~..l~. ..................... ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. ,..~ed use a.d occupa.cy 3. Natur~o$'~wo~k (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal ........... ~ ...... Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....Z...~'.~'.....~..~.......~... ............... ~ ....... Fee ......~...0...Z~ .......................................... I .......................... (to be paid on filing this applicaticl?) 5. If dwelling, number of dwelling units............/ ................ Number of dwelling units on each floor ............................ If garage, number of cars ......... ./.. ................................................................................................................................ 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 .~.P~.. Height ..../...~... ....... Number of Stories ..../.. ............................................................................................ .~ ........ ;/ .... 9. Size of lot: Front ....Z...~'... ............... Rear ..... ../.~..~... ................... Depth ..... /. ....... .~.~-~..~....~Y.. 10. Date of Purchase "' '/"~"~'"'7 .................................. Name~ ~'~ __al Former Owner ..~..~..~ ..... 11. Zone or use district in which premises are situated ......... ~..~...~.~..(...~..~. ...................................................................... t2. Does proposed construction violate any zoning law, ordnance or regulation? ... ~....~. .................... ~ . Name of Owner of remisesC~ ........................ Address ./~..~. .................. Name of Archit~t ...................................................... Address ............................................ Phone No ..................... Name of Contmcto~e.~..~~. ...... Addres~.~.~.~.~hon~ ~o~.~...~?.~ PLOT DIAG~ Locate clearly and distinctly all buildings, whether existing or pr~osed, and indicate all set,ok dimensions from pmpe~ lines. Give strut and bl~k number or de~ription according to de~, and sh~ street names and indicate whether interior or corner lot. ST^T OF YORK, ................................................................................................. being duly ~~d says t~ ~e is the applicant (Name of individual signing application) above named. He is the ......................................................................................................................................................... (Contractor, agent, co~orate officer, etc.) of said ~ner or ~ne~, and is duly authorized to perform or have performed the said work and to ~e 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 fo~h in the applied ~r~th. Swam to ~f~e me this · ..... ~ MARION A. REG~ · *: ~TARY PUBLIC, State of New York No. 52-3233120 Suffolk Coun~ Term Expr~ Ua ~h lo, '~ I 'r 1.21 .¥ 7-' 3zxo ~ 0;0" ,f /'~o TE ..... . Ui.I~xc~Yt~TEE.~ 2 iX 0" 'i