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Home My WebLink About4196-zFORM NO. ¢ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~... ~5:~L5 .... Date ..... July ...... Il, ......... , 196.9. THIS CERTIFIES that the building located at .lq/S. t~ain..Ro~d .......... Street Map No ............. Block No ........... Lot No.. axeer~por~,..~le~ .York ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... l~a~:~h ..... 4~.., 19.69. pursuant to which Building Permit No. 4J, 96. ~-. dated ....... l~ar~h ..... 5,..., 19.69., 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 ... Clubhouse..(main. building) ....................................... The certificate is issued to... IsLand. gnd. Golf .&. Cot~ltl~y .CLIlb ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... Building Inspector House ~ 5025 ~la.tn Road FORNI NO. 2 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? 196 Z Permission is hereby granted to: · ..E~r,2e-ae...~e~s~ffer~..~/G..-l~rt¢}..~ Golf & ~o~ry Cl~ In( ............ ~e~,~ .............................................. ................. ,~f,,~,, ..................................................... to .......... ~.u~3,f,..~r~.. at premises located at ....................... ..~.,'(~.....~.&..~*'),..~.~..~',~..-~.~.-,.~.~.~,'~P.~.'~ ................................... .................................................. G~.~z~,r,r.t .....~..~ ........................................................................ pursuant to application dated ................................... ~/~.~{3,~......~....., 19...~t~., and approved by the Building Inspector. .Fee $...~.e..(~, ........... IFORM ~NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL'ERK'S OFFICE SOUTHOLD, N. Y. Appr~oYed ..................... 19 .... Permit No .................... ~ ¢ /~' ~-~ Application No. 'g//~ ~ Disapproved a/c_~~~.. (Buff,ding ~eetoor) APPLICATI02~ FOR BUILDING PERMIT Date ........... ~[4Jg~l~]et ..... .~. ......... 19.. 6,~ INSTRUCTIONS a. This applicati,on must be completely filled in by type~vriter or in ink and ,submitted in duplicate to the Building Inspecf~or. b. Plot .plan showing 1,ocation of ~¢t and ,of buildings o n premises, reIatio.nship to adj,oining premises or public streets ~o~ areas, and giving a de'~aile,d description of lay out of property must be drawn ,on the diagram which is part of this application. c. The work covered by this application may n~ot b e commenced before issu.ance of Building Permit. d. Upon approval of this applicati, dn, the Building In spec~or will issue a Building Permit ~o the applicant. Such permit shall be kept cn the premises available for inspectRm throughout the progress ,of the w, ork. e. No building shall be occupied or used in whole oz¢ in psrt f~or any purp~ose whatever until a Certificate ,of Occupancy shall b~ave been granted by the Building Inspect~r, APFLICATION IS HERE3¥ MAI~E to the Building Department for the issuance of a Building Permit pursuant 1~o the Building Zone Ordinance o~ the ~own of So,athold, Suffolk C~unty, New ~Z~rk, and ether applicable Laws, Ordinances ,or Regulations, fo{ the construclion ~f build ings, additions or alterations, ,or ~or removal or demo- lition, as herein described. The applicant agrees ~o com ply with .all applicable laws, ordinances, building code, h.~using code, an, d regulations. .......... (Signature .of .applicant, or ri.amc if a corp,oration) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contract, or, electrician, plumber or Name .of ,owner of premises ...[.~..l.~.~ .~..~.I).¢i..6.';[.O.~..&..C.¢~¢'7];~¢. ¢.l~b...t~..~. ............. '...:**... *. ........... If applicant is a corporate, signature of duly authorize d .officer. (Name and title o£ corporate officer) 1. Location ~of land 8.n which pr(~posed w,ork will be done. Map No... ~ .......... Lot No .... ~ ..... ~/ --Z-~1~ I~/8 ~ain Road .E] flreenpo~t .[,,,.~.,.,.~,~'.. ............... Street and Number .................................................. Municipality 2. .State existing use and ,occupancy ,o~ premises an d i~tended use and ,occupancy of prep.osed construction. a. Existing use and occupancy ...C.~[~. ~ .l*&~;[~;i.~;t~ ............................................ b. Intended use and ~o,ccupancy .... ~.~l.e..',¢2.~tl. a~. a~ldi,~lOn .&. Al:[e~8.1:tor[ .to..bt~ilding... 3. Nature of work (check which applicable): New Building ........ Addition ...:KKr. Alteration .:l~... Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. t{stimated Co,st .... 20~(]00.~'. ................ Fee ...~e.0~ ......................................... (to be paid ~n filing this application) 5. If ,dwelling, number .of dwelling units ...ltOl~$.. Number of dwelling units on each floor .............. If garage, number of cars .......................................................................... 6. If business, commercial ,~r mixed occupancy, specify nature and extent of each type of use .............. 7. I)imensi~ons of existing structures, if any: Front .............. Rear ............. Depth ............. tleight ................ Number of ~Stories ........................................................ Dimensions .of same structure with alterat}ons .or additions: Front .............. Rear ............... Depth ................ Height ................ Number of Stories 8. Dimensions ,of entire new construction: F~3nt .. 2~ ............ Rear ...~ ........ Depth . 2[~ ........ Height ............ Number ,of Stories . .0~1~ .& .~ .................................................. 10. ]:)ate of Purchase ............................... Name (~f F.ormer Owner ............................. 11. Zone .er use district in which premises are situated... ?.~ .~..~.~ ...................................... 12. r~oes proposed con,struction vi.elate any z3ning law, ,ordinance or regulation? ....... ~1~ ................. Name of. Arqhitect ........... ' ................... ". Address ...................... Ph,one No ............ Name .of Contractor .... Ilal~ ................... Address ...................... Ph,~ne No ............. PLOT DIAGRAM Locai~ clearly and distinctly all buildings, whether existing .or proposed, and indicate all set-back dimensi,ons frum p~operty lines. Give s~reet and block number ar description according to deed, and sh.ow street names and indicate whether interior .or corner l~ot. 8ce filed STATE OF iXrEW YORK, )S.S. ....C/m~....'~f~.../../~.~:..~. ................... being duly sworn, ,deposes and says that he is the appli- ~/' (Name of in~fi~i(d'u.al signir~applica~on).,,~-,,.,~ ---~ // ~ // ~,- ////---..--c~ ~ ~ ~ ~/~ ~ ~ .................. (~antrae~agent,~O~ac~ovate officer, etc.) of said owne~ *r ,owners, and ~s duly authorized ~o pmff,~rm or have pe~ormed ~e said w~k and 9o make and file th~s applicati.on; that all statements contained in this application ave true to the bes~ of his knowledge and belief; and that the w~rk will be performed in the mann er set ~orth' in the applicatiofl filed therewith. Sworn ~o before me this N,*tary Public .... ~ ................. GounW nt) ()OfQ~fLtA C. KEO~ NO [ARY I~UBt-lC, State of New Y6~ No. b2-2093~qO QUallfmd ~n Suffolk County/~ ~O~ ~Rir~s Marca 30, 19~