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Home My WebLink About4205-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ..z.. 3191.. Date . . April· .24...,1970 .. (}\2l1 PM "- M Street THIS CERTIFIES that the building located at Map No. . Ford. Ac:rØ3lock No. ...... . LtN .1.... ... 0 o. . . . ýrø.mport ..N , r.. . conforms substantially to the Application for Building Permit heretofore filed in this office dated ... .~rc~ . . . 1.7. . . . ., 19 <í9. pursuant to which Building Permit No. '+205Z dated Ma.rch. . .1.9 ... , 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 ...... .Pr.1vate. .one. .!amiJ.y.dwelJ.1ng.......................... ...... . The certificate is issued to . .f8'er D__. .... . Ow.ner. .. ·MJo... .PeteJ'..... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .S..pt. . 9 .1969 . . by. .R.. V.111a. . ~ --- ..........~... ~"'..\... .~l House (/ 1625' Building Inspector FORM NO. Z 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) Nt! 4205 z Date .........................JIaz.......:l.9..........., 19..69. Permission is hereby granted to: ···..heð··CH4ea·A/C··Pe-te.··....··..······· .. .... .... .... ... ...Gr.eup.or.t......... .... .... .... .... ... .... ...... ................................................................................ to ........Bu1ld..D-.:..QD8...tam.1J.y...d..U1Da.. ......... ...... ..... ..... ........... ............... ....................... ................................................................................................................................................................ ot premises located at ..Lo:t..'...-......li'oJ.'dbaa.. &Cn..·..ec. .1. ............... ............... ........ ............ ... ... ... .... ... ....... ...... .... ........Gu,U.. poaù.· ··LaÐe········ . ...... ..··GFtHln-pOl'''···· ... ........ ......... .... .... ......... ..... ................................................................................................................................................................ pursuant to application dated ..................................MaJr..........t?...., 19...69, and approved by the Building Inspector. Fee $.U~.ºº........... I~t~ ··········..············Š~·i·ld"i~9··i~~p~~t~~········~·...... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~ü&L Per it No. :J!f I 'J(p 9 , Jj ;:¡ ó·"J ~ Bldg. TO WHOM IT MAY CONCERN: at æ/// The sewage disposal facilities for a structure located ?ð>t./Y L~/YL-/ ~ ~~./a~ (Give deed 10 at ion) ¿;).A".h ) / ~ have been inspected by this department and found to be satisfactory. SEP 9 1969 ?~()"?I~ i 1 E Bl.{~I"~8t EF!;;:iT\e~"7 D str ct ng neer FORM NO.1 Examined .....i!!.~..../.l........, 196.1. Approved .........................:.:............, 19........Permit Na. ~.l..p...;¡...'b.. TOWN OF SOUTH OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH OLD, N. Y. .1-, ",1-') 5 Application No. ............................ Disapproved ale ............ /' ..........·............·........................·.·..·..·.·.·...·.æ·.·.·.·.·.....................................~....~..~..~..~.......................................... (Building lector) APPLICATION FOR BUILDING PERMIT Date ....m.!9:~.~....J~....................., lk9...... 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 ta adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust 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 Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo 'tion, as herein described. The applicant agrees to comply with all applicable laws, or~i a ces'~Uilding cod and reg a ions. , <2 ... ......, -, . . ................ ........ ......... ~... ..,. ........ .... ..... .... .......... .... ... (Signature of applicant, or name, if a corporation> . ·~ls~..~K·¡,SL~t)........·.......·....··......· State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .........................................~.J:..l.\.bD.~Q......................................................................................................................... Name of owner of premises~..LE.R.......v.:;:}.......J2.A.Y.r.).O................................................................................... If applicant is a corporate, signature af duly authorized officer. ................................................................................................. (Name and title of corporote officer) , I 1. Locati,#f land o~hich pro¡>ased work will be dane. Map No: ...~~~...~.L.Lot No: .':t.............. Street and ~~.:t;:rG\J.w....,.:?Q.I'...,tD....Qa.A.ù.ToeDH.e.'Œ...e~:)..GiŒFi 'þ,Qß.J..,...(µ:.I, Municipality "~'--," r 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Existing use and occupancy .......R. ....................................................................... ................................................ Intended use and accupancy .......... !<::;$.I..œ.!\.)ÇE...................................................................................... a. Nature of work (check which applicable): New Building ....¿.... Addition .................. Alteration .................. Repair ...............4- ~aval .................... Demolition.................... Other Work (Describe) ...................................... Estimated Cost .......~..,.º..Q<;>...·...Q~...................Fee .L?..~....................................................................... (to be paid on filing this application) If dwelling, number of dwelling units .......1...................Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 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 ........................................ Dimensions of entire new construction: Front .......t;..o..'........... Rear .....ty,º.~............... Depth ...~.~............... Height ............................ Number of Stories .....::2-............... Size of lot: Front .......1.0.0............. Rear .......,(0.9........... Depth ...3..~.~................ Date of Purchase ........................................................Nf.")'e of Former Owner ........................................................ Zone or use district in which premises are .situated...\:;".~?'...QÞ.-'~~''''''''';r''''''''''''''''''''·''''''''''''·'''''' Does proposed construction violate any zoning law, ordinance or regulation? .......f.:I.Q.:..................................... Name of Owner of premises 7...'A.:..~.~ø.Q..........Address ..ª~I(,.'h'>{.Ü..IJ).:y..... Phone No!žfJ.e..-::.~1. Name of Architect ......................................................Address ............................................ Phone No. .................... Name of Contractor .£.:;I;;::,..~.iQ.o.i)..............Address .6~............... Phone NM'7.?,;,;.'.º~~.. 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. .:'lB<; , q Q; c3 oJ...tL~(lO GuLL íJC,II.ID ~ fl " Q ~ ~ ( J \È œ\ùE... / ./ ~- ----- '-- 335' Lù m. W3ßfilJ.S ~1'GTJ,-$F ~E~...J ~/ ~ ................................../~~{......~::.:.....:.....~.........being duly sworn, deposes and says that he is the applicant above na~~:m~eo~s i:::Vi.~.~.~.I..~.i.~.~~.~~..~~~.I.ë!.~.~~............................................................................... (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 applica!ion are tr~e !o th.e best of .his knowledge and belief; and that the work will be performed in the manner set forth In the application filed therewith. ~.~~~~..t~.~2y:::yt::s.........2Y.~......, 19..~¡.~~ ç (). ~ Notary Public, ..~I.ti'j ,.~.~~I,jv.w¡¡;~~¡ii~...···:··..is·i9~~ï~·;~·~¡~~·~¡:j'..·..··..................... N0rTl~R·~~~::."':~ ~ .-.'.'".; :;:":'1:-1,,/ Tern;-E-. :>..:, ::':, ,'J'!lp