HomeMy WebLinkAbout2295-ZFOP~M NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE: OF OCCUPANCY
THIS CERTIFIES that the building located at ~ ..... T~I~II..JJI~.~..~ ................... Street
Map No...~ .......... Block No .... ~ ......... Lot No~ll~lJ:~ .......... ~D. lJ.~.~,~.~...~..t.~.~ ................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
................................ ]~J~.~v.a~.....~0....., 19.~... pursuant to which Building Permit No .... ~.~..~..
dated ......................... J~....~ .............. , 19..~J~., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ........
...... ~.l.v.~.t.e...t~m..~.exoll.~...~.~,elling ...........................................................................................
The certificate is issued to .... J~....~,..T~o~I~TL ............................ J~llez' ......
(owner, lessee or tenant)
of the aforesaid building.
H.D. A~prova/ ~mne 19, 196~
by R. Villa
Building In~~
FORM NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 2295 Z
Permission is hereby granted to:
Chal... ~aeker...AZC..~rJ.n..~... I:~oI~I.;Lu .....
........ 8~utho3.d ....................................................
to ...]~[tlJ~...l~w...Gna.. f~m~ :~... c] td'~, "1 ~ ...................................................................................
at premises located at ...F,~t'B.....~,x~/zl..~[aF.13o~...La~,l ........................................................................
................................................. ~outha]At..~i..Zo ...............................................................................
pursuant to application dated ......................... ~'$bll]'~.....].O ....... 19...~ and approved by the
Building Inspector
Fee $. ~,0~.~.~...~,.. ~hk
GUARANT~D TO T~-IE
OTTO ~.VAN ~dYL ~ SON
GREENPORT NE~ YORK
TOWN OF SOUTHOLD
BUI rLr~lNG DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.
Exam,ned ...... ...........
Approv~ ........................................ , 19 ....... ;Pe~it No. ~ ~
Disapproved a/c .....................................................................
{Buildi~ ~n~tor)
Application No. ~ ~- c~ 5'
APPLICATION FOR BUILDING PERMIT
~-- ~. ........................................................... , 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 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 o 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, es herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code and regulations.
Ed. J.Donlin
(Signature of applicant, or name, if a corporation)
..~.S.~.e~aat...dwa,l,...N..J~ ........................................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
............................ P.\ .~g4~ ~. ..........................................................................................................................................................
Name of owner of premises ............ ~.....~T,...D~r~.iD. .........................................................................................................
If applicant is a co~orate, signature of duly authorized officer.
(Name and title of co~rate officer)
1. L~ation of land on which pr~osed work will be done. Map No: ..... ~ ..........................~ No: ..~ ........
Strem and Number ..~...~.~o~...~e.~......S.o~%~..~.~ ............................. ~..~..~.,...;.....~. .........
Municipali~
2. State existing u~ and ~c~ancy of premiss and intended use and ~cupancy of pr~o~ cons~m~fi~:
a. Existing use and ~cupancy ...... ~[~..~ ................................................................ ~.....,;., ....................
b. Intended use and occupancy ...... .Q~..~...~.~ll~ ........................................... ;,.~'~ ............................
3. Nature of work (check which applicable): New'Building ..... ~... Addition .................. Alteration ..................
//~ Repair .................... Removal .................... Demolition .................... Other Work (Describe)
Estimated Cost /~,,u'-~ - . .~...0. o00 ~.c] 0~]4:
(to be paid on filing this application)
5. If dwelling, number of dwelling units ....... .o.~..e. .............. 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 ....... .br~. ................ Rear'. ........... .[J:.2 ............ Depth ..~.-..~...~...~,.bc..-.~
Height ............................ N~mber of Stories ..... OD.~ ................ *
9. Size of lot: Front ....],0.Q ................ Rear ..... ],.Q~, ............... Depth .....~,~,,ff. ...................
10. Date of Purchase ............... ~.'~.~.~ ................................ Name of Former Owner .......... .D..~.~,~...~.s.~ ...........................
11. Zone or use district in which premises are s~tuated ................. ,~.....~,.? ..................................................................
12. Does praposqd c~onstruction violate any zoning law, ordinance or regulation? ................. ZLO ................................
13. Name of Owner of premises ...]~.C].W;~.~ ~..o.~. li~ Address ..~.~[..~.~ .;yZ~....~..e...e..~..~....0..~...~.[.. ne No .....................
Name of Architect ...................................................... Address ............................ ................ Phone No .....................
Name of Contractor ..C.........Q~..~..o.~..s.k;..J....~;....C-..~..o...~..o...~..~.~ddress ........ .C..~..c.~..o.[~.e.; ............. Phone 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 numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
~ee attached plot plans
STATE OF NEW~,YORK, ,_
COUNTY OF ....... f S.S.
............. ~..~.j.~. ...... ..~..O...~...~.......~...O..~'.........~.. ...................... being duly ~0rn, deposes and~s that he is the applicant
(Name of individual
above ~med. He is the ........ [~.~l~,~e.~.~ ............................................................................................................
N0. 52-01tzs~ Suff0tk ~unty (Contractor, agent, corporate officer, etc.)
of said owner or owners, and i~,~~perform o~ hage perfo?~ed the said work and to make and file
this applicotion;'that all state~~ ~his application ore true to the best of his knowledge and belief;
and that the work will be pe~orm~ in the monner'~t fodh in fhe applic~ion filed ther~ith.
Sworn to before me this ~n ' /
'Fr 7; / ........................................... ...............
Noto~ Public, ~~.~..:~un~ (Signa~r~plicant)
S-9
SUFFOLK COUNTY DEPARTMENT OF HEALTH
Date June 19~. 1964
Building Permit No. 2295Z
TO ~CM IT MAY CONCER2~:
The sewage disposal facilities for a structure located at
e/s Town Harbor Lane, $outhold (Donlin)
(Give deed location)
have been inspected by this Department and found to be satisfactory.
District Engineer