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Home My WebLink About4617-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z 403Q Date OctoDor 26 , 19 70 TI-IIS CERTIFIES that the building located at 8/8 Budd'm l~nd ~ Street lto~d Map No.~tll~. Block No. Lot No. 17, ~~e) ~ou~o~d, conforms substantially to the Application for Building Permit heretofore filed in this office dated FeDr~a~ 19, , 19 70 pursuant to which Building Permit No. 46Z7 Z dated F~y ~9, , 19 70, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this ce~ificate is ~sued is ....... ~tVate one ~y ~Ol~tnq ............ The certificate is issued to RO~t ~ G~r~e~lo. & ~1~0 ... (owner, lessee or tenant) of the aforesMd building. Suffolk County Dep~tment of Health Approval ~U~S~ 24, 1970, ~t ~. V~l~a Build~g Inspector HOUSe 4t 250 Budd's l~ond Itoad TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TItlE WORK AUTHORIZED) No. ~6~t7 Z ~ Permission is hereby ..~..~.~ and approved by the Building I~nspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z391~ ... Date AUgUet 21~ , 19 70 THIS CERTIFIES that the building located at l~add ~ s Polld Road Street Map No.Willow Poin~lock No. Lot No. ~.7 $ouShgld N, Y, .... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. ~'O~l~ . 17 , 19 ~ pursuant to which Building Permit No. 144~17Z dated FeB .19 , 19 70 , 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.. Private. one family..dwelling ........................ The certificate is issued to . Robert; (~ual*riel2to.. ~; .Wife.. .0,~rrters.. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval AUg . 21+..tg?0 by. R- ¥illa . B-ilding Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. 1970 Dist~o~ Er~Ineer District Engineer TOWN CLERK'S OFFICE . ................... c.o ' In~ector. b. PI~ plon showing I~otion of lot or~s, end givi~ ~ detoil~ ~ri~ion of I~ ofp~ mu~ c. The work c~ered by this oppli~i~ m~ d. ~ ~1 of this o~lic~ion, shall ~ k~t ~ the premis~ ovoil~le for i~i~ th~gh~ ~e p~r~ of the wo~. e. No building s~ll ~ ~cupi~ or u~ in whole or in po~ for ony pu~e wherever until shell h~e been gmnt~ by the Building In~r. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building permit ,Rureuant to the ~Build!ng Zone. Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or I~ Kegu~ations, for the construction of buildings, adclJtions or alterations, or for removal or demolition, as herein descr bed The applicant agrees to comply with all applicable laws, ordinanc,~es, building code, hc~§ing code, and regulations. ...... .................... (S g ature b.S/applicant, or name if a corporation) ........ J.l~l.[I...Cla-,'k.. E,~;~.e e.i~ ,...G,~'.e anpo.~:l;.~,.. E, ,L, ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engis~eer, general contractor, electrician, plumber or builder. ........................... ............................. · ........... .... ~,~ h.~ =.t,.....,T.,,...Qtl~m. ~.~,~,l,~.q .................................................................. ,.,~,,.....~ j.~,.:, ........ If applicant is a corporate, signature of duly authorized officer. ~,' ., (N~me and title of corporate officer) ' Location of land on which proposed work will be done. Map No.: WzlZow Poznt ........................................ Lot Nle~.~.,,,,.,., .......... ~treet an~ ~d,,,~he, ~U S on o A2shamomoque Municipality 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Vacant b. Intended use and occupancy ....~..~..s.~...d..~.~t..t..a...1. .......... 3. Nature of work (check which applicable): New Building ..... ~C ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........~O.~O.O.O.e.(~O ............................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .],. .................... Number of dwelling units on each floor .......... '1: .............. 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 ................................ I 8. Dimensions of entire new construction: Front ........ ~ ....................... Rear ........ ,~..I. ............ Depth ...,~..I .............. Height ......~.0.~. ...... Number of Stories ................ .Z......Z~..~. ........................................ : ................................................. 9. Size of lot: Front ........ ~!,.~.Q ............. Rear ......... 'I~.CI ................... Depth ....... ~L~.~ .................. 10. Date of Purchase ...... .~../..],,~..~.Q ................................. Nome of Former Owner ....B~Leec3calt..~lo~s.~,..C,o~ ...... .... Residential 11. Zone or use district in which premises are s.ruazea ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ..~..o. ................................................ 13. Name of Owner of premises [~,.~.l~tla.~..-~ie3~.o ....... Acktressl~..C,La~'Ja..-°-t.o...G, la.p.f~, Phone Name of Architect ...... .S.....e:_~....e. ...................................... Address ......................................... L. Phone No ..................... Name of Contractor ...... .~...e~...e. .................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether i~terior or corner lat. STATE~r ~ ~K/ / __ ~ ~ S S ~ COUNTY OF ~~.~ ' ' '- ~ .......... ~D.b~,E~...~T~...~.~I~I'J~,i,P~[,~.O ................... ~ .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ................. .0..~...13..e...~. ............................................................................................................................ (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 contoinecl in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ,~ ,~ t ~ (J! ' .....of ............... , 11 /~ /~ // / · . ...... J..l.~.. ~.T......~[; ...... ~...~......~, ..-..~ ...... · 0 CO.~,ZZ.~,,,I I natur f ' ' ............................ Notary ~r--,~~.~~'~hso.!,_Z° ~. _~ 1 ? i --q A-3 ~::~T~