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Home My WebLink About4638-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~39~8 ...... Date THIS CERTIFIES that the building located at Map No. ~ .. Block No. IL~ Lot No. .~ep~ .18 , 19 .70 l~tin R~ad Street East ~arion ~.~, conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ]iai'eli ~ , 19 ?0 pursuant to which Building Permit No. br638Z dated . I¢~arcll ~ , 19 50, 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 . ' Priva~;e ~ne f_mn_ily d~;a~!l, illg .................... The certificate is issued to -Da.vid Park ....... Owaer ........ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Ju~e. 12~ .19 0 .R, Villa House , 12~00 ...~...q~..~... ,~_ ..~z~. ...... Building Inspector l~OIC~1 NO. :~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PE~,IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4638 Z Permission is hereby granted to: .... l~r...lat~t3L~....A~....~a~...~l~..&. W~ta to ............... ~at]ua..ne~...e~ae...~:am~r..A~r~:l:lar~ .................................................................... at premises located at ................. ~.....~....q...~.....~...~t~...~. ....................................................................... ............ ,:..: ................... , .................. ~.....: ...... :.;.~a.~t..~a~.:~cr~ ......... ~X~ ...................................... pdrsucm$ to application dated ............ .~ ............. ~....]~1~ ....... ~ ...... , 19.~.0.., and approved by the i~uilding Inspector. ~ ~ udd~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. TF. MPORARY Certificate Of Occupancy No. Z. 3855... Date THIS CERTIFIES that the building located at Map No. ~ ~. Block No. ~ Lot No. July 1, , 19 70 Route 25 . Street East Mar£on, N.Y. . . issued is . private, one The certificate is issued to of the aforesaid building. conforms substantially to the Application for Building Permit heretofore filed in this office dated M~ch 5, , 19.7 O pursuant to which Building Permit No.4638 Z dated .l~:ch. 5, , 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 family dwelling. David Park ..... Suffolk County Department of Health Approval ........ ~uii~in~tor (owner, lessee or tenant) June 12, 197.0., .Robert villa House ~ 12500 Route 25 S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date /~~ //., /~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ~ive deed location) ~ have been inspected by this department and found to be satisfactory. JUN 1 2 ]97~:] District Eugineer District Engineer TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ................................................ :. ........... ~ (Building Ins/~ APPLICATION FOR BUILDING PERMIT Application No .... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildi[ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adloining premises or public streets. areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatio 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 o Building Permit to the applicant. Such pern shall be kept on the premmes 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 (3 Certificate of Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other opphcable Laws, Ordinances Regulahons, for the construction of buildings, additions or alterations, or for removal or demolmon, as herein describe The apphcant agrees to comply with all apphcoble laws, ordinances, budding code and regulations (Address of applicant-) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu~ld~_ Name of owner of prem.ses ...~.~.~/...~: .~.....~......~....~~. . If opphcant is o corporate, signature of duly authorized officer. (Nome and title of corporate officer) Location of land on which proposed work will be done Map No ..................... Lot No .................... Street and Number ..... ~.......7~. ~.. ..................... ~....?...~....~ ............................... /~>t -- /.~..~ 0 Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construchon. a Existing use and occupancy ....... :~..: ......................................................................................... b Intended use and occupancy ....... ..~...~..~ ......................................................................................... 3. Nature of work (check which applicable)' New Budding ......~... ......... Addition ................. Alteration ............... Repair .................. ~emoval ................. Demohtion .................. Other Work (Describe) ..................................... 4. Estimated Cost .......... ~' ~....~'.~...~...~....O. ............................ Fee ........................................................................................ (to be paid on fihng this apphcat~on) 5 If dwelling, number of dwelling umts ........... ./.. .............. Number of dwelhng units on each floor ........................... If garage, number of cars ............. ~ ................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use .......................... 7 D~mens~ons of existing structures, ~f any. Front .......................... Rear ................................ Depth .................... Height ........................ Number of Stories .............................................................................................................. D~mensions of same structure with alterations or additions: Front ....................................Rear ......................... Depth ................................ Height .....................Number of Stones .............................. 8. Dimens,ons of enhre new construct,on: Front .. .?/'l~..! ................... ReQr ..... ?...~....~ ............. Depth .....~...?../. ........ Height ...... ..~.../...~ ..... Number of Stories ...... ../..,~-. .............................................................................................. 9. Size of lot: Front ..... ./..~.....~..~.~../.... Rear .... ..~ .~..'~ ............... Depth .....'~....~....~...~...~....~.. ...... 10 Date of Purchase ....................... ./..~...~.~. ............... Name of Former Owner .'~...~.~....~ 1 1. Zone or use d~strict in which premises are s~tuated .... ~.~.: ........................................................................... 12 Does proposed construct,on v,olate anyzomn,g law, ord,nance or regular,on:~ ...~ 13. Name of Owner of premises .~..,.....~...~?- /,,L ............ Address...~....~ ............ Phone No.~...~.~...-...~..~..~ Name of Architect ........................... ___..>~..~.. ..... Address .............. ,; ......................... Phone No .................. Name of Contractor ..~...~..~..~%~ ~'~- ....... Address ..... .~..~ ................. Phone No.~....~..-..~'...~..~..· PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dtmenszons fror property hnes G~ve street and block number or description according to deed, and show street names and ind~cat whether ~nterior or corner lot. STATE OF NEW ~YORK . 1, ~ COUNTY OF . .,;.~.-:~.~...~..f../'Z'.. ....... .f o S. ~'~"/U ~ /(/c'~/~.~/~x/? being duly sworn, deposes and says that he ~s the apphca~ (Name of md~wduat s~gnlng apphcat~on) above named He ~s the ( ~x// ,/~,4 ( 7 ~(~ ........................................................................ (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and fil th~s application; tha~ all statements contained ~n this application are true to the best of his knowledge and behef, an that the work wdl be performed in the manner set forth m the apphcation filed therewith. Sworn to before me this ...... ~.~. .... day of .......................... 4~ .............. , 19.:.; ~ ~ ~ ~ ~.- ,, ~ ,,~ ,~ .......... L...~....~Z...~~ ........ Notary Pubhc, .~.~.~r.~..~:..~ .......... ~¥~.~C~q~% , ..q~, ~ (S~gnature of apphcant) / ~ NOTARY PL, SLIC, St,ttp of bJew York No. 52-7207~00 ~ufb~tk (~)unty J L ¥ I¢ j ~"= I'