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Home My WebLink About5613-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z~rT£6 .... Date .... Jul2 · 31 , 19 72. THIS CERTIFIES that the building located at t~ound .View Load Street Map No. 0~l~~ By ~ck No. ~eC I' · Lot No. 2~ . .0~i~ conforms substantially to the Application for Building Permit heretofore filed in this office dated N~v · $ , 199~ pursuant to which Building Permit No. dated ~ov . .~. , 19 71 , 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 PrinCe ~e family, dweti.~' ...................... The certificate is issued to Rev,. S~ea. C~ist~am. & ~i~e ...... ~era (owner, lessee or tenant) of the aforesaid building. SUffolk County Department of HeMth Approval ' g~e' 24' ~ '~ 9~2'' by 'a; Villa UNDERWRITERS CERTIFICATE No 'pe~dS~g .................. ttOUSk NUMBER ~ ...Street - 80~d Vi~w- R~ / BLuldmg Inspector / TOWI, I OF SOUTHOLD BUILDING DEPARTMEHT TOWH CLERK'S OFfiCE $OUTHOLD, H. Y. BUILDING PER/vilT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMP~LETION OF THE WORK AUTHORIZED) -Z Permission is hereby granted to: pursuant to application'dated ............................ ~{~. ........... ~ .......... , 19..~.~,., and approved by the 73.~6 ..,89 BO cO v~, WOOD NOu. LO'.~/ P D_O t-- E I~TI E 5,,~. NC. OFFICE AE. P'IAPJ"J_0.2__'7_'7 7_. ASSkjlvl E_ g ELF:v'AT, O~.I. . or_29,0_ ........ &~g_~..g._S_~:A_ LEVELAF N.E. CO~NEr~ OF- LOT, VAN TLJYL. DE ~.ZC,,IgTf LICE~.,,,E b,' LAP'iD S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date JUN 21 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewag~e disposal facilities for a structure located (G'l"ve deed'~l~catlo.) ~' have been inspected by this department and found to be satisfactory. ~ uf G~n~z-ai Englneering Services FO~M NO I -- ~'~'~ ~/~% ~ TOWN OF SOUTHOLD '~I ~-' ~ .... ~ ~ ~ BUILDING DEPARTMENT/'~/~ ~ ~ ~ ~ ~ TOWN CLERK'S OFFIGE~/~ ~ ~ ~ ~ ~/ ~ ~UTHOLD N. Y ~l '~ ~ ~ ~ Exomine~ .... ~**~**~.~ ...... ~ ............... ]9 ........ ~* ~ ion ~ .... ; ...................... ~proved ....................... ~C ........, )9 ........ L~mit No .......~......;~....-~.....~ ~ ~ ~ ............... (Buildiflg Insl~ector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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 amos, and giving o detailed description of layout ofproperty must be drown on the diagram which is port 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 o 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 ~ Ordinances or. Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, *{:~l~ein c~escrib~d; The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and ~ulclt!ons. ~ ........ ..... ' . (Signature of app.licant, or name, if ~i:~c0rP,orat on) (Address of applicant) State whether opplic,a.nt is owner, lessee, agent, archite;t, engineer, general contractor, electrician, plumber or builder. ............................ ....... ............................................................................. ..................... Name of owner of premises...,~......~' ~'...............* ...~..~.,~.. ...............~:h .~...~.. ....... .G..~...~...~..~....~.'....~..~.. ................................... :~ .................. If applicant is o corporate, signature of duly authorized officer. ................. ................................................................. (Nam;";;~d title of corporate officer) Street and Numbe~......~.lg...~.~..~/....~.~.....[~.~.. ........................................ ~.~'/.:~.~?..."~... .................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....~...~.....~'..~---- ~J/..-- ........................................................................ 3. Nature of work (check which applicable): New Building................../ Addition .................. Alteration .................. Repair .............. "1' Removal .................. Demolition ............ ~... Other Work (Describe) ........................................ · b~o O J 4. Est,mated Cost .~....~r?..,.J ............................................. Fee ..... ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... /. .................. 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 hype of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterotion~ or additions: Front .................................... Rear ............................ Depth ................................ Height .................... II//Y///~ ....... Number of Stories ..................... J/Y~ 'z/~rF! ....... 8. Dimensions of entire new Construction: Front ....~......'~.:.. ................ R,r ......'~K...:Z.: ........ Depth .~.."..'.~...' ........ Height ....J.~.'. ........ Numbe~' of Stories ........ / ............................................................................................................ .~..~.'. 9. Size of lot: Front ....... .L~..~... ......... Rear ........ .................Depth .....~..~....O..~ ................. 10. Date of Purchase ........................................................ Name of Former Owrmr ........................................................ 11. Zone or use district in which premises are situated .~./~.'..~.~/..~......~(~(/,.....-~....r,~:~'~. ............................................. 12. Does proposed construction viol~ce any' zoning, lax, ordinance or regulation? ...... ,*'ZI("~' ......................... ~ ....... 13. Name of Owner of premises ..~'~u~.'.~...~".~'/.~,~....Address~-?..~t.~.~.......7(.I.~..e'./.~.,/..~/.~ ......... phOne N~2~-..~....~..?..~.'"'"-- Name of Architect ...................................................... Address ............................................ PhOne No ..................... Name of Contractor ...~--~.....~'~../.'.../'~..!~..~.~...,~ ....................... Address ..'~...u..~..e./.~.......i ................ PhOne No.'~..~..~...-....~.....6~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from properly lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. _ ~,. ~| STATE OF NEW.Y--DI~d(~.,,~ tee COUNTY OF .. ~..%~..'[.'i~.).~,. ........... )'~" ................... ....~. ~..~.......~...'......l~...).!.l.!..q....~....~. ..................... being duly sworn, deposes and says that he is the applicbnt (Name of individual signing application)~. above named. He is the .................................... ..~..°.,,,,,.."~:,.r,..,~.~ ............................................................................... (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 application are trt~ to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application fi)ed therewith. Swam t~ before me this . / _ -~ .... .... ....... : ..... . x / ' - .............. F'/~~'. '_" ]:? ?Z ........... .,,....~... ~e, rzo, v~....~.....~ .....L.~a.~_z..: ..... Notary PubI,~~ ........ Countyol-~r-q~W (Signature of applicant) ............... ELIZABETH ANN flE¥1[tE NO.,TARY_ PUBLIC, S'~te d /(ew York no. 52-,~125850, ~lfolk County