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Home My WebLink About5136-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..ZI+807.... Date .. Sept THIS CERTIFIES that the building located at 0ax*rol._l A~e Map No. :Kg Block No. ~ ... Lot No. Xl~ P~Cclllio Street conforms substantially to the Application for Building Permit heretofore fried in this office dated .Feb. ~[ 7, 19.71. pursuant to which Building Permit No. 5't3~ dated .. FeD ~' , 19~1,., 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&rate .olle SamLl_.y..dw~lllng ....................... The certificate is issued to Wa~ter H~rston .... of the aforesaid builchng. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No pSItd:[lag · ttOUSk NUMBF. R ~8~ . .Street .. Car~'oll Ave (owner, lessee or tenant) .~. 2. .1.97 .2. by R, Villa Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town GLEI~K'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PF-R~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 5136 Z Permission is hereby gra~ted to: ot premises locotect ot ......... W..~.. ..... ~,,~.r.,.l~l~,.,~,.~....,A.~,~...,(,.~,....~,.~.],.~,,~.P.~P,) ........................................... .............. : ........................................ ~.,e.~**~. ......... ~.~.~. ..................................................................... pursuc~t to applicotion deted [Feb ~ 19 71~, and approved by the Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date 0~ ~ ~ 197M Bldg. Permit No. 3d z TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed ~ocation) have been inspected by this department and found to be satisfactory. Chief of General ~ngineerin~ ?ervices T~)WH OF soUTHOLD BUILDING DEFARTMINT TOWN CLERK'S OFFICl SaUl'HOLD, N. Y. · ..... ......... L.Z ............. . ~:~)roY~ ........................................ , 19. .. Per. it No ............................. Disapproved a/c ..~..~ (Building Inspector) APPLICATION FOR BUILDING PIRMIT INSTRUCTIONS ~ a. This aPPlication mu~t be completely filled In by typewriter or in Ink und submitted In duplicate to the Building ~ Inapector. b. PI.at pi.an sho~. ~l?l~ I.o~t, Ion of lot .a.nd of bu.ildings on premlle~, relationship to adjo ning premiee~ or pub lc streets or ~ areco~ _m'~l gl~l .ag a arum.ca coecrlptlon of layout of property muSt be drown an the diagram whlch I! part of thle application. c. me wo~, cm~ered by this application may not be commenced before i~uonce of Building Permit, d. Upon ai~raval of this application, the Building Impector will Inue a Building Perm t to the app cant Such perm t ~' shall be kept on the pmmlNe aval ab e for Impectlon throughout the prngreu of the work. e.. No building shall be occupied or uNd In whole or In port for any purpose whatever until a Certificate of Occupancy ~ shall nave been granted by the Building Impoctor. R~APPLICATION IS HEREBY MADE to the Building Dapartment for the nuance of · Building Permit pumuant to the ulld!n~. Z_m~, O~, Inance. of ~e T?(n...of..Sauthol. d~ Suffolk C?unty, New Y, ork, and other applicable Law~ Ordinances or ulatlll?aI .tar me c.mmructl? o?.ou!l, alngl) .a~.ltl.onl or alreratlonl, or tar removal or demolition, al herein deecrlbecl. app icant agrees to comply with aft aapllcame law, ordlnancee, building code, houBIng code, and regulations. Walter Hairsten (Signature of applicant, or name, If a corporation) Ave Pecenic (Address of applicant) State whether aapllcant Is owner, lance, agent, architect, englncer, general contractor, electrician, plumber or builder. Name of owner of premlm ...W&3,t, elr...~S~.s~e~:: ......................................................................................................... if applicant Is a coq~orate, signature of duly autherlzed officer. (Name and title 'of corporate officer) 1. Location of land on Whlah prapoced w~rk will be done. Map No.: ........ ~ .......................... I.at No.: ..... ~ ............. Street and Number ..........~/~..~:.~X'3:~,~,~,,.A.~gE ......... .~,.9..c..9~..e......~.-...Y.... ............................................................. Municipality 2. State exiSting u# and occupancy of premlm and Intended use and occupancy of pmpaeed comtructlon: a. ExiSting ucc and occupancy .....~0,git,l~.t~...~,ff.~ ...................................................................................................... b. Intended uN and occupanc?'. ...... Aq.~....~.:B.t...~'.~q~.....~..w..9.~,~..:41:~.~ .................. ............................................... 3, Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...]~e.'~.e~l ..t~J ................. 4. Estimated Cost ..................~10......'1'. ........................... Fee ....... .1...0..e...0..0.. ...................................................................... (to be paid on fi!ing this application) 5. If dwelling, number of dwelling units ..~ne ...................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 ........ ,,~0. ...................... Rear ....... 90 ................ Depth ...... ~..~. ............ Height .................... Number of Stories ...................................................................................................................... 9. Size o~ lot: Front ........ .~.0~ ............ Rear ....... .1.Q0 ...................... Depth ...2~.~...~ ................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...... .a.&.n....el.;LB::I:. ........................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;) ...... i~ ................................................. 13. Name of Owner of premises ...Wa,~,::t~Z'...~.~Z'~l, Address ............... ]~eou~e, ............Phone No ..................... Name of Architect .................................. . ................... Address ............................................ Phone No ..................... Name of Contractor ..... .~.{L~.~ ..................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indical'e whether interior or corner lot. STATE OF NEW .YORI¢ ~ $.S COUNTY OF .... . .~..~....~..~..~,~ ........... 1' ' ............................ T~&~,t,e~'...~i.~,,~B:IF,4)~ ................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ....................... ...C~'...~...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 contained in this application are true to the best of his knowledge and belief; and ti,ar the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ............... · '"'"'" N°tary Public3~r~c'~'~a~"er~:'c:'~r~'r'4¢~':'r")~'/4esar'~'~'4'"" C°un~)/~--~~a0TA~l~a~e~, ~a~e~"o~Vlr~w[ ¥,k (Signature °f applicant' ~ai'm ixpires March 30,