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Home My WebLink AboutColonial Village MR 166SUPERVISOR'S OFFICE 16 South Street Greenpod, N. Y. Tel. Greenporf 7-0550 BUILDING DEPARTMENT TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. TOV~N CLERK'S OFFICE Main Street Sou~old, N. Y. Tel. Sou~old 5-3783 BUILDING rNSPECTOR'S OFFICE CERTIFICATE OF OCCUPANCY Build:Lng ~ ~ No. X'R.X?O Date This certificate is issued to of the aforesaid building. THIS CERTIFIES ~at the building located et ' Street, Map No. m , Block No. 3glX , Lot No, ~ in the Town of Soufhold, conforms substantially to the approved plans and specifications heretofore filed in this office with Appllcetion for Building Permit dated A~'P~3 ~ 19~L, pursuant to which Building Permit No.~l~ , dated ~ 19 ~, was issued, end conforms to ell of the require- ments of the appliceb~ provisions of the law. The occupancy for which this certificate is issued is (owne~, lessee or +enaflf) H,D,App~oVal 8apt, 79 1966 (The Cer+ificete of Occupancy will be issued only after the Building Inspector is convTnced of the completion of the eonstrum~ion Jn compliance with the Multiple Resldence Law end with other laws, ordinances ,or recjuJetJons affecting the premises, and Jn conformity with Se approved ~lens end speclficetions. J~e~ FORM NO. 5 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN CLERK'S OFFICE SOUTHOLD, N. Y. At:t:idavit: oF Final Cost: ot: Consl:rud:ion STATE OF NEW YORK } COUNTY OF ..... ~ .......................... SS.: F. rade~L~k 2. Rich A/g...C.o. lp..n.%.al Vl~.llage....Z,~ing duly sworn, deposes and says: (appIicant at agent) that he (~) is the applicant (or agent of the applicant) named in the Ap~ication for Building Permit dated .......................... Ap;~J.1...8 ..... 19,.~6 ...... relating to construction or other work to be performed on, or in connection with, the premises located at N/.~. ~.:~ ..~.Oad ..~.....A~.l...s....~ay - · . ~. Southold ~ N.Y. a...p...r.~.v..~,.~.~...r.~.~9,~. ............ ; that the estimated cost stated in said application of the construction or other work described therein was Thirmty..Z.:L~em..~b, ql~,~.ft~ ............................................ Dollars ($..~;.j.QO.O. ............... ); that the actual final cost of such construction or other work was ........................................................................................ Dollars ($ ................................ ) and that the with the applicable l~ovisions of J~w. said construction or other work was performed in accoj~nce (applicant or agent) Sworn to befor~ me th i s,,..,'-~,,, [,~./..~a y of~..~...~...~. ...... .m. ..........19 .......... Permit No. M · 1~.~.. '1 6.6. .............. No. Filed Cost Permit Fee Paid $..8.?..0.C) .............. Final Cost $ ............................ Additional Fee $ ........................... (Costs for the work described in the Application for Building Permit include the cost of all o~ ~e construction and other work done in connection therewith, exclusive of the cost of the land. If the final cost is less than the estimated cost stated in the Application ~or Building Permit, no portion o~ the fee paid upon the filing of the application will be refunded.) FO~M NO. 1 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TO~'N GLERK'S OFFIGE SOUTHOLD, N. Y. Approved ............................ %x. ......... , 19 ........ Permit No ....................... App,,co,,on No ...... APPLIGATION FOR BUILDING PERMIT ......... , 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 property must be drawn on the diagram which is part of thi~ applica- tion. 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 pa rt 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 a 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ~ (Sig~foture of opphcont, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant ~;~ carper.ate, signature/duly out, zed officer. (Name and I'~tle of corporate officer) ~' 1.Location of land on wh ch proposed work w be don Map No''~'d/g- 'J~-- // ''/~f'~:~'~/~//~.'..~'Lot ' o Street and Number ....~.'~.~..'Z..~..~~~.....~;~A~,~ality__..._.~ 2. State existing use and occupancy of prernJses and intended use and occupancy of proposed construction. a. Existing use and occupancy .~/'~J.d,~4,~.... ...................................................................................................... b. Intended use and occupancy ....................................................................... 3. Nature of work (check which applicable): New Building /""/ .... Addition .................. Alteration .................. Repair ................. ~,_ emoval .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ...~...-~..~...~....~?..~.. .................................... Fee ...¢~...'./....M~.. ..................................................................... (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 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 ..... ./...~....~'.. .............. Rear ...~..~...~... .............. Depth ..~...~... .................... Height ..,/~..../. ................. Number of Stories ...~:¢,~ ............... 9. Size of lot: Front ..~..~.:.... Rear .................................. Depth .............................. 10. Date of Purchase .......................................................... Na'm~ of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated....~...~ ............................................................ 12. Does proposed construction violate~ ~ ~'/~_, ~a~ny zonina law, ordinance or~ ~'~¢'~-~ .,regulati°n? ~.~. .................................................... 13. Name of Owner of premises~~ ..... Address ..~.~......~..:.~..,.... Phone No.~....~.~..g. ....... f'-;~ ~ *'T/-~ T~'~ Z, dress .~.'-- Phone Name of~ -,~ect/, ~ ,/'""~' .......... {/...~-..~...~ .-'~..~..~..Z,. ~ ........... Ad "~:~ ,.z___~ , ~,/_ ,"~" .... No ................... Name of Contractor,,~-~.~..~.~. Address .~~.....~..'.~. ...... Phone No .................. PLOT DIAGRAM koc(:te clearly and distinctly ali 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. STATE OF NEW YORK, ) ~ ~ -- COUNTY OF ............................ ) ~"~" // .~ ....................... . . . ..:~.....~ ............ being duly sworn, deposes ond soys thor he is the applicant (No lng above named. He is the ............... ~ .................................................................................................... (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 a,nd belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~..7~..'. ~ ........................ day of ............................................ , 19 ........ Notary Public ............................................................ County (Signature of opplica'nt) SUFFOLK COUNTY DEPARTMENT OF HEALTH Riverhead, New York Building Permit No. TYPE OR PRINT LEGIBLY IN INK Health Department Plan No. Application for Approval of Commercial Sewage Disposal S~stem TO: The Suffolk County Department of Health Dat~/~ Application for approval of commercial sewage disposal system is hereby requested. (Nam~ and side of street, and name and distance t~ nearest intersecting street) Hamlet Towu Village I hereby certify that this commercial sewage disposal system has been con- structed in .~¢cordar~ce with plans approved by the Suffolk County Department of Health on (d:~te~ and wibh all the requirer.:cnts of the latest bulletins on ~sewage disposal o'f the Suffolk. County Department of ~ealth. Ready for inspection ~/ FOR USE OF HEALTH DEPARTLiEIqT G~LY Installation satisfactory Yes /--- .1 t~o Based on theinformation stated hereon by the applicant and other information made available, it is the opinion of this Department that this system with proper maintenance can be expected to function satisfactorily and is not likely to cause a nuisance, provided designed s%wage flow i~ not exceeded. Structural features are not included. S EP 7 1966 SCHD - S-13 6/58 TOWN OF $OUTHOLD Multiple Residence Law Permit PERMIT NO, II_R_ 1:~, l.~_..J~ 19LAPPLICATION NO. 166 Am, ~ ~,~ 66 LOCATION _~?~e I~_/II !!_/ Il~n g,~,~l & ~l~t M/ i~,,~Ant~ Av~.. ~J~,~nld Application having bee~ made on covering construction oa a ~ l'dlttple ~e~l~e~e (new, altered, or conv~ed) multiple residen~ build'g, by or in behalf of application having been exami~d and recommended for approval on , 19 , for a permit ~]~nlnl ¥11]m~e ?n~_ (l~ed. Rich) (owner) , for e dwelling located as above stated, and fha said is hereby issued for fha performance of +he QO~,~IC~;I~'I (architecture~I, structural, mechanical, etc.) work described in the above numbered application and any accompanying plans and specifications. If no work is performed w~thin one year from the time of its issuance, this PERMIT shall expire by limitation. Approved Al~' J*l 8 ~9 g~ Enforcement Officer Subject te approval of County Health Dept of leverage disposal & water supply eta. Certt£/eat~ o~ oceupaney requlred be£o~e any'occupancy, Est/mated Cost fl!~d - $ 3~tOOO~ F~e paid $ 87.00