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Home My WebLink About3468-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Date . . . . . . . . . . . . . . Sept. . . .2;;. - 19-6?. THIS CERTIFIES that the building located at . . .t/15. Rat, . . . . . . . . . Street Map No. . Block No.,,X, Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . ...1 19. pursuant to which Building Permit No. - Z -67 34 6, dated 19 (-,7, 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 isftxar� Priva` t6- one . . . . . ... . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . The certificate is, issued to jkj.j.t,5j, 4*"&C-.k ;ca 1zk! . . . . . .0-7,1zle'r . . . . . . . . . . . . . . . . . . . . . . (owner, fessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval -Sept- -3_969, - - -by- Ri -Vi:1-1—a- . Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'TOWN CLERIC'S OFFICE SOUTHOLD, N. V. BUILDING; PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3468 Z Date .........................$ 1. ..................., 1 .... Permission is hereby granted to: .. ........ �44 .......400.1100....Net...y9 .................................. ................................................................................ to .......�-uild ` ew °ne...f :1.1.y..dwelling............................................................................ ................................................................................................................................................................ at premises located at ...... .. §0C�..�E et 'wee sof A�q�a�;��r ��I�C��............ ....... ..... ..... ........... i.. !..`.s... ..7 ® ....................................................................................................... ................................................................................................................................................................ pursuant to application dated ........................ Y..3...................... ., 19.7. :, and approved by the Building Inspector. . Fee $... .X9...00............. . ..................................................................... ......... Building Inspector r I N L A N D gaged, low. -�- LEVON LANE 432 MIDDLE COUNTRY ROAD MILLER PLACE, NEW YORK SELDEN, NEW YORK 473-7349 732-2177 Ao S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date SEP 2 Bldg . Permit No . TO WHOM IT MAY CONCERN : ,,--DD The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory . District Engineer District Engineer FORM NO. 1 TOWN OF SOUTHOLD f/ '`�✓T/ BUILDING DEPARTMENT TOWN CLERK'S OFFICE /f SOUTHOLD, N. Y. Examined ......9 d'....... .....� .., 19.. /T Application No. .. .�7�:.�., ...... Approved ................................t......, 19........Permit No. ... ....4.....� C� Disapproved a/c ...... - ........................................................................................ .............................. .......... .............. (Building ins p ctor)................................ APPLICATION FOR BUILDING PERMIT Date ............ ............. ....... �).................. 19. . ....... INSTRUCTIONS t 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 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 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 orin part 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 or alterations, or for removal or demolition,_as herein described. The applicant agrees to comply with'all applicable laws, ordinances and regulations. (Signature applicant, or name, if a corporation) ................................................................................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................,.rtiJl. ........v.... ... ..... ..................................................................................I...... ...... Name of owner of premises ...... ..-..... �.` ........ ............................................................................................................... If applicant is a corporate, signature of duly authorized officer. ................ ..�.. . .. ......... (Name and title of Vlporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ..( ...,��J,,� W.................................................IQ) �� --11 W/,—, ......!.... ................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....................................................................................................................................... b. Intended use and occupancy .......1... .....�............ .. ...d-�:..................... ................................................ 3. Nature of work (check which applicable): New Building .... .......... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition.................... Other Work (Describe) ........................ 4. Estimated Cost / �o 1.... . ....................................Fee ......................................................... .............................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...............................Number of dwelling units on each floor ............................ Ifgarage, 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 some structure with alterations or additions: Front ................................ Rear ................................ Depth ............................ Height ................................Number of Stories ........................................ i / P / 8. Dimensions of entire new construction: Front........ ................. Rear ...... .... ........... Depth ....�_5.'. ............. Height ....... .............. Number of Stories ......./....................... 9. Size of lot: Front .......�Q... ............... Rear .....L.c .... Depth .........J../: J�................... 10. Date of Purchase ........................................................Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated................................................................................................. 12. 'Does proposed construction violate -any zoning law, ordinance or regulation? ........."2'?-� ................................. 13. Name of Owner of premises ........................................Address . Phone No. ........................................... Name of Architect ...� Address ...... ........ Phone No. :.a/. Name of Contractor ...% ........... .............. ...................Address ........ ........... Phone No. PLOT DIAGRAM Locate clearly and distinctly all 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. / 1�3 21 0 STATE F NEW YORK, COUNTY OF .. .........................) SS. ' :............. . ....... .. .............. ..............being duly sworn, deposes and says that he is the applicant (Name of individual signing lication) 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 and belief; and that the work will be performed in the' manner set forth in the application filed therewith. Sworn_ to before me this MILDRED CHAPMAN `-" Z N10TARY PUBLIC, state of�ew York ......... day off.................... �10..52.Q6�$100. s4 I' .�°� nmis ion Expues March 30, 15 ........... ..... .............. Notary Public, .. ......... Y 9 PP .......................... ................... Count (Signature of a lican FORM xO._1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ,7SOUTHOLD, N. Y. Examined ...................... ........ .... 4 ..... 19 A lication No. pp r f �. Approved .............................p..`........, 19........Permit No. ................................ ` Disapproved a/c ;,.�:'..��✓''" ............... .�": ......"�'"" �..�....,.. ......................................................................................................................... .......... .. . .. ...... ..... ............................... (Building Insp ctor) APPLICATION FOR BUILDING PERMIT Date .......... ............... .. 19.t4..,......... 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 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 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 part 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 or a Iterations, or for removal or demolition, as herein-described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (� (Signature/f applicant, or name, if a corporation) ......................-:::'a...--:u::.........,... ...................................... (Address of applicant) State whether ap I' ant is owner, (lessee agent, -a-rchitect, engineer, general contractor, electrician, plumber or builder. Nameof owner of premises ..................................................................................................................................................... If applicaryt is a�corporate, signature of duly authorized officer. ................................................... ........................................... (Name and title o or orate officer) 1. Location of land on hich propos w rk will be done. Map No: ............................................ Lot No: .................... Streetand Number ...................................................�........................................... ...........�............ �` ; ��?...... Municipality, 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............................................. ..................................................................................... b. Intended use and occupancy ... J..l.... c`":*" t . ...:. ::: ..LY . / ^ ' 3. Nature of work (check which applicable): New Building — ........... Addition -----,` /Qte�o|ion .................. . /o"""ir .................... Rwnnovo) .................... Demolition------' Other Work (Describe) —....�--.'--- 4. 'Estimated Cost .............. --------.Feo ----------------'�—..--...-------- �obepaid on �|ingthis oppUco�on} ' - 5 If dwelling, number of dwelling units ------' . --.Number of dwelling units on each' floor -- ------- |f garage, number of cars ......./................... ............................................ -..�---.—.--.—....---------.. ' . . 6. If business, commercial or nnh/ad occupancy, spncifvnotureondextentofeochiypnofusa ----------.. 7. Dimensions of existingstru ,rau if ony. Front --.—.----. Rear ..------.. iD6'+k '--``_____._ / Height ---------. Number or 'Stories ......................;-------�------------..`-------' . - Dinnansions`of some structure -with'oIterations or`oddi+ions. Front ................................. Rear ................................ Depth ---------. Height --------- Number of Stories _—�.,--------.. ^ . / n � O. Dimensions ofentire new construction: Front--.��.��`----- Reor —.��—��.---- Depth —.^-______.. Height ......./'e---- __ of Stnries---� ........................'0— / [ / y. Size of lot: Front -- /—<—Y----- Rear —. ---- ---___. ' 10. Dote of Purchase ........................................................Noma of Former Owner —,-------____—_____ � 11. Zone or use district in which premises one situoted-------. ---------_--____________. 12. Does proposed construct/on violate any zoning low, ordinance or regulation? --- .................................. 13 Name of Owner of . bas ./ ddress .. --. Phone No. �—�... �----. Nona of Architect .. Address . --. Phone No. ------.. . 2z/77 Name of [ontroctor —. . ''/��^�:�./\ddress -7..~�`'--~~ --. Phone No. ------- / PLOT DIAGRAM Locate clearly and distinctly all 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. [JN 4 STATE OF NEW YORK, S.S. {J ' \ .~'----------.�=':`''"--'^~�' ....... -----"="'y duly,sworn, deposes and ""," that he is the "pp"^=" (Name of individuo| signing opp|ioVon) above named. He is the ----------..------ ___--_—_-----.-----------.. (Contractor, agent, rota officer, etc.) ' of said owner or owners and is duly authorized to perform or have po/fmnnud the said work and to mal<e and file application;this h || statements contained in thion are true to thebest of his knowledge and belief; KP and that the work will be performed in the rrfflh fSp(jth -'Ikthne a plication filed therewith. Sworn to before me this AOTARY pLiBLIG' "oun!. mmission -7 day of ar �� -----'_~— ,--. --------.. Notary Pu6|k, .�,� .. (Signature of opp{i6sw�