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Home My WebLink About2352-zFOR. M NO. 4 TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY Map No. Z, eb~.osk/,... Block No../),D,~, ...... Lot No .............. -E,e~[~03~! .......$[,~, .................... conform~ substantially to the Application for Building Permit heretofore filed in this office dated ...................................... ~,~.;I..],.....~...., 19.~.. pursuant to which Building Permit No..~.~;~7~.,. dated ........................ A$1'i'~' ....... ~br....., 19..0.~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for. which this certificate irS issued is ........ ..... priVa~e"~ne"~am:~'ly"cl~e't'li~g .................... .......................................... , .................. . ........ The certificate is issued to ..Alt.th~.~..~&~O;~, ........................ 0~1~ .............. , ............................. (owner, lessee or tenant) of the oforesaid, bqilding. H~D.Approval Sept 2~, 1968 by R, Villa ' 'Building Inspector ~k ' TOWN OF SOUTHOLD BUILmNG DEP,~RTM~:NT TOWN CLERK'S oFFICE SOUTHOLD, N. ¥. BUILDING PERMIT' (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 2352'z Permission is hereby granted to: ............ ,.~o,u~hO;l~b., ....................................... Of premises Io~ated Cf ./J;(~.~.~.,.O'r~T','~""~'~",~/'~,x'B~'"~W"~O~l~,~ ............... ": ....... "'" ...... , ...... .......... (~,e~..~?.~.,,.m,,I~,..~,~.):i.:..,~o~t~,;.::.,~.,..~ ,...~.....: ............. ,-.,; ........ :.....:. ...... ........... :~.'.:....: pursuant to application dated ...................... ;A~,.tt-.~J~,...~,., ....... i 19~... and aPproved by the Building InSpector Fee $...~.~)~O~..~J ..... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date September 23. 1968 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities at Elizabeth Lane for a structure located (Give deed location) $outhold have been inspected by this department and found to be satisfactory. District Engineer FORM ~TO. I TOWN OF SOUTHOLD //~. BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... Approved ........................................ , ..................... ......................... APPLICATION FOR BUILDING PERMIT o Application N ............................. 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 propertymust 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 Jn 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, building code and regulations. (Sig ca porQtion) ......... ................... (Address or appr~cant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............. ~,t~....~......~....j_ .................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ..~..,.~; Lot No: ........................................... 2. State ex~S~mg use and occupancy of premises and intended .use and occupancy of proposed construction. a. Existing use and occupancy ...... .~.,~~...r~.~ ................... ~.....: ...................................................... b. Intended use and occupancy ....... ,(~b<l,~.~Z....~K~....~....~ .................................................. 3. Nature of work (check which applicable): New Building ...... ./~.......... Addition .................. Alteration .............. Repair .................... Removal .................... Demolition ..................... Other Work (Describe) ..................................... 4. Estimated Cost .... ~.~ ..................................... 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 af 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 ..... ~fr.,~. ............... Rear ..,~..~.. ................. Depth ..,¢~.../~.. .............. Height ....... .J..~. ~,. ........ Number of Stories ..... ~ ............ 9. Size of lot: Front ....... ~.~).,.~. ........... Rear ./.~.:.~,.~. ............. Depth ~',~. ............. 10. Date of Purchase. ~...,.f..-~, ............................ Name of Farmer Owner ............ 11. Zone or use district in which premises are situated ................. ,L1....~.,4,~. ......................................................... 12. Does:, proposed construction_ ~¢,~/ ~,/vi°late any zoning law, ordlnance~,~ z~__-°r.- ~(,~,regj41'gti°n? ....... ~b/.,~ ................................... 13, Name of Owner of premisesf_~-~.,~.~..~/2,~. ...... Address ./,)~f',~ ..................... 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 oil set-back dimensions f'ri~r property lin~s. Give street and block numbers or description according to deed, and show street names and indi6at whether interior or corner lot. COUNTY OF,.~.~ ..~- ' ' ~~v ~'~'~ signing app icatian) duly sworn, deposes and soys that he is tho 'applicon' above named. He is the . 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 b~f~ me this ,x ........................................ ~%,, ruHc, State o~ ~ss~n Expires i~arch