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Home My WebLink About3239-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE DF OCCUPANCY No. ~ 27~ Date ~'llllr '19 .~ , 19 (~7 THIS CERTIFIES that the bmlding located at ~/~ ~ ~Ve Street Map No~kO~ ~k No. Lot No. ~ ~0~ ~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ~p~ ~ , 19 ~ pursuant to which Building Permit No. ~2~ .~ dated ~p~ ~ , 19 66, was msued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ~va~ e~e ~a~t. Zy. d~e~1f~g ..................... The certificate is msued to F~ ~o~ie~ ............ ~ .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~ ~ 196~..~y R~ .~]1~. Building Inspecto¥ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING I~ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLEIION OF THE WORK AUTHORIZED) 3239 Z -O~te ....................... ~.~..~.....~., ,~...~ ? Permission is hereby granted to: ..... ~ ~__~3~.,ttee~..&..~,~m....~....~ ~l~mmm~ei ............... .~..ei~e ........................................ at premises located at ...X~.,..~ .............................................................................................. : ........... ....................................... Z,~m~....~..~,.....~t~e,..~.~, .............................................. pursuan¢ to application dar,ed ........ ~ ............. ~A~f,.....~l*~...i ........... L., t9.~1,., and approved by the Building Inspector. , S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at Lupen Drive~ Gu%chogue (Give deed location) have been inspected by this department and found to be satisfactory. District Engineer District Engineer FO~I~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om,ned ..... ~...¢~.?..., 19...~....~. Approved .................................... , 19 .....Permit No .............................. (~r) ...... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Th~s opphcation must be completely filled in by typewriter or mmk and submitted in duplicate to the Buildm, Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adlommg premises or public streets o areas, and g~wng o detailed description of layout of property must be drawn on the d~agram which is part of this applicatior c The work covered by this apphcatson may not be commenced before issuance of Building Permit d Upon approval of th~s apphcat~on, the Building Inspector w~ll ~ssue a Building Permit to the applicant. Suc' permit shall be kept on the premises avadoble for inspection throughout the progress of the work e No budding shall be occupied or used m whole or ~n pa rt for any purpose whatever unt~ a Certificate of Occupanc shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding Deportment for the ~ssuance of a Budding Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances o Regulations, for the construction of buildings, additions ,or alterations, or for removal ar demolition, as hereto descnbec The opphcant agrees to comply w~th all apphcoble laws, ordinances aged regulations ss of applicant) .................... State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrioan, plumber or bu~lde If applicant is a corporate, signature of duly authorized off~cer~ ......... ..... (N~;Ifne and title of corporate officer) 1 Location of land on which proposed work will be done Mop No' . .................. ~.. Lot No' ~... Street and Number ....... ~ .... ~ ......................................................................... Muniopality 2 State ex~sting use and occupancy of premises and ~ ntended use and occupancy of proposed construction a Ex~sting use and occupancy .................................................................................... b Intended use and occupancy .... ~'~...~.:~ ~.~..~ ...................................................... 3 Nature of work (check which apphcable) New Budding ................ Addff~on ................ Alteration ............. Repair ................ ~qemoval ............ Demohbon .............. Other Work (Describe) .................... 4 Estimated Cost ......... .~...,~.~.~...~ ...................... Fee ............................................ '~"~-- (to be pa,d on filing this apphcat,on) 5 If dwelling, number of dwelhng umts ..... / ...... Number of dwethng umts on each floor ................... If garage, number of cars ........ ~.. ................ 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........................ ' .... Rear ...~...~. ......... Depth ...Z.~ .~ ......... 7 D~mensions of extstmg structures, ~f any Front ~.~.. ~ tr Height .,~¢~..~ .................. Number of Stones ..... ~, ......................................................................... Dimensions of same structure wsth alterations or oddmons Front .................... Rear ....... Depth .......................... Height .............................. Number of Stones ..................................... 8 Dimensions of ent,re new construction Front ...~...~....'¢~r~ ....... Rear . . .'~.....~. ......... Depth . .~..~..:.~...].'. ....... He,ght ..~,.~...~. ................Number of Stones... ?~.... ............ 9. Size of lot' Front ..... /..~Y~..~ ...~ .......... Rear.../.O~0. ~ .......... Depth../.~..~....~ ...................... 10 Dote of Purchase ...................................................... Name of Former Owner ........................................ 11 Zone or use district in which premises are sttuated ............................................................................... 12_ Does proposed canstrucbon v~olate any zoning law, ordinance or regulotton~ ........................................ 13 Name of Owner of premises~.~.. ~ Address ~..?/-~.......~~Phone No Name of Architect ...................................... Address ..................................... Phone No .................. Name of Contractor ...~ ~.~.~.Address ..~ ................. Phone No .~...~..~...¢.~ PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether existing or proposed, and red,cate all set-bock d~mens,ons fror property hnes Give street and block numbers or description accord,ng to deed, and show street names and ind~cat whether interior or corner STATE OF NEW/YOP~I~, // ) ~ ~ COUNTY OF~,~..) ~ ~ ......... .~~~- ..~ ................. being duly sworn, deposes and says that he is the applicon (Name of ,nd~als,gning ~appl,cat,on) above named He ~s the-- '~ -~-~'..~:~.......~%~.....~. ............................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and fih this apphcat~on, that all statements contained m th~s apphcahon are true to the best of his knowledge and behef and that the work will be performed t~G ~n~ ~orth in the apphcahon filed therewith Sworn to before me this .... ~R~ '~0, sts~ ~ ~o~' ' ~