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Home My WebLink About3037-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z38Y8 ...... Date ............. /~ttly....1.3 .... , 19.?0. THIS CERTIFIES that the building located at . S/S .Lake .Dri.',,e .......... Street Map No...XE ........ Block No....X-lC. ..... Lot No. XE ...... $.outhoiLcl ..... E,,Y., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Ap'ri].' ' '2' · ', 19. '66 pursuant to which Building Permit No. 3037~.. dated .......... Ap.r;L.1...1+..., 19.67., 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 ... P. rivate, one .fan;i.ly. &weIIing .................................... · .0;~tel· ......................... (owner, lessee or tenant) The certificate is issued to .~iaZ'ie &/ol'.lale ...... of the aforesaid building. Suffolk County Department of Health Approval touse · J.uly...1.3...t967...by. PL,..Vii.la TOWN OF $OOTHOLD BU~LDIING DEPARTMENT TOWN CLERK'S O~:FICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 3037 z Vote ............................... .~t.~....~. ......... ~9.~;. Permission is hereby granted to: Willi~_~..b~h.~.~.....A./g.....~.ie...We~te ............ ....... .~o... ;~4~ ~. ~.y.. ~ ......................................... ................. ~,.~t,, .$~.t,o~ ...................................... to..~i~-~...n~,w. · ~ne...$..~ t:~.. ~.'~,e.]:.~.i-ng. .................................................................................... et premises located at ...... ~r/~....,~..~..])~ ..... ~'/~"K~;r'"~t~, ..................................... ~ .................. .............................................. ~ oz~;l~ol~l r ..~{.o.Z.., ................................................................................... pursuant to application dated .............................. .~)~.~..~....,~. ........... 19..~., and approved by the Building Inspector Fee $,.~Q ~.O.O .......... Build n~ InspectOr .... FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. TEMPORARY E:ERTIFIOATE OF OEIEIUPANEIY THIS iCERTIFIES that the bmldmg located at 13/![!..Lake..D;~iv.e . .~ ......... Street conforms'~substan~ially to the Application for Building Permit heretofor~filed in this office dated., ..." ' "ri Apxit. 2 ., 19.66 pursuant to which Building Pefmit, No. 303.7 dated .: ...... ;'(:7~. ;.'{AI0I~.I..h-.., 19.6~, was issued, and conforms to ~hll of the require- men/s ~f the ap~lie"able, provisions of the law. The occupancy for which/this certificate is Th~ certificat~ is issued to .. l~a~ie. ~ol'hlo ......... 0wru~e ...... . ....'. .............. , (owner, lessee or t~enant) of/the aforesaid l~uilding. S. uffolk County Department of Health Approval . i['o2t.y...i~% ~. 967...by. ~, .vt~aa. [ ' ' Building 'Inspector SUFFOLK COUNTY DEPAFdIIENT OF HEALTH JUL ~ ~ ~? Date mdg. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structur~ located at s/s Lake Drive 830'.56~ West ~enn~'s Road, Southold (Gi~ deed location) have been inspected by this Department and found to be satisfactory. Distr~ct Engineer' NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~..( 19~.. ....... ...... ......... , Approved ........................(/ :: .............. , 19..M... Permit No...,~.ux)...~..'.~....~.----~ Disapproved a/c ....::~:: ...... ~.?~~ ...... ~--~,~:..~~ .... ............................ ~':~'~'~'[[~[~' i~ector) ............................ Application No..~...!,).~...~. ............ APPLICATION FOR BUILDING PERMIT Da,e ...... ........ ):: ......................... , 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 decailed description of layout of property must be drawn on the diagram which is port of this app icotion. 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 o 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) ! ' State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. Name of owner of premises ....... L.~.../'.~..~....L:~...... ~,..¢.J~..l~l/..L.'. '~.. .......................................................................... 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.: ........................ Street and Number ..~/~../.~.L~....J~/.SJ~.~.~..~./~. ...... ~..47...¢-:...~.~.~..~./~.~.~..~..~./;.~.~..~?.?.~L~.~.`.?~..~.~ /V~unicipa ~Jty 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 ................................................................................................................................. 3. Natur[e of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repai~' .................. Removal .................. Demolition .................. Other Work (Describe) ............................. , .......... 4. Est~mCted Cost ' I (to be paid on filing this application) 5. If dwelling number of dwelling units ............................ Number of dwelling units on each floor ............................ If gar, age, number of cars ............................................................................................................................................. 6. If b~siness, commercial or mixed occupancy, specify nature and extent Of each type of use ................ ; .......... ,. 7. Dime,hsions of existing structures, if any: Front ............................ Rear ................................ Depth ............ ~ ....... He~gl~t ........................ Number of Stories ................................................................................................................. Dimensions of same structure with a,lterations or additions: Front .................................... Rear ................ ; ........... Deptl~ ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... .~...~. ...................... Rear ........... ~. .............. Depth ........~ ........... Heigt~t- ..... /..~...'. ...... Number of Stories ............/ .......................................................................................... ~ ............ 9. Size ~f lot'. Front ........ ~...Z ............. Rear ....... ~...~.. ..................... Depth ....... .~...~..~ .............. V C cc/ / 10. Datejof Purchase .......... :~...~.../..~....~...~..~ ..................... Name of Former Owner ..... l .............. .~. ........ ~....~.../ ............... 1 1. Zon~ or use district in which premises are situated ..................................................................................................... 12. Doesjproposed construction violate any zoning law, ordinance or regulation? ..... ~...O. ............................................... Name of Architect ...................................................... Address ............................................ Phone No ........; ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property i~es. Give street and block number or descr ption according to deed, and show street names and nd cate whether int~rior or corner lot. STATE OF NEW YORK, }SS ................. i ................. ~',t.~..L,.L,,,~,,!/~,.~ ........ ~..~.~).~-~../']...L:.~~. ....... being duly sworn, deposes and soys that he is the applicant '(Name of individual signing application) above na ed. He is the (Contractor, agent, corporate officer, etc.): of said o~ner or owners, and is duly authorized to perform or have performed the said work and to makeJ and file this opplic,otion; that all statements contained in this application are true to the best of his knowledge and bblief; and that the w~rk will be performed in the manner set forth in the application filed therewith. Sworn to b;efore me this , ~ /~ ~ ............ .~..; · .............................. dayof- . /-~(,~/¢IL,_/; ., 19~.~ ....... --~ ./'/~ ~/,,_/"/, '%~/~7%//~_/ , .&...+. ..... ; .... , ............................................................