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Home My WebLink About3326-zFORH ~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I~OWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE 13F OCCUPANCY No.~. 273.~ ..... Date ............... Ztlll~.. 2~ ....... 19. t~ THIS CERTIFIES that the building located at~/..8...~..o~..~.h..B.~..y~fl~l'..]~0~,d Street Map No...~ ....... Block No .... ~ ...... Lot No.:~: ..... ~OiI~:]',o.~L~ .~.~ ........... conforms substantially to the Applicati,on for Building Permit heretofore filed in this office dated .............. ~1~'.. J~.., 19.~ pursuant to which Building Permit No..~. ~ dated ............ ~.0.~...~...., 19.1~t5., was issued, and conforms to ail of the require- ments .of the .applicable provisions of the law. The occupancy for which this certificate is issued is .. ~:~e..0~ .f~.l~r. ~l~,l~_~ ......................................... The certificate is issued to ~$~.~. ~[~0~I~e3~ ....... 0~TI~:~ ....................... (owner, lessee or tenant) of the aforesaid building. ~uffolk County Department of Health Approval ~...P_ .1.~ .~5~ . b~r..~[~ .~r~u.~ .... "'r .... il¥ih ' .......... TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOI. D, N. Y. N.o BUILDING P~RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3326 Z O,~e .......... ..../~....~..g..:. ....... ~..~. ....... , Permission is hereby granted to: _ -- .D.~.,...D.~.~...~.!.~....~.:..../~..~..~.~..~.~.~ ~ ~,*'r~ ~ .~..~......~....~......~..~.h..~..T.; ................................ ..~ ..... ~.~..~.~..,..~../4.?..~..~.........~...,~, to ~...'.,~,~....~..~.~. ..... .e.....n'..~....,.F..,".~..,..~..v: ....... ~.~.~..:..~..~ .................................. Building Inspector. ~ee $./.. .................... 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 (G~ve deed location) have been inspected by this department and found to be satisfactory. District Engineer LAND 150, O MAP Of PI::LOPEI2,TY DE.B. BU~.GEHEISTEP_ ~UTHOLD T~WN OF .~:ADUTHOLD, N,Y. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... ..... Approved ........................................ , 19 ........ Permit No. '~' [~o~proved a/c .................................................. APPLICATION FOR BUILDING PERMIT Application No ........................... Date November 19, 1966 19 .......... INSTRUCTIONS a. This application must be completely filled in by typewmer or in ink and submitted in duplicate to the Buildin. Inspector. b. Plot plan showing location of lot and of buddings on premises, relatzonship to adjoining premises or public streets c areas, and g~ving a detmled descr,pt,on of layout of propertymust be drawn on the d,agram which is part of this applicatior c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of th,s applicat,on, the Building Inspector will issue a Building Permit to the applicant. Suc. permit shall be kept on the premises available for ,nspection throughout the progress of the work. e No budding shall be occupied or used in whole or ,n part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Budding Inspector APPLICATION IS HERI~BY MADE to the Building Department for the issuance of a Building Permit pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other cpphcable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply with oil applicable laws, ordinances, building code and regulations. o,. ...... ...... ........ ne~ (Signature or applicanT, oRL~ame, it a corporation) 65 SmJ. th S~;ree~;,Lllke 1~o ~n~onkoma~New ¥o (Address of applicant) -- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde, owne ~ If applicant is a corporate, s~gnature of duly authorized officer. (Name and t~tle of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................Lot No: ................... Street and Number Sou';hold, Municipality State e~×isti~g use and occupancy of premises and intended use and 6~culSancy of proposed construction: a. Existing use and occupancy none b. Intended use and occupancy ...... ~.:i:...:g.~;..1..e....~..m..i...1.~....~.e..1...1..i..~; ................................................................... 3. NQture of work (check which applicable): New Bu~ld~ng~.X...~. ............ Add,tlon ................. Alteration ................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..................................... 4. Est,mated Cost ~..1.~.:..0..0...0.:. ......................................... Fee ......................................................................................... (to be pa~d on filing thru application) 5. If dwelling, number of dwelling units ....o...n.?. .................. Number of dwelling umts on each floor .o..n..e. ..................... If garage, number of cars one-car garage 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................... 7 D~mensions of ex~stmg structures, if any: Front .......................... Rear ..........................Depth .................. ~ ...... Height .......................... Number of Stories D~mens~ons of same structure with alterahons or addmons: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ........................................ ' " 57 4'' 28'0" 8 Dimensions of ent,re new construct,on Front .~..~...~. ................. Rear ...........................Depth ........................... H..- approx. 16~ e,gn~ ........................... Number of Stories ..o...i~..e....; ................ 9. Size of lot: Front ............. ~..:.~.~. ....Rear95.5' Depth 1 Se ¢.2.4 !966 10. Date of Purchase ...... P ......... ~. .................................... Name of Former Owner ..~...o..~,.~..h...o..1..d.....~..e..?.?...1.~.?..m.~..n..$....C.. 11. Zone or use d,strict m which premises are situated ............................................................................................... 12 Does proposed construction violate any zoning law, etd,nonce or regulation? ...... nD ......................................... · Df.Bessie B.BurgemetsCer 65 SmtCh S¢. ~' NoJUS-St6.4 ]3. Name of Owner of premises ........................................ ,%aaress .... ~,EM~(~yl%t~).~l~;.~;~/,.~none .................. Name of Architect ..]~.~.~...~QK~.S .......................... AddressQQaSkQkQQ~.r4.~.D.~. ~hone No.~..2.$..-..1..Q. QQ Name of Contractor .D..~..:..B..:..B..~...~.~..e..rg..8..~...s..~..~...~. ........... Address6..~.....~..~..i...~..h.....S...~.:.~..L..k..:..R...°..r~one No.J...U..8...-..~..1...~.~. PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether ex~sting or proposed, and red,cate all set-back dimensions fret property lines. Give street and block numbers or description according to deed, and show street names and ind~cat whether interior or corner lot. STATE OF NEW Jt'Ol~,~ ~ c c COUNTY OF ,~'~'~.~ffr~... ....... /~r~....~..~.'~..~.f..~.. .................... being duly sworn, deposes and soys that he s the applicar ·'-(Name of ,ndividual ~igm~,,q/ op~) above named. He is the ............... ~;.(.d~. .......................................................................................................................... (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 fil th~s apphcat~on; that all statements contained in this application are true to the best of his knowledge and beheJ and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this -~ -- , .............. .~...~·... day of ..~..~.~;...~... ............... , 1 .~..?.... bx ! It/ , d" f ..... ................. ~ ~t 'F~.~' ' Notary Public,. ......... ~..~..... ................... ~.~e..~c~;~c~~ (S,gnature o~pphcant)