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Home My WebLink About3336-zFORM NO. 4 TOWN OF $OUTHOLD BUll.flING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnle Of Occupnncy THIS CERTIFIES that the building located at ... Br. oad~.,.atera .Rd ........ Street Map No. Nmss,..Pt.. Block No ........... Lot No..285 .... 2utch~gue...N,Y., ..... conforms substantially to the Application for Building Pemit l~eretofOre filed in this office dated .......... Dec ...... ?., 196f~. pursuant to which BUilding Permit No. 3.3362.. dated .........Dec ..... .12 ..., 19.6.$., 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. ri.v~te, one. f~lly..dwelling ...................................... The certificate is issued to . Mx,. &. ~lx,s. Richard .M~hlex, ..... 0wne~.s ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval D~C...~..1967. · .by. R.. ¥illa ........ UNDERWRITERS CERTIFICATE No..P.e..n.d.~..g. ' ......... HOUSE NUMBER .... $62.~. ..... Street .. Broadwater. Road.. ,-Nasa..Pt+ ........ FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3336 Z Permission is hereby granted to: ............ ~** .. ~:L~.~.s~5...~..C.....if. ~.*..h...~rfi...F..e,.h..[e r a ................. C.~ ~h~,~,p...e. ~,.....~.,.~..~, ......................... to .......... h~,~..~w...o~...~.mn~7...sl~.~l;L~ .......................................................................... at premises located at ..~..~8~t.....~..~O~.~O~e ....................................................... ................................... ~g~.~e ~.~ ...~.~.....~O.~g~..~.~......~[~ ...................................... pursuan¢ to application dated ..................... ~e~e~. ......... ~. ....... , 19~..., and approv~ by the Building inspector. Fee $ ........ ~J~ .gtO .... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. DEC ~ 19~7 TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give d~ed location) / have been inspected by this department and found to be satisfactory. District Engineer FORM NO. I · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUT.OLD, N. ~. Examined ........ .~..~.~ ....... ,~..~.~ Approved..r....; ............................... 19 ........ Permit No. ; ....... ; ..................... Disapproved o/c .......~'.. {Building In~ector~ Application No ............................. APPLICATION FOR BUILDING PERMIT Date.....~...~.. ..................................... 19.~.....~..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink'and submitted in duplicate to the Building Ir~spector. 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 location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Bu!lding Inspector will issue a Building Permit tS '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, S~ffolk~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 arLd regulations. . (Signature of applicant, or name, if a corporation) ................ ..................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· · ' ~ ' ...................... Z ..................... Name of owner of premases ........... ~. ...... If applicant is a corporate, signature of duly authorized officer /'~-o /, -- ~-~ ~:D0 ~" ................................................................................................. (Name and title of co~orate officer) · 1. ~afion of land on which prop~ ~ork will ~ don~. ...... ~ ~ /Municipali~ 2. State existing u~ and ~cu~ncy of p~mises and intend~ use and ~cupancy of p~o~ ~Stmction: ~..,~,,ng.se ..d~..~ ....... ~..~....... ................................................................................ ....... ........................... ;:; ............. 3. Nature of work (check which applicable): New Building.....~ .......... Addition .................... Altera'rf'6~ ..~.Z.....~ ...... Repair .................... Removal .................... Demolition .................... Other Work (Describe) 4. Estimated Cost ........ ----~...~.,~..~ .............................. Fee ............ ../.~.Z.~ ....................................................... (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 of each type of use .............................. ~ ~ Depth.....~ ............ 7. Dimensions of existing structures, if any: Front ........ ~ ........ Rear ......................... Height ...... i,..~. ........ Number of Stories ~ ................ ~ .................. Dimensions of same structure with alterations or additions: Front ........... ~ ................. Rear ................................ Depth .............................. Height .............................. Number of StbrJes ................................ 8. Dimensions of entire new construction: Front, ...... ..~..~.. ......... Rear ........ ..~....~... ...... Depth ....~.....~... ............. Height .....i..e~..... ........... 'Number of Stories ....~.;;..... ...... 9. Size of lot: Front ........ ~..~..~. ....... Rear ...... ....... Depth 10. Date of Purchase ........................................................ Name of Former ~ner ........................................................ 11. Zone or use district in w~ich premises are situated ....... ~....... · ............ ........................................... 12. Does pr~osed construction violate any zoning ~, ordinance or reg~~ ...... ~..~....~.~ .............. 13. Name of ~ner of premises.~.~...~~ress .~~.~.~Pho~O........... .......... Name. of Architect ............. ~ .......... ~..~ .................... Address ............................................ Phone NO ..................... Name of Contractor..~..~.~'.....Address .~..~.~..Pho~ N~m.~.~ 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 ~ STATE OF NEW COUN'r oP ............ : ....... S S' . · (~ I}~ [(~/~'..~..?..~... :' ....:.....being dulY sworn, ~,~ses and ~ys that he is the applicant above named. He ~s the .......................... ~...,..] ........................................................................................ (~nt~t~, a~nt, co,orate officer, etc.) of ~id owner or owners, and is du y author zed to pe~orm or h~q pe~or~d the said work and to make and file this ~plication; that all statements contained in .this application are ~tm~ to the ~ of his ~ledge and belief; and ~at the work w be ~ormed i~ the ~nnet. set fo~h m th~appMcation ~l~therewith. Swo~ to before me this _ ~ ~' ~ ~ ~ ~/~.~. ~ .~_.../~ d~ of ..~~ 19 ............ ,~,,(~ apPlicant)