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Home My WebLink About3877-zFOP*M ~0. 4 TOWN OF SOUTHoLD :BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD. N. 2'. OEP. TII:'II~ATI~ OF O0OUPANO¥ THIS CERTIFIES that the building located at . .1~/$.. '(~e~' .ROad ......... Street Weo~t Creek EstaJ~es, . conforms substantially ~o the Application for Building PSrmit heretofore filed in this office dated .......... F~ar~h .... ~.~., 19..~[~ pursuant to which Building Permit ]No. ~.. dated .......... X~IlI~.. Ma.~ 19.6~, was issued, arid conforms to all of the require- ments .of the applicable provisions of the law. The occupancy lot which this certificate is The certificate is issued to . .P,.tchard. A~bt~ ......... i:(I~el' ......................... (owner, lessee or tenant) of the aforosaid building. Suffolk County Department of Health Approval ...~t~l~e...2~,.. '~. '~y 'R'.' .VIl;~.a.. · FOI~I NO. ~ TOWN OF S0UTHOLD ! BUILDING DI~FARTM£NI? TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 3877 Z Permission is hereby granted to: '~~..~.,~.~...~.....~.~.,..~ .... ,,..~~ .............. ~ .............. :... ...... [',,,--,,,~. Z~,:~:,~.~ ,,~. .................... 'i;'"~"-~.' ........ at premises located ,,, .......................... ~ ....... ~ ............... ..................... , .................... ..~.~.. ~:.~,~,.~.:. ,~ ~ ~,.,:..~....., ..................... :....e pursuo~t to opplic~Hon a~tea .......................... ~-..,....~....?,..,]9,~.., ,ha opprov~ by the Building InspectOr. ~ :} ~ :~ ~ . ALBIN s-9 SUFFOLK COUNTY DEPARTMENT OF HEALT~ Date June 26~ lQ68 Bldg. permit No. ~877 TO WHOM IT MAY CONCERN: at__ The sewage disposal facilities for a structure located deed location) --. West..Creek Estates, Lot Nc. ~ Southo~d, New York have been inspected by this department and found to be satisfactory. "'"% Distr~ct Fmg~nee~ Distrmct Fmgineer TOWN OF SOUTHOLD ~/~ ~ ~ BUILDING DEPARTMEN_T~"~'/~/~"~ '~'~ ~ ~/'~ ~../' ~-c~ ~.'~ TOWN CLERK'S OFFICE 13~ ~ /~, ~' ~ ~ SOUTHOLD, N.Y. ~~ ~ ~' ~ ................ ... No ........ ......... ~ppreved ........................................ , 19 ........ Permit No .......... Disapproved a/c ~.....~.. ~~ector) APPLICATION FOR BUILDING PERMIT 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 co~nmenced 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 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 a corporation) . (Address of applicant) ~,&. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............... ...]~....o..~.~...~.......~.....~..~..~. .............................................................................................. If ~ij~a,r,e~or/e, signat_ure of~,~luly authorized officer. ................... 1. Location of land on which proposed work will be done. Map No: ...~..q~...~.~.q~..~J.~..~...e..~Lot No: ..... ~..~ .......... Street and Number ........ ..G~.~J~?t,..~J~ ........................................................................ : .............................................. Municipality 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 .......... f)Z~...:~i~,[],~'...~'.~l~.~.t~Z~.e, ...................................................................... 3. Nature of work (check which applicable): New Building ......Z. ........... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost ........~.. . .8. ~. .0..0..0.. ....0. ..0. ............................ Fee .......................................................................................... (to be paid on filing this application) one u 5. If dwelling, number of dwelling units ............................ N tuber of dwelling units on each floor ............................ If garage, number of cars ................... .f,..'l[~ ................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front .......~.. ................. Rear ......J~. ............... 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 ........ ~ ............... Rear .....~ .................. Depth ......~...2. .................. Height ......... .~..~ .............. Number of Stories ........ ../. ................. 9. Size of lot: Front ....~.~.~...t..~..~.. .......... Rear .....~.~..e~.~.~. ......... Depth ......,~.0.~.8..~ ........... 10. Date of Purchase ~T..o~....~...~6~f Name of Former Owner 11. Zone or use district in which premises are situated ........ .~...e..B...t..~...e..~...~..t...l~... .............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~1:) ........................................... 13. Name of Owner of premises ....~....O...~.~.....~...b..l..~.. ...... Address ..~.a.~.l.~. .............................. Phone No. ,5..8...]...-.~.~..2.~. Name of Architect ......Gq...~.~.~..J[~..iAI~.~.:ILt.I~. ........... Address ....~...e~....e.~ .J~...Z'..~.. ................ Phone No..~...2...2..-.~...2...2.? Name of Contractor ..~..a~....e...~.~gZl..~Jg~R.e.~...~f~.,.....^ddress ...~..o...~..~....*/T...~.~;J'.~..~.e..9.~...~..~Phone No. ~..~.,3.-..~.]...~...~ 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 corner lot. STATE OF NEW YORK, COUNTY OF: ........ ...... i s.S. ~T~Jl~ J'o ...~...0..~....1~...~.~. .............. be ng duly sworn, deposes and says that he is the applicont (Nome of individual signing application) above named. He is the .....................C,4~I3,J;~.&O.Ii;.~Z'. ............................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners and is duly authorized to perform or have performed the said wo, r,k and to make and file this application; that all statements contained in this application. ,om"l~-ue to the best of/~is knowledge and belief; and that the work will be performed in the mannei set forth Jn t~e application filFeL, ther, e'~/~th. Sworn to before me this ~8 ..~ ( ,~/~./~//~ . 2,~ ... day of Notary Pub' lc, .~..E~G~;~ · .. ~; .....~..~.~'~,-~ou nty ' ~~(~~~ ..... NOTAIbT PUBLI~, State of New York / / ( / ( / Sco, t¢ :-4-0%