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Home My WebLink About3912-zTOWN OF ~SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD. N. Y. I:)ERTIFII~ATE OF OI:)CUPANCY No. ~,. 3.h:.00 ..... Date ............... ~'I~ ...... .~ ...... 19.69. THIS CERTIFIES that the building located at . ~/es~v~ecrd. I~.~_e ............. Street Eastern Shores sec ~, Map No ............. Bloct~'No ............. Lot No. 75 ....... 0~A~l~.t .... ~L,~.~, ..... conforms substantially ~o the Applicati. on for Building Permit heretofore filed in this office dated ........... ~T~l~. ....be .... , 19.6~. pursuant to which Building Permit No. '39]'~ '~' dated ............. ~11I~ .... .].], 196~., was issued, and conforms to all of the require- meats of th'e .appliCable provisions of the la w. The occupancy for which this certificate is issued is ... Pr. ira,re, nn~ .family:. d~e llir4~ ........................................ The certificate is issbed to .t~h~lel~l$ .Sehrio.tde,l~ ............. ~ql~lx ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~lO.~e...8..~.~.. ~r. I~,. 1~1l~ ....... FOP,~'V~ NO. :~ TOWN OF SOUTHOLD BUILDING DEPART/v~EHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 3912 Z Permission is hereby granted to: .......... ~.m~t,~o~ .................................................. to ~.u,~,..~w...~e .. ~.~ml ~...~¢e~.:Lt~ ......................... ~ ............................................ : ............ at premises located at ....,~O,~,.~r~....~J~.~..~.....~:L~..~L~tO~ ............................................... ........................ ~..~......~..e..~.~.~.~. ~... ~.~.. ......... .~.~ ~.e~,....~ ......................................................... pursuan¢ to application dated ............................... ~.,t~t~. ......... .~..!...,., 19...~.~., and approved by the, Building Inspector. ~:ee $....1.q~.~.~. ........ S-9 SCHD SUFFOLK COUNTY TO WHOM IT MAY CONCERN: The sewage disposal at DEPARTMENT OF HEALTH Date_ November 8, 1768 Bldg. Permit No. ~?12Z facilities for a structure located Green~ort.~ ~fes%wood Lane (Give deed location) ~ ou ohold have been inspected by this department and found to be satisfactory. Dia~iot ~gil~ District ~ngineer FOBM lq'O. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. ~_'7 Approved ........................ t..?. ............ , 19 ........ Permit No ............................. Disapprovedo/c ..~......~ ....... 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 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 property must be drawn on the diagram which is port of this application. 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 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 bui dings, 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, engi'neer, general contractor, electrician, plumber or builder. ............ : ........ ............................................................................................................................... Name of owner of premises ...... .~.~.~...../~....~...~.........~....:...~...~'...~..~...~../..-~.....~-.~' .................................................................... If applicant is a ~rate, signa.ture of duly authorized officer. ........... (Name and title of corporate officer) ~,E~,.~j/ ~- 1. Location of land on which proposed work will be done. Map No.: ,~..,,~,,.-~,Z',..~.,~',,.~,~'~2.~.$.., Lot No.: .~.,~. ................. Street and Number .....~....~..~...~'....~..c~.~.....~.a'~.,~...~. ........ .~.~..~....~...~.~...a...,~..?......../:~.,.~.... ........................................ Munimp611ty 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. Nature of work (check which applicable): New Building .....~... ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..~1~,'¢~'-~ .................................. Fee .......................................................................................... ~' (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 ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ 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 .~R..~...~. ...................... Rear " ~ ' · .~..~. ................. Depth-~.. ..................... Height ......:~....~..~ ..... Number of Stories ....Z....~:... ...................................................................................................... 9. Size of lot: Front ./..~..~.. ................ Rear ..... /..~.....~. .................... Depth ...L~....q...~../~...~.,. ..... 10. Date of Purchase ...... ~;/~.jp, ..................................... Name of Former Owner/a/.,,7;,.,9...~.,th/v.~D....~..~.~ .~.~ ........... 11. Zone or use d str ct n v~hicH prem ses are s tuated ~'~/'~9 '~'D' ,,'.t~&, ........... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....J,~..~.: .............................................. 13. Name of Owner of premisea~',.C',2,~v',~/.&/,/~E~{, .........Address.....~'~-~ ...... e Z"........................~'° $ ~ - ..~.~. ~.. ..... Phone No....~ ................ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor~9,~'~'..~.~...~'.~A~.c?.,~.~'.,S..~4/.Address ...~.~.~..~...ff~'...g.~.~....&~'... Phone No.~.~...~..~...Z~l./ 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 number or description according to deed, and show street names and indica'te whether interior or corner lot. STATE OF NDvV YORK, ~ e ¢ J COUNTY oF ................................ ~' ""~' ....... 4~-~-..°~-./.~...~.,..~...4C-/~'4'~.$J;.~'~/... .................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ...... ~.~..t.,4.~.Z~'..xJ~, ......................................................................................................................... · (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to peHorm or have performed the said work and to make and file this application; that oil statements contoined in this application are true to the best of his knowledge and belief; and that the work will be performed ]n the manner set forth in the application filed therewith. Sworn to befgre me this ............ of .... ..... Notary Public, .~[.~,0t.~......~.....L.(-~,~.... County (Signature of applicant) ~ ~ARION g. NOTARY PUBLIC, State of ~w York J~o. 52-3233120 Suffolk Count~ ,Term Expires March 30,