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Home My WebLink About3921-zFO1~M 1~0. 4 TOWN OF $OUTHOLD ~ BUILDIF4G DEPARTMENT~ TOWN CLERK'S OFFICE: SOUTHOLD, ~1. Y. CERTIFICATE OF OCCUPANCY No. Z 3410 Date .~',~uar~. 23~ , 19 69 THIS CERTIFIES that the building located at ..V~.~,OD,..~Oj~ ....................................... Street Map N~/~m~nc~d''A'' Block No. Lot No..~.~lB...~t~.t~,~i',U~.,...l~...~D. lt}f .............. ~'~i~"'P'~' ....................... conform~s substantially to the Application for Building I~ermit J~eretofore filed in this office dated ........................ ~.l~..~.....~,.~..~ ....................... , ]9.6...~.... pursuant to ,which BuiJding Permit No. ~.?..~...]:....~.. da.ted ............. .~.gA'l.~.....~,~.., ................... , 19..~.~.., was issued, and conforms to all o1: the requirements of the applicabJe provisions of the law. The occupancy for which this certificate is issued is ........ . .~.r...X..v..~.~....O.~le... ~amil .y...~.ell ing ............................................................................................. The certificate is issued to ......... .~...~.~.~.~.m...8.t....~...~.~..d...~..~.~.~...~, .......................................................... (owne~r, lessee or tenant) of the aforesa'id building. Health Dept. Appr~al~ January 22, 1969, ~obert V~11a Building Inspector FOP,~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y, BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PREMIS ~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3921 Z Dote ............~ ........... ~ ....... ~J.~. ........... Permission is hereby gronted to: to at premises Iocoted at ,..~.~.....~. ~y..~t~Ol~,..~%~..~J&~),..~j~J[~..~..~ ..................... ...: ................ ~.....V~t~--~oo,~ ....... ~h~t,'~ ................ ~ ....................................... pursuon~ to opp~ic~tion d~tod ....................... ~. ~ ~,, , 1~....6~ ~na opprov~ by the ~uildin~ S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH Date Jan~3a~; 22~ 1969 Bldg· Permit No. ]921Z TO WHOM IT MAY at CONCERN: The sewage disposal Vm~ston Rd facilities for a structure located (Give deed location) ~ %~ho~ Southo!d have been inspected by this department and found to be satisfactory. Owner ~[ill!am Oardmer District ~nglneer District Engineer TOWN OF $OUTHOLD ~:?"~'- "' ~' ,'/~ BUILDING DEPARTMENT~/~(~ TOWN CLERK'S OFFICE~ ......... , 19 · · ........ Apphcahon No ..............L ............ Approved ........................................ , 19 ........ Permit No .....~ .............. ~.. ....... Disapproved a/c ......................... ...... ................................ ........................ APPLICATION FOR BUILDING PERMIT A Date ........... .......................... , 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 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 ~or 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. (~ddress of applicant) V If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) t 1. Loca 'on of land on wh'ch proposed work will be done..Map No: ~~./~. ~.. Lot, No: ....~..~...~.. . StreetandNumber .,.)//~ .~................g...... ~~ ..... .. .....'"". Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. use and occupancy ............................... ~ ......................................................................... Intended 3. Nature of work (check which applicable): New Building ~'~ Addition Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost ............... ./...~,.,..','.: ............................... Fee .......................................................................................... (to be paid on filing this application) §. If dwelling, number of dwelling units ~ Number of dwellin~ 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 ............ ~.....~ .......... Rear .............. i~.~ ........ Depth ......~.~.....~. ........... Height ............ ;~.~ .......... Number of Stories ........ .~.. ................. 9. Size of lot: Front ....... .~.~..~. ............. Rear ........... ./.~..~ .......... Depth .......... ;~.~.~..:.?...O. ..... 10. Date of Purchase ...................... i.-~.//..~.L~.~.. ................. Name of Former Owner .................... ..~...c....~..~... ...................... 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ............. ~..(.4 .................................. · ~v'm ~c~,d, - ,1 F~ ,.~/~.~ 2,~.~..c;c..Phone 13. Name of Owner of premises ........................... .~ ........... Address .../. ....... .~ ........~. ........ No..Z ................ Name of Architect .~.g...~./.~.f~.t~.....4'....?...O. Lqa', ......... Address ...... .3.~l.!~..X.~..~.~.~...~,~.....U.... Phone No ..................... ......... Name of Contractor .....~..q ....... ~....~ .......................... Address ......... M.,~t, ...... ~. No. 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 ................................ f~,~R' v/~/~V%/ ~ ........ ~ .............................. being duly sworn, deposes and says that he is the applicant .... (Name of individual signing opplicati~ above named He is the ............................ ~-~'.~'.¥~.~.~.=.~ ................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du'ly authorized to perform or have performed the said work and to make and file this application; that al statements contained in this application are true to the best of ..his knowledge and belief; and that the work will be p_erformed in the manner set forth in the application filed therewith. Sworn ti,.~.. _b~Re r~;ytho~S .~.~ ,19 ~.~. / L/ - , ' ": ...................... Notary Publi~'..~'~,~r,,, ...... /.:.....~...~...~.. C~i:flr~.~ PUBLIC. State o, ~m' '~'~'gi'i'~~';Ijure of applicant) { ~ ~. 52-323~120 Suffolk C~ ~ ~ Mar~;~ 30, J.~...~