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Home My WebLink About3960-zIvORIV[ I~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD. N. Y. CERTIFICATE OF OCCUPANCY No. Z~.~¶ 8 Date IO1' . ~. ...... 19..68 ]~HIS~TI~IES.th&t the. bqilding located at i//S ~Gel'OIIi ~YO Street ep ~8 ~roeK ~8~av~s ............................... ~ ~o ............. ~o~ ~o ............. ~o~ ~o...~ ....... ~t~ .... ~... conforms substantially to the Applicati,on for Building Permit heretofore filed in this office ~A dated 19..~.~. pursuant to which Building Permit No. ;~.,~ 17 68 dated .......................... 19 ..... was issued, and conforms to all of the require- ments .of the_applicable provisi.ons of the law. The occupancy for which this certificate is ~rlva~e one Family dwelling issued is .................... ~li' ~1~1l~ ........... O/a~ ........................... The certificate is issued t,o ........................................................... (owner, lessee or tenant) of the aforesaid building. !1o~. ?, 1968 b7 ~. Villa Suffolk County Department of Health ~pp,rova! ......................................... .......... ..... Building Inspector FOKM 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? 3960 Z Permission is hereby granted to: at premises located at .......~LQ]~.....1,~I ....... ~.~l~..J3~Q~..J~.~l~j~.l~t~,t~Jl ..................................... ....................... .W~.....~.~,~..D,~ .............. ]~t,t£~k,...~.,~, ................................................. pursua~,t to application dated ............................... ~T~ul~lr. ....... ~1.~1 ....... , 19..4~, and approved by the Building Inspector. Fe" --ew S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~ Bldg. Pelrmit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilitie~s (Give deed loc'ation) for a structure located have been inspected by this department and found to be satisfactory. ) Disapproved a/c .................. (Building Inspect6r) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ' SOUTHOLD, N, Y. Application No. APPLICATION FOR BUILDING PEPJ~IT ........... ........... ........... 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 end of buildings on premises, relationship to adjoining premises or public streets or areas, end giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issucnce 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 Jn whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICJ~TION 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 oil applicable laws, ordinances, building code, housing code, and regulations~ ............ ....... (Signature of applicant, or name, if a corporation) State whether applican~t is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................... .......... ......... ............................. Name of owner of premises ~.." ~'/ ~. ~//'~-~'~ .~.. If applicant is a corporate, signature of duly authorized officer. ................................................................................................ ~~p /~o~-e_.~ ~ \ (Name and title of corporate officer) , ~ _L~ 3 1. Location of land on which roposed work will be done. Map No.: ...... ....~....?.....~......~... ........... Lot No.: ...... !. ................ Street and Number ..~.~.~. ....... ~..~..;~.~.....~..~.Z...~.....~... ....... .~.....~)...! ............. .~..~..~..-~....~..~......~.....~....~.~'. ............... 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 3. Nature of work (check which applicable): New Building Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... ~6.....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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number o~ Stories ............................................................. ~ ....................................................... 9. Size of lot: Front .........~....~....../..... Rear ......... ~...~...~. ............. Depth .....~....~......'~.. ....... .~¢....~' ! 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ....................................................... ~......~ .............................. 12. Does proposed construct on v o ate any zon ng ow, ordnance or regu at on~ 13. Name of Owner of prem ses .~...U....~...~.../~...~...~..~'E.~..Address [ ~ ~...¢)....~..: .~.~..!...~1... ne No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor /~'.~.~....~./~..~.(...('..,~...~/~'.~..S.....Address .~......~...~.,. Phone No.~'.~...~.....~..~...O 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 indicate whether interior or corner lot. I STATE OF NEW,,,YORK, · ~- ¢ c COUNTY OF ...~.¢.~..Z~.~..~'.~./,~./~,.....~'°'°' ............................. ~.~.....L~r.........~....~...~....~..d...~....O... ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ~ ~~O~ (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 file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the applicatio~led ther~ith. Sworn to bede me this __ ~ ~ // __ ........ ......... ........... z':"'"% ............. ........ ......... .................................................... Y~ , :...~ ....... .~ ..... ~ ......~..~-.~..~-.m~eet~a~ ~ Y(Signature of applicant)