The URL can be used to link to this page

Home My WebLink About3969-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No....~..J.32D .......... Date .....JliI[I:;~.tl#I~I~..~...2. A ...................... , 19.~... THIS CERTIFIES t~t the building I~ted ~t ~...~~~..~ Street ~ap No ....................... Bilk No ....................... Lot No...~~...~...~ ........................ confor~ substantially to the ~licotion for Building ~rmit here~fom filed in this office dated .................... Z~....22~ ........................ , 19.~.. pursuant to which Building Permit No...~...~ d~ed .......... ~.....2A, ...................... , 1~...~., w~s issued, and conforms to ~11 of the requiremen~ of the ~]ic=ble provisions of ~e law, The occupancy for which this ce~ificate is issu~ is ........ .~=l~a~..~. ~"--* 1 ~..~ .............................................................................................. ~e certificate is issued ~o .....~.~ ~ ........................ (~er, I~ or te~nt) of the aforesaid building. He&lth Dept. Approv&l, Sop~eJnber 25, 1968, Robert VllI& .......... .... Building Inspector FOlt~l 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? 3969 Z Permission is hereby granted to: et premises located at ....~It3,..~..&.]~I~.~I;L~:I~II~t..~,-"~R .................................................. .......................................... .~'~o.~ ......... ~,,.~,. ............................................................................... pursuant to application dated ............................ el'.~. ....... ~lt .......... , 19..~., and approved by the Building Inspector. Fee $ ~...0..?...0~... ........... Building Inspector Approved ~' 19..~.. .... Permit No. ~ ~ ~ ~ ~ Di.~pproved o/c ...~ ...... ~ ...... TOWN OF SOUTHOLD ~ V'~,.~ O,' t.~, BUILDING DEPARTMENT ~'.,,.L~ ~ ,- ,. · TOWN CLERK'S OFFIGE ~ ~; ~ ~ S~TH~D, N.Y. ~ ~ ~ ~~ ~1 ~ A~li~tion No ...... ~.~..~ ........ APPLICATION FOR BUILDING PERMIT D te ..... .................................... .... 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 buildings, additions or alterations,~r removal or/~emolitlon, as herein described. The applicant agrees to comply with all applicable laws, ordinan~'build_~y~le~n~s~n~ code,~and regulations. · ~.o-~..2e.~e~_n~.~t,e:blon~..~le~..7~az'~r .................. (Add~ess of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contrac~'or, electrician, plumber or builder. .................... ......................................................................................................... ; ................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ' Street and ~lumber ~1~. oorner ***D~...ton ~load & North/'leld Lane 8outho d .I~,Z, ............................................................................................ ~., .............. .~.~..Jl.: ........................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~0.-'~ ..................................................................................................................... b. Intended use and occupancy .....o..,~.,e~..~....e~...~...~.~'....?..?.~.~..~.o..?. ............................................................................ 3. Nature of work (check which applicable): New Building ..... .Z.. .......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ (to be paid on filing this application) §. If dwelling, number of dwelling units ...... ~ .................... Number of dwelling units on each floor ............................ 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 additJoos: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... 7....~..~. ....................... Rear ...... .~...~..e. ............... Depth ...~..~..e...~.~ ......... Height ...3:.~.~. ........... Number of Stories ......... .~. .......................................................................................................... 11. Zone or use district in which premises are situated ..... .?..e...~.~.~....e~....o..e. .......................................................................... 12;' Does proposed construction ~iolate any Zoning law, ordinance or regulation? ............ ~..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 F STATE OF NEW YORK. ~ ~ ~.. COUNTY OF ...~ ............. ~*'~' ................ ~.~I~I~I..'~,..~.~I~,Z ..................... ....'..~'.~ ............. ~be~y'sworn~ond says t~t he is the applicant (Name of individual signing application) above named. He is the ........... ~&~ ...................... ~~~...: .............................. of said owner or owners, and is duly authorized to perf~ have' performed- the said~orkX~ and to ~ke a,d file this application; that all statements contained in this application-are t~e to the best of his knowledge and belief; and that the wore will be performed in the manner ~t:fo~h Jn the application filed therewith. Sworn to before me this ~A · ................ ....... .............................. Nota~ Public, ....~ . - .~,~9~,~.,n~_ (S'g e o app 'c ) / S-9 SCHD RECE1VFn I~EPAitYME~iT OF iII!ALII! RIVERttJ'_-AD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date September 2~, 1968 Bldg. Permit No. ~969 Z TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure at N/E Corner Dayton Road & Northfield Lane (Give deed location) located Southold, New York have been inspected by this department and found to be satisfactory. $O~ ,. Engineer