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Home My WebLink About3760-zFOI~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...... ~.1~..~ ..~..~.~.~.~.~....~..~..~t~ ............... Street Map No....~..~.~....~..a...~..eB~[Jk~JJ~.l~..e. ................... Lot No....~ ............J~....~.~,J:..t,...~..~...~.......~..?..~.?. .............. conform~ substantially to the Application for Building Permit heretofore filed in this office dated ....................................... ~TB~'i ....... .1.~ ........ , 19...6J~. pursuant to which Building Permit No...~..~..~.. dated ....................... ~J~.l!.. ....... .~.~. ........... , 19.....~..~., was issued, and corfforms to all,of the requirements of the applicabletprovision~'of the law. The occupancy for which this certificate is issued is ........ .... ! .......................................................................................... The certificate is ibsued to ......~I, IBf~...~O~J)~.Q~ ................... .(~.e..~. ............................................. (owner, lessee or tenant) of the orates*id building. H.D.Approval ~Tune I+~ 1968 by R, Villa Building Inspector FOItM NO. 2~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TIlE PRE~ISE~ UNTU. FULl_ COMPLETION OF THE WORK AUTHORIZED) N? 3760 Z Permission is hereby granted to: ...... to ~U~t,~, · 4~V. · ~ltli~ .. ,~,~c. · &Mel~. ~lklg~ .................................................................................... at premises located at .....~.~.....~i~[.Q~3...~IN~..~i. ....... ~.~.~..~..,.~.~l~ ............ .......................................... ~t.t.~t ~Ic,..~l~. .................................................................................. pursuar~ to application dated ......................... ~.,~;~e ....... J.~. ............ , 19..~J~., and approved by the Building Inspector. Fee $ ............ .~ .......... s-9 SUFFOLK COUNTY DEPARTMENT OF HEALTN ~t e Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. District Engineer Approved ~ ........................................ ,,9 ........ Disapproved o/c ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT~t ~ TOWN CLERK'S SOUTHOLD, N. Application No. 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 commenced before issuance of Building Permit. d. Upon approval of this application~ the Building Insl~ector 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 al.I.applicable laws, ordinances,~building code an~. '('~'i~r~ii~_,~ ~ ~- '~; j~'.' '~ ~ i ~ ~~' ........ ................... ..... State whether applicant is owner, lessee, age~a~engineer, general contractor, electrician, plumber or builder. '~'r~ ~i' ~ner of premises ...................... ~ ........... ~ .................................................." · ............. 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 I~ done. Map No.'~......~....~.... Lot No' .... u..4...~4-.. Street and .umber ..~.C....i?~--~ ............. ~.....%u..n.i.~i.l~.C~ ii..t~~(~°~/'a~ ~~..i....~....".~... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....................... ~ -~'i ~]'~,~ ...................................................................................... b. Intended use and occupancy ............... ~..~~ ...................................................................................... 3. Nature of work (check which applicable): New Building / Addition Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... ...... ~.I.P...O...~. ..................................... Fee .......................................................................................... 4. Estimated Cost (to be poid on filing this opplicotion) .5. If dwelling, number of dwelling units ........... .~.. ............. Number of dwelling units on eoch 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 ......... ..~..~. ............. Depth ....?....~. .................. Height ........ .~...~. .............. Number of Stories ............./. .............. 9. Size of lot: Front ....... ~...~.~.~../ ......... Rear ....... /..~.~ .............. Depth ....... ~.~...~.. ............... 10. Dote of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ........................ J~.. .................................................................... ]2. Does proposed construction via ate any zoning Iow, ordinance or zeou[otion? ....... ~....~. ........... ]3. Nome of Owner of premises ..~....~Address ../..~..~.......-~...,..'~.~h~ne Nol .~.'i.~ ~. Nome of Architect ................................................... ~,~_, ~.. j~)/,/,,, Address ............... .~) ............. ~7,_~,~/~.~ ...... I~hone No ..................... Name of Contractor ..-c..~..~ ......................... Address ~ ........... ~ Phone No..~...~..~.....,5~,..~.~ v PLOT DIAGRAM Locate clearly and distinctly oil 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. C (~ e C J~ 171 STATE OF NEW YORK, ~, ~ ~ COUNTY OF; ............................. ^~/~'~' ................... ~ ......... ~ ~ .......... , ....................... being duly sworn, deposes and says that he is the applicant above nam(Nec~.m~;fis(~thCl~vidual signin.g.~.l.~ .... (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 forth, in the application filed therewith. Sworn to before me this~ Notary Public, .....~~ Count~"'"~'~-~i'~;;~'~re of applica'""'""""""'~'-'~'~ ............................. ~;ommlsston Expires March 30,