The URL can be used to link to this page

Home My WebLink About3824-z F~RM NO. 4 ? TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFF~CE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at 2'1S..~o~ot~:[al..l~o&d .............................. Street Map No...~...e.~,~. ...... Block No ....................... Lot No..~.~,..~'~.~l~h~),,~...J~,e,~/...~ ................... He~.ght:s conform~ substantially to the Application for Building Permit heretofore filed in this office dated ................... .~.~.~..~.~....3.~. ......................... i.., 19...~...8.. pursuant to which Building Permit No. ~1~,~.~...~.. dated ........ ~,~.~.~1....4.~ ........................... , 19.68..., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ~iva..t..e....9.~..e.. ~.am~Iy..~ll~n.g. ... The certificate is issued to .........~;[lbO~::t...Htlghes_..(c~ner.) ........................................................ (owner, lessee or tenant) of the aforesa.id building. Health Dept. Approval, August 29, 1968, ~obert Vi].la ......................... .... L ......... FOR~ ~0, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3824 Z ' Building Inspector.:', .Fee $..~0.~00 .......... Permission is hereby granted to: - · .............. ,~..-.1~,~-~, ................................... to ....l~e~,la..ae~...~..,t~t~.~.~t~el,X~ ................................................................................ at ~premises lOCated at ;--.-{~l}~,,~-.t ............. ;~.;~..~[~:~_.-~;~,Z...~.~ ........................ ..... : ......................... ,eo~t~.....ll,~,, ................... '....., ................... : ............................................... ,pursuar~t, t° application dated ..,'/. ............... : .......... .-~.~"~'~',~.?3*~.';t*"~ '19..~.~.., and approved by the $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date August 29:1968 Bldg. Permit No. 3822~Z TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at W/ Colonial Rd. 150' N/O Eds Rd. (Give deed location) ~outhold~ Southold have been inspected by this department and found to be satisfactory. Distriot Engineer District Engineer FOI~AY~ NO. ! TOWN OF SOUTF~OLD BUILDING DEPARTMENT '~ 'TOWN CLERK'S OFFICE SOUTHOLD, No Y. Examined ......... ~....~..I ......... , 19 ...... /'~ 19...:)... Permit No~,, Approved ........................................ , .......................... Disapproved a/c~ ............................. ~,.,~,~.~ ............... v (Building Ins~ect~ APPLICATION FOR BUILDING PERMIT ¢ Application No..?.....~....~...Y .......... INSTRUCTIONS a.~ ?Fhi~apl~lication 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 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 sh.all 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 all applicable laws, ordinances, building code, housing code, and regulations. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... .~..J,],~.~.~...~'~,U~e.S ............................................................................................................ If applicant is a corporate, signature of duly authorizerJ officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .~..~.~f~,.~;~,J~.~.....: Lot No.: ....~, ............... Street and Number ............... Municipality 2. State existing use and occupancy of premises-.and intended use bnd occupancy of-proposed construction: a, Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy .............. ,~_~f~,],~r_,~'~e_-L]j_~3~. ........................................................................ 3. Nature of work (check which applicable): New Building ..... .~..~.~. ...... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .........~,~.',,~,0.,.0.,0..~,,0,.,0. ........................... Fee ...... ~.~.O.,..0.Q ..................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor .....6, ...................... 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 ..... ~9.!.8!.~ .................... Rear,~.~LP,!! ................. Depth ....2.6.! ............. Height...................18t Number of Stories ...... ......'1 ....... . ............................................................................................... .. . 9. Size of lot: Front ..... ,],~.0..~. ............. Rear ..J,3~..~ ......................... Depth · .12~ ....................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed constructio~ violate any z~ning law, ordinance or requlation? ..... 11,O .................................................. 13. Name of Owner of premises ,..~..,I'[llgJ~t~ ............... Address,~0...~.~,,. .......... Phone 1%?~...-.022,q:, ..... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~..~1~.c)....~.9.~$.~...[~f~ ............. Address ....,.,qe.l~.e, zl.~..~[~ ................ Phone Ix~2..-.23~.7 ..... PLOT DIAGRAM Locate clearly end 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. STATE OF NEW YORK, ~c c COUNTY OF .... ~,U, ~'~,, .9.~, ~, ........... ~ .... .,.~Q~.~.~.~...~...~.~-.~.~ ......... ~,..~.~ .......................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .~.~.~t~,.O.~.~....O~...,,~l~],f~Z¢~..~.O. lll~...~.,. ............................................................................. (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. Swora to before me this ~ ~ ~ ..... ~. ........... ~y of ..~.~L~;,.~.~. ....... , 19.~... ~. ~. ~AJ /v,'dd s