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Home My WebLink About3693-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT - Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No.zs'~37 ....... Date ........... June...29 ....... , 19. THIS CERTIFIES that the building located at .... .R. 0,W.,. $/8..t~ay~.iow. R~et Map No..i';oke ....... Block No. xx ....... Lot No.~ .... 8o~,thold...N~Y... ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. 0¢~;...20., 19.67 pursuant to which Building Permit No. 3693Z .. dated ............ 0et .... 31.., 19.67., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Private. oae. £amlty. <lwe.l.3..ing ...................................... The certificate is issued to . .im~er.t .¢].emenz ........ Owner ......................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) .... ~.,k..~7...!9.69...~.y..~ :.V.i.~.~.a.. UNDERWRITERS CERTIFICATE No .... pending ...................................... }lOUSE NUMBER .... 7'~20 .... Street...!~* .0..i,,[,~ ...Ba,wY%r.~.~.w..i-.',QU..d ....................... Building Inspector ' ' f / FO~ 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? 3693 Z V~-e Permission is hereby granted to: ~l~.~t .~,.~.~.~.~..~...~r...,~.,.~,,....~.. ~t ........ ~....~ ....................... ~ ....................... to ~1~.. ~-..~...¢~.t~!~i~ ......................... : ............. : ............ ......... ~. ...................... 8~l~ ~.~ . .~ ............. ~ ....... Building Inspector. ,Fee $..'~.~ .......... ~, / Building Inspecto/ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY Bldg. Permit No. The sewage disposal facilities for a structure located (givexdeed location) have been inspected by this department and found to be satisfactory. District Engineer ~N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ....................... ~ ................ ;," ~ ~ ~ ~ ~ A~mved ........................................ , 19 ........ Pe~it No..~.~...~..~..~. ........ ............. ........ .......... : ......................................................................................................... ~.1" ...................... ........ ~/..y~.~.. ~..~,~ APPLICATION FOR BUILDING PERMIT ~,~L~- .p~ . ~te ............. ~.~,..~ .......................... 19.~ ..... I~$TR~CIIO~S Thi~ applicotion mu~t b* compl~t~l~ fill~ in b~ ~writer or in ink *nd ~ubmitted in duplicot~ ~o th~ Buildin~ ~n~ctor. b. Plot plon ~howin~ l~otion o{ lot ond o~ buildinO~ on pr*raise*, r~lotion~hip to *djoinino pr~mi~ or public ~reos, ond oivinO o ~il~d ~ription o{ Ioy~t o{ pmp~ mu~t b~ drown on th~ dio~mm which i~ lh~ ~ork covered b~ thi* oppli~tion mo~ not b~ commenced b~for~ i~u~c~ o{ 8uildino ~rmit. c. d. Upon opprovol of lhi~ ~pplic~ti~, t~ 8uildino In~ctor will i*~u~ ~ Buildin~ P~rmit to th~ shall b~ kept on the pr~mi~ ~v~il~l~ {or in~p~tion throuohout th~ pr~r~s o{ ~h~ work. e. ~o buildino s~ll be oocupi~ or u~d in whol~ or in port for on~ purpose whot~v~r until ~ C~i{i~t~ ~holl hov~ b~n ~mntod b~ th~ Buildin~ ~n~tor. APPLI~TIO~ IS H[RfiBY ~fi to th~ 8uildino ~m~nt {or th~ i~*u~nce of ~ Buildin~ Buildin~ Zon~ Ordinance of the lown o{ Southold, Suffolk C~n~, ~w York, ond ot~r opplic~bl~ Re~ulotion~ {or th~ construction of buildings, ~i~ion~ or ~ltoroti~*, or {or removol or d~molition, a~ her~in d~ribed. The ~pplicont ~ore~ to comply with oll opplic~bl* Iow~, ordinonc~s, buildino ~ ~d r~ulotion~. .... ~~.~....~... .......................................... {$i~n~turo o{ ~pplic~nt, or name, .................... ~ff~.~.~ ................................................. State whether a~licont i~ ownor, I~se*, ~nt, o~hlt~ct, ~noi~r, ~n~rol controctor, *lectrici~n, plu~r or builder. .... ~~~ ....................................................................................................................................................... Name of owner of premises ...... T~..~..~.~.~........~/-~..~.~'~-~ ......................................................................................... 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. Mop No.: ........................................ Lot No.: ........................ Street and Number ..s,~,F/~....~.(~.....~'J~.....~Ui~...~., ..................... ~....o~.....1~..~...o~-....O..~ .................... 2. State existing use and occupancy of premises and intended use and occupancy bf proposed construction: a. Existing use and occupancy ........ ! .......................................................................................................................... b. Intended use and occupancy .....~....q.~..~.~.~.'T~..~..~.~ ........................................................................................ 3. Nature of work (check which applicable): New Building................../ Addition .................. Alteration"]~...'...:....~.. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...........~'..~.~u~t',i~.,....'~.. .......................... Fee ..~'~.,~..' ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. ~ ........ i....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 ................................................................................................... i ........ ~ .... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ,~.7.,,..~.,. ............... Rear ....~,~,.~..~... .......... Depth .~..~ ./.~.: .......... Height ....,/.[../.~,... Number of Stories ....... /. ............................................................................................................ 9. Size of lot: Front ...... .,/O.'~. ............ Rear ....... ./.cL~ .................... Depth ...~'~..'~.. ................. 10. Date of Purchase ...~',e~'/~.,~/,~4~,~...-.. ....................... Name of Former Owner mZ'.OXt~/...~./,~...(~',-,~..~. .............. 11. Zone or use district in which premises are situated ....... ,~.¢~T~Z~.~--~.,~-~.,K~.¢~. .............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... .r~'..~ ........................................... 13. Name of Owner of premises ]~>D/'~-~ .~.....L°/,69~6'7~..Address ..,Z~.~.Z'~.,~-~4~,4~.... ............. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~nx.~o.,~,~1.~'~....~.....~.~ ...........Address ..~.~..~.~) ..................... Phone No~.6A~...~.~...~.Z~ 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 numbep'or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ c c COUNTY OF ................................ .... ~.A'Z'.~........~........~,.~.~',e~.~,.~. ............................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) obove homed. He is the ........ ~.~ ........ ~ ............................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ma;ke and file this application; that all statements conta:ined 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 · ..~%-~/..~.. day of ....~~ ........ , 19...~..~ · t ~ ~x,,~. ~ ~ ,/~ ..... ~.~ ....... .v../.:. ~...../~...~/.....~.. .... ~'~o an/ t'ubli~ .~(~¢~-....~.?..;.L~..~-r~.. County ~' (Signature of applicant) ............... : .... ~OTARY PUBLIC, Stae c; ...... v ~ ( / ~,o. 52-3233120 Suf[ol:, v Term Expires March 3~,