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Home My WebLink About3707-zFOP~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, ti. Y. CERTIFICATE OF OCCUPANCY No. ~...~,5.6 ............. Date ............ Septembe~:..$.~ ..............., 1968... THIS CERTIFIES that the building located at ..(~..M~:I~Oi~..ROt~,~ .......................... Street Map No ....................... Block No ....................... Lot No..Mat.t.%t,l,lc~k,..,New..l:ork ....................... conforms substantially to the Application for Building Permit heretofore filed in this office doted ................. No.v. embe~.....13., .................. , 19.67... pursuant to which Building Permit No. dated ...... ~.Nl:~..enlbl~r.....l~ ................ , 19.J%7.., was issued, and conforms to oil of the requirements of the appl_icoble provisions of the law. The occupancy for which this certificate is issued is ........ ....... l~.~.v, at~..Ma..£am/1.Y...d~e~-t~g ........................................................................................ The certificate is issued to ......-~.t~r...K:l.=~es=n~r .............. ; .................................................... (owner, lessee or tenant) of the aforesaid building. Health Dept. Approval, AprX1 30, 1968, Robert V~lla ......... ' ..............nsp ............... FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3707 Z Permission is hereby granted to: et premises located et .~....~l~9..~ee[~.~,~]~jl~..~J/'~.....~..~., ............................... ..................... ~ ........ J~.t.t~$.t,a~:~...ll~,~;, ................................................... : ......... ................................ pursuon¢ to application dated ....................... ~..~ ......... ~, ............ , 19..~.., and approved by the Building Inspector. Fee $...~..~..~...(~... ......... Building Inspector $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. 97o7 TO WHOM IT MAY CONCERN: The sewage disposal facilities (Give ~eed location) for a structure located have been inspected by this department and found to be satisfactory. District Engineer District Engineer FOEiY/ NO. 1 TOW~ 0[: $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined A/~"~/ / ~ , 19...~../ Approved ........................................ , 19 ........ Permit No .......................... ~ .............. r ............. ............. 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 ad oining 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 shall be occupied or used in whole or in port 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 and regulations. ......... 74...,..~.....<. .................. (Address'~' ................................................. of State whethg, r~applica~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. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot .No.: ........................ Street and Number ~,,~4~j/.,~ MfIf/~L~ ~ ~ T/~W~ 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 ...=~ ...........Demolltian .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... Z. .................................................. Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling unj,ts_.~.....~ ...............Number of dwelling units on each floor ............................ If garage, number of cars .....S...'~....~ ............ ../.....~ ................................................................................. 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 ............................ f~'Number of Stories ................................ 8. Dimensions of, entire new construction: Front .................................... Rear ............................ Depth ....... :.... ............ Height ../...~'.../.~...~..*./.... Number of Stories ............................. ~, ................................................................ x,.~/. ~'$ ' /~W', ~,,'~ x ~ ~ ,~"~ ' ...................... 9. Size of at: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owne~ ........................................................ 1 I. Zone or use district in which premises are situated '~"~ ~'~'~ 7~' ~ ]2. Does proposed construct on vj~late any~.$onin~ aw, ordingnce or regu at on? ............................ 13. Name of Owner of remise~...../~..~' ~'~'~J~"¢$///?A~dress ..~....~.~/.,~"l~'..~,, ~ Ph~ kl~,' .................... Name of Architect ~ ............................... ~ ........... Address Phone No ..................... Name of ContracZ~.~..~...~..~.......~.'..~.~......~....~..~...Address '"'~";'~"'~' Phone No.~?...~..-.....~'.../.?.../. 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. ,¥ ~, STATE OF NEW YORK, COUN, Ty OF ............................... · '..~.~.~. · - .~.. '/~'"~ ~/'~ ...~../...~. ~ ~ ,being duly sworn, deposes and says that he is the applicant (Name of individual signina~pplicotion) abow~ named. 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 make and file this application; that all statements contained Jn 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 -~ .......... of ........., . ~.,. ~. . ~ ~.J ,_ ,.-~~~.~.~...~~ ........................... Notary Public, .F..Lt~..~.,...Z~~.' County ' - '/ (S~ure of applicant)