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Home My WebLink About3507-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. 1~. ¥. P.f~RTIFII~ATI~ OF OCCUPANI~¥ THIS CERTIFIES that the building located at ...l~t/,~...(~l~llrt. l~oa~ ........ Street W t Creek Est_.. Map~X~o1 ............. Lot No. 1~ ...... $outho. ld,... I~.-.Y,... ............ ~lOC}~ No ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ~T~O..2 ....... 19.6.~. pars uant ~to which Building Permit No..~.0~.. dated ............ ~Tlllle...~ .... , 1967., was issued, and conforms to all of the require- ments .of the applicable provisions of the /aw. The occupancy for which this certificate is issued is ...P~.~.-¥'.'~..o.~I.e..~'¢.~:~J~J,y...dl~l~[Elg. ...................................... The certificate is issued to . Dllarle. tgog{}ol,~:~d. ............... O~jyae,~ ............. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval .~alrl,..~ [..1968...by. ~..~il~].a .... Building Inspector \ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIs PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3507 Permission is hereby granted to: ............. ,~,~'~¢o.1,~ ......................... ~. ................... at premises located at .[~,~...~J~..~.~[tt...~]~.~...~.f/~.~.~.~. ............................................................ .................... ~....~.. liOn,t,* ....:.,~.~o~ ,...~,..: .......................................................... pursuan¢ to application dated ....................................... ~..~......J~..., 19...~.~.., and approved by the Building Inspector. Building Inspector / SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. -~C37~ TO WHOM IT MAY CONCERN: at The sewage disposal faciliti, es for a structure located (~i~eed l~ation) ' have been inspected by this department and found to be satisfactory. V, ~'~ r~n,r· ..... District Engineer FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , ........................... Applicotion No. ,,_~.,.~.,...0....~.. .......... Disapproved a/c .~ ................ ~pector) 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 6 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. The applicant agrees to comply with all applicable laws, State whet~ger applicar~,is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. If applicant is a corporate, s~gnature of duly authorized officer (Name and title of corporate officer) Iii. ~.~ ~'/~ ..../../~. ................ 1. Location of land on which proposed work will be done~ Map No.: ..... ?.~.. at No.: Street and Number ..................................................................................................................................................... Municipality State existing use and occupancy of pre~s and intended use and occupancy of proposed constructian: 3. Nature of work (check which applicable): New Building ............. '~/./ff..Addition'. ................. Alteration Repair ................ ~ Removal .................. Demolition ............ ...~,. Other Work (Describe) ........................................ ~' ~ ~'~.. ~ Fe . 4. Esllmated Cost ......./C.. .......... /.. ................................. e ......................................................................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ ~ ........... 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 slructures, 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 ..... ~..~....:.:~...,..z. .......... Rear ..~.~...~..~....~ ..... Depth ...~....7....x...~.....~.... Height .~ .......... Number of Stories ...... ..~.. ........................................................................................................... 9. S~ze of lot: Front ............................ Rear ........ ~. .......................... Dep h ............... :..../..~.-~-. ~ 10. Date of Purchase ...... .~....~...~'..~ ........................... Name of Former Owner .~....~...~ ....... 11. Zone or use district in which premises are situated ..... ..~.~ ............................................... ~ ............................. Does proposed c~nstruction violate any zoning law, ordinance or regulation? ...... ~....~. ............................................. 12. Name of Owner of premises~.~ddress..~...~...~[~.L~.'. Phone No....~ ....... 13. Nome of Architect ...................... ......... Address ..~.--...~ ...... Phone No.............-'--'-~. ....... Name of Contractor..~...;.....~...~....¢~...~..~ .......... Address~.%~..%'~. ......... Phone 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 number or description according to deed, and show street names and indicate whether interior or corner lot. ,,~ ~ STATE OF NEW ~RI.~./' ~ t S S COUNTY OF ..,.,~......uM....~....~ ' ' ........................ ~.~:..,.~ ..................... being duly sworn, deposes and says that he is the applicant (Name oF individual signing gpplication) obow~ 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 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 befoJ'e me this ................... ~..~day of ..: ......... ~ ............ , 19...Z. (~~(.~ ~.. Notary Public;.].~.~¢~¥.:l.....(~...;....~..~..~;..~...~.~.t.~C Count?~ ......................... i~f~'~';';~';; ;~"~l~i;~'~'~t'i ............................