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Home My WebLink About3568-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. :~. 3~.33 ..... Date ............ ~TI~. ~. ] ....... , 19.6.8. THIS CERTIFIES that the building located at . W~.'~. R~..d ........... Street Map"-- - -i~o~.~!. P0.~{; ~oc~No ............. Lot No...'~. ~.....~1..~..l~..~.....~. :.~!. ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~%ig... <{/].. , 19.6.~ ~)ursuant to which Building Permit No.. 3~.6.~.. dated ......... &~. ]] ....... ,1967.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...Pl'~.v~te. Me. f~.nl~.].y..4~'el.3.~txg ..................................... The certificate is issued to .. ~T~.ep.h..&..}~...~'.e..~.~....l~.e.k.e.l~ ....... .0~t~e~,~. .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~.1~..~.....~. *..~.Q.6.~...b. lr' .R.?..V.~.~..~.. .......... 'B ilhi k' I'n' s' JJt'o' ' -' [ ....... FOl~M NO. 2 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? 3568 Z Permission is hereby granted to: ............ .~..o.~.e..~.....~La... ~$.~ .~ ................... ....... .~......~.~?..~.t,...~..'m. ............................... .......... ~.,....~.,.,:~.o....~.......~.,,..z.:. .......................... to ~tZld ~ ~me finally dvel3.t~ at premises located at ~..~...~.....~.....~,..~.,.'~'...11~...[:~1~ ................................................................ ............................... ~...~ E..... ~.~ .=...=~..~.L.....~...~.O.~ .~... ............................................. pursuan¢ to application dated ................................. ~l~e.....~,,~ ....... , 19~,., and approved by the Building Inspector. u0Tr= ~ LOT-~00 MAP 0[' LAMD ~ u 12vr=N'~D Forz JOSkPL-t 'fo~VM oF "~ouT~oL-~ · S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date .~/~/.~ Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure (Give deed location) / located have been inspected by this department and found to be satisfactory. -Dls.~rig~ ~terE n g i n e e r BUILDING DEPARTMENT V' f~/~-~ ~,~T/,(~,:c~?~-.~ TOWN CL~RK'S OFFICE Examined ....... :L 19:7 ~ppJicatlon No ............................. Approved .......................... ~ ~.~ .......... , 1~.[.~... Permit No. :~:~/........... ....... , ........ APPLICATION FOR BUILDING PERMIT Date .......... ./...r. ...... , 19 .... 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 drown 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. 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 name (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ~ilder. ....................... .................................................................................................................................... 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'.. :...~...Z ~ Street and Number .~.~. U~/'(jc~ /~.~...~,..~...~. ' ~J"J"c('(..Q~.~.~. ~ ..~...~'-~C)'~'"/.,':'~,~".~.~ , . ' ........................................................................... ....................... ........ 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. Natlure of work (check which applicable): New Building ....... r~ ...... Addition .................. Alteration Repj~ir .................. Removal .................. Demolition .................. Other Work (Describe) 4. Esti~noted Cost .......... ,./.~..~)....~ .............. Fee ! (to be paid on filing this application) 5. If dwelling, number of dwelling units ...................... Number of dwelling units on each floor .../~"~ If g?rage, number of cars 6. IF I~usiness, commercial or mixed occupancy, spec~ify nature and extent of each type oic use 7. Din~ensions of existing structures, if any: Front ............................ Rear ................ :; .............. Depth Height ................... Number of Stories Dirrjensions of same str~cture with alterations or additions: Front ................... ~ ............ Rear DelzJth ................................ Height ........... ~'. ............. Number of Stories ............r:z~..:. ............... 8. Dir6ensions of entire new construction: Front ...... ~..~......~.../.."~..~. ....... Rear ....4~...~...~./..~.... Depth Height ~-)~'...L...I ..... Nu~m!;jer o~f ~tories ............................. ~ ................ 9. Siz~J of lot: Front ........ .~...~....,~...~..... P~ear,>~....../..~?......~......~Depth ....~...~t.~.../:?.~..~., ..... 10. Dat,Je of Purchase ......... :~.././..~./../.~...~..' .................... Name of Former Owner~..,..,/~..~.../.~."...C.' .~.../.~.. 11. Zode or use district in which premises are situated 12. Doe? proposed construction violate ar 'zoning Iow, ordinance ?r regulation? ....... .,~ ~ 13. Na~ne of Owner of ~ LcC~ I~hone No. Nar~e of Architect /~' j' Phone No......r=~.. ....... Name of Contractor ............................ Address ~ Phone No. i PLOT DIAGRAM I_ocat~ clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-b~ck dimensions property lines. Give street and block number or description actzording to deed, and show street names whether inieri. :orner lot. ~;2 (~'~/~ STATE OR NE YORK, 1, SS COUNTY !OF ................................ $ ' ' ................................................................................................. being IName of individual signing application) abow~ nan of said o~ this oppli, duly sworn, deposes and says that he is the appli( ed. He is the (Contractor, agent, corporate officer, etc.) ~er or owners, and is duly authorized to perform or have performed the said work and to make and ~tion; that all statements contained in this application are true to the best of his knowledge and belief; that the Swam to b~efore me this ............... ~d~y ........ ~..~..~.-~. ~,., .~.~.,,~ ~. ·. .......... ,19 ........ Notary puhlic~).~A.._.¢r.~...~~ounty~" ~ /~ j ( ~ / ~R~O~ j ~ ~0T~Y rUBUC, ~rk will be performed in the manner set forth in the application filed therewith. 52-3233 ~l°~e.~m ~xpir~s Ntsrch 30, 'e of applicant) FOEI~ NO. I TOWN OF SOUTHOi. D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ....... ...... , Permit No. ............ ......... · ~,.~. .......... , ~.~..~?..~ Disapproved a/c ............................................. ......................... ....... / V (Buil~Jrr~g Inspe~t/~r) APPLICATION FOR BUILDING PEP~MtT ote Application No. ~.~'~ ~ 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 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. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Buitding 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 applicaNe laws, ordinances, building code and regulations. /7'~i~"n'~'~'f~/o~f"~'l~plicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ............................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) /~ ..~.~L~dt N~o,~ 1. Location of land on which proposed work will be done. Map No ~.~.~.P. ' [7 ~ .~.~.. Street and Number ..~..~,)...4¢?~..~.~..LT~...~../~. ........ ...~...J~...: .......................... .~.,.~...?.~..~.~.'.O...e.~. ............................. 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 -~..~.'.~...~. ~.~ ~- (.~.. ~'t~'~' 10. 11. 12. 13. property whether Nal!ure of work (check which applicable): New Building .................. Addition .................. Alteration Rep~air .................. Removal .................. Demolition .................. Other Work (Describe) EstiJ'nated Cost ............ ~ ........................... Fee (to be paid on filing this application) If 4welHng, number of dwelling units ........... '~. ............... Number of dwelling units on each floor Ifj~arage, number of cars ............... / If business, commercial or mixed occupancy, specify nature and extent of each type of use Dimensions of ex st ng structures, if any: Front .................. .......... Rear .................................. Depth Height ..................... Number of Stories Dimensions of same structure with ~lterations or additions: Front ............. ~. ..................... Rear Depth ................................ Height .......................... :.Number of Stones ..............: ................. Dimensions of egtire new construction: Front ....... ~ ...... ~ ............. Rear ....... ~..~. .............. Depth ....3.~,..~. Height .~ ............. Number of Stor~es ......................................................................................................... Siz~ of lot: Front .....~.~,.~...~L.~. Rear ..... ~.~.~.,....~..... Depth ...3~.~.,.~.E.K..~...~JGIf~ ,, '. Da~e of Purchase ....... ~/~.~ ........................ Name of Former Owner~x.~.O.~.4~.~.~.~.~ZY.~/~..~ Zone or use district in which premises are situated Do(s proposed construction violate any zoning law, ordinance or regulation? ................................... ,,v. No, ne of Owner of premise~e~.m.!.~fi~*~.?.Address ..~.~.: .............. P~one No. No, ne of Contractor ....~.~.~.~ .................... Address ~ Phone No. PLOT DIAGRAM ~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions nes. Give street and block number or description according to deed, and show street names and corner lot. c >' ' 'tx' STATE O]: NEW YORK, 1 c c COUNTY OF ................................ ~'~' ................................................................................................ being duly sworn, deposes and says that he is the applk (Name of individual signing application) above na~ed. 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 this appli :arian; that all statements contained in this application are true to the best of his knowledge and belief; ark will be performed Jn the manner set forth in the application filed therewith. that the ¥ Sworn to I ........... /./ Notary Pt ,efore me this ........ day of nature of applicant)