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Home My WebLink About3572-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. E;ERTIFIBATE OF E)P,E:UPANCY No..Z. 29.k .... Date ............ ]~eoeI~¥0~...t+.., 19. THIS CERTIFIES that the building located at .W/~..Gil3..e%t~e. ;Ir ......... Street conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... tug ..... ~.. , 19 67. pursuant to which Building Permit No..3~. dated ............ A~.g... 16.., 19.6~, was issued, and conforms to all of the require- ments of the applicable provisions o~ the law. The occupancy for which this certificate is issued is .. ~.~Va~..on~..fan/~.~, ~:~;I l!~ ..................................... The certificate is issued to .Bog~. ~ehl~l~l~a~ ....... 0~ ....................... (owner, lessee or tenant) of the Moresaid building. Suffolk County Department of HeaRh Approval . ~'o~,. ~ . 19.~ .. h~ .R,..~il].a ·. ~fld~E Inspee~ FOI~i~I 1~I0. 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 AUTHORI. ZED) NV 3572 Z at premises located ................................................ ................. t ......................... .~ ...................... Buildinn Insnector. - , ' ~"-' ' ' : SCHD SUFFOLK COUNTY bgP.l~,f£]%NT OF HEALTH Date Nov..3.0., 1967 Building Permit No. 3572 TO ~0M IT MAY CONCERN: The sewage disposal facilities for a structure located at ~,~/S Gillette Drive, ...... (Give d~d~- -' 1700' S/O Main Rosd, ~t M~/i~on_, N~ Y. have been inspected by this Depart~ent and found to be satisfactory, Dlstriot Engineer Di~[i-6-t- Engineer - IOG.O MAp OF LAIdb t20CC-~ ~ 12 6 dlj I kl r__LL r_12 AT r-A6T kl~.tV TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ............. ,, Approved %L 19 ........ Permit No Disapproved~ ...................................... ...... ......................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in dupiicate 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 applica- tion. 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. AJ~PLICATION 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, alterations, or for~r.~ovol or de~rnolition, as herein described. (S'g at~ of applicant, or name, if o co~oratio~ 611 Linnet St,~ Gre~.n.~.ort ~ N Y. (Address of applicant) State whether applicant is owner, lessee, agent, archite:t, engineer, general contractor, electrician, plumber or builder. owner Roger Schineller 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.: ...?..0.3..8.. .......................... Lot No.: ...~..~ ............... Street and Number ...(.z.~.];..~.e..~.~..?.....]~...i..v...e.:..?. Mar± .o.~...~..~...q.o...~..t.....~.~..8.~.. ~ar± o_n_ ~ N. Y o. ........... 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*...~. ~.~...~....O~...e...~...~..~..~....~..~..~.~...~..~..~.~ ............................. ..... ........... 3. Nature of work (check which applicable): New Building';.~.-..... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost .............................................................. Fee ........................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~ .................. Number of dwelling units on each floor ......O..~..?. ................ If garage, number of cars ....................... OM .............................................................................................................. 6. If business, commercial or mixed occupa.ncy, specify nature and extent of each type of use .................................... 7. Dimensions of existing structures, if any: Front ....~..O...R~ ................ Rear .................... 'i~.....'Depth .............................. Height ............................ Number of Stories ................................................................................................................ Dimensions of same structure with alterations or additions: Front ~l:~l~ ...................... Rear ................................ Depth ................................ Height ................................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .....~9.? ................... Rear ...~.~?. .................... Depth Height ...... ~.~.~ ................. Number of Stories ....~.. ........................ 9. Size of lot: Front 'L0,~' ,, 10.,q' ].00' .............................. Kear ................................. Depth .............................. 10. Date of Purchase i~S Na'n~ of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? 13. Name of Owner of premisbs ..~lz.~...~.q~....~)....e..]-.~.e.~ddress ~.~...~...~.?..?.~...~...~./L..G.~..~.I~/~.~ ................ Name of Architect ~ 2~me ~ ~-~co ~ddres~ ~'~]~~ Name of ContractorR~e~II~'8* FI'OIl. eS Tn.. --.. 1=.0. BOX 2"/'J~;'"~.:~J~.:~. .................................................. /~aaress ......................... Plqorle INa....!.."t..!...~.~./ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set,back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. 'l STATE OF NEW YORK, ) COUNTY OF ............................ ) S.S. ................................................................................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above 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 applicatjgn~ited therewith. Sworn to before me this ......... 0o o, ..... ......... _ · . ..... ~f.~.f~....~. .......... . ............................................................. Notary Pub~~.....~...,...~Cclt~¢. ~..sm,e u-, New ¥o,, (S,gnature ';~pplica,n,)'