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Home My WebLink About3600-zTOWN OF SOUTHOLD ]~UILDII~G DEPARTMENT TOW'N CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ]~. ~998 .... Date .......... ~'~h ' · · 6 .......... 19.68. THIS CERTIFIES that the building located at .]~/~...~O~;hf'iel~. ~La~e,.. Street Map No.. ;~X ........ Block No..X~; ........ Lot No.~l~ .... ~/~b~}~.~-.~.,.~, .......... conforms substantially %o the Applicati,on for Building Permit heretof, o~e filed in this office dated ....... A%l~ ..... ,"~} ....... 19.~. pursuant to which Building Permit No...3~. dated .......... ~el~.t; .... ~ .... , 19~.~.., was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The .o,ccupancy f. or which this certificate is issued is P~i.v~to..one. famil~3, dw~3.,il~,~ ........................................... The certificate is issued to .. ~.~%h]..~1~t2}10~1~ ....... 0W~I~ .......................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval -~4a,T.~h.. '~F '~{~'' ']~' '~' 'Yi'];~{~ ..... Building In~c~r FORM 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) 3600 Z Permission is hereby granted to: ........... Jim~,..4?~it~..~g...Pm~l....8~tme]~. er to .~nll~l..~...~.e..~'~,m'll.....~we2'l ~1 n,& .................................................................................. at premises located at ..]ll~:l'.~lq..~."l&ld ..T.~lIll .................................................................................. ............................................ 8oXt~l:u:t '~1 ....... '~ ................................................................................ pursuo:n~ to application dated ................................ ~XI~. ......... ~,,~ ...... , 19..~..~..., and approved by the Building Inspector. Fee $....'t O~,OOL ....... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, 14. Y. Approved ........................................ , ]9 ........ Permit No ................................ Disapproved o/c ~......***.-..***... ........ ***********_*********_*******_***_*_******__**__**********_*******__***** (Buildi~ 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 adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust be drawn on the diagram which is port 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 o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 oil applicable laws, ordinances, building code and regulations://' / (Signature of applicant, or name, if a corporation) (Address of applicant) State whether op~icont is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ...., .~....~,..~ ............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of 'and on ~.h..~~..~.n.i Street and Number ,. Municipality / State existing use and occupancy of preSSes and intended use and occupancy of proposed construction: o. Existing use and occupancy .......~'/~'~.~.~ .......................................................................................... b. Intended use and occupancy ....~ .................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair ............... :~l~emova .............. Demolition .......... · Other Work (Descr be) 4. Estimated Cost . .~ .~..~..C~... F~ / o (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 structures, if any: Front ..........................Rear .......................... Depth ............................ Height ............................ Number of Stories ............................................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height ............................... Number of Stories ........................................ ~' j,---- , 8. Dimensions of entire new construction: Front ............................ Rear ....... ...~'...JZ. ........... Depth ..~..~. ............... Height ....... c~..~. ............ Number of Stories ........ ../. ................. 9. Size of lot Front ~. ~ ....... Rear ! ~"-~'~ Depth '~ °e~-C) ,0. Date of Purchase .Z..~.....~...~.. ...... i ................... ~l'~'e of For~;"~';'"~~ ~ 11. Zone or use district in which premises ~'~'"~[~'~ ............ ~. .......... iiii iiii~iiii~.~..iiiiiiiiiiiii ..... 12. Does proposed construction violate any zoning law, ordinance oJ: regul?ion? ........ ..~...~. .................................... 13. Name Of Owner of premise~.~.~.~....Address ....~....~ ................... Phone No?....~......~....~./' Name of Architect ......... .'. .................... ~..~.-T.~..~ ........ Address ...... ,~ ................................... Phone No ..................... Name of Contractor ~"-'" .. Z~.. ~ .......... Address ~ ................ Phone No.~...~'..d.....~.~...~.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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. 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, age?t, 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 t_he application filed therewith. Sworn to before me this ....~....~....~ ~ ~ .......................... day of ............................................ , 19 ........ ~ Notary Public, . ........................................................... County (Signature of applicant) SUFFOLK COU~,~X DEPA~TME~ OF HEALTH Date Bldg. Permi% TO WHOM IT MAY CONCERN: ~f2~l The s~w~ge dispos~l~_~%~facilitiezj~~jfor a structure~ ~/,,l°cated, ,at ~/ ~ Oive-~ loca~'ion) / / ' have been inspected by this Department and found to be satisfactory. ·. District Engine.er ~::. ' bistrict Engi-~er