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Home My WebLink About3603-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~.]/~......~.'.~.~..~..~.'~.~ .............................. Street M?Ctqonic Baye Ej~,ta, tg~ Ammen~ed ~a~, ap NO ....................... ~,oc~ No ....................... LO-r ~o ........ ~.~.e..~..n.p.C. Ft.~....~...~.~ conforms substantially to the Application for Building Permit heretofore filed in this office doted .......................... ~.t, ......... .~ .................. , 19..~.~.. pursuant to which Building Permit No..3.~.0~...~. da'ted ....................... .~...e.~.~ ....... .0. ............ , 19....~..~., was issued, and conforms to all of the requirements of the applicable provisions of the law.' The occupbncy for which this certificate is issued is ........ ........ .~.$.v~.e.....o..~.e.....f. ~.~...z.y....~.w..e. ?,.~ .~.~ ...................................................................................... The certificate is issued to .~]~2~,~t~....,]~, ............................ ~,~.~.~. ................................................ (owner, lessee or tenant) of the aforesaid building. Healt Dept approval ~uly Under, writers # N638~80 10, 1968 by 2, Villa Building Inspector FORM NO. l 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? 3603 Z Permission is hereby granted to: .... ~.,...~t.~..,........aZ.~.....~.,....~ .................. at premises located at .~.~.,J[,~,~.JJ'l~lJ.....e~...~..~...~*~Jl~ ......................................... ........................................ .e~..e~.~, ......m..,. ~.,. .................................................................................. pursuan¢ to application dated .............................. J~J])~....~ ............. , 19..6~.., and approved by the Building Inspector. Fee $'J0..4~ ............ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date J~Jl. 1 0 1968 Bldg. Permit No. ~0~ TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed location) have been inepected by this department and found to be satisfactory. District Engineer FORM NO. 1 'I'~OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................. , 1 · Approved ~ 19 ........ Permit No. Application No ............................. Disapproved ~_~.~. (Building'Inspector) 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 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 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, os herein described. The appJicant agrees to comply with all applicable laws, ordinances, building code and regulations. ........ ...... (Signature of apphcant, or name, if a corporation) .......... (Address of a?'plicant) .... 7"'" i ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ............................................................................................................... If applicant isa co~rate, sign~e~.~thori,~ officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ~..~.0 ~ /~/..~.,,JC ...~.../~..,(~,..~., ~'/(// ~ O~C~Z~ Munici~lity ~[ State existing use and occupancy of premises and intended use and occupancy of propos~ construction: a, Existing use and occupancy ...,~..~.,.,.~.~.~ .................................................................................. Intended use and occupancy ....... ~.....~.L.Z.~...,..L~.~.~ ................................................................... b. / 3. NatllJre of work (check which applicable): New Building ..... .1~........... Addition .................. Alteration ............. Repair .................. -~ ~-,Rem°val ..................Demolffion .................. Other Work (Describe) ................................... 4. Esti~nated Cos~'~....../..~..f...~ ............................... Fee ..................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ~ ....... Nurnber of dwelling units on each floor ................ ~ ...... If g~rage, number of cars .............. '~ ......................................................................................................................... 6. If ~usiness, commercial or mixed occupancy, specify nature and extent of each type of use ............... ~ ....... 7. Di~e, nsions of existing structures, if any: Front ....~ Rear ................................ Depth .................. Height ........................ Number of Stories ............................................................................................................ . I Dimensions of same structure with alterations or additions: Front .................................... Rear ....................... Dep;th ................................ Height ............................ Number of Stories ................................ 8. Din~ensions of entire new construction: Front ........... .~....~.. ................. Rear ......... .~.~. ............. Depth ,~..~... ........ Heibht .................... Number of Stories ........ ~......~.7~'.~.../~..~. .................................................................... / ~k.. 9. Siz~ of lot: Front ......./...~.....~... .......... Rear .................................... De/pth ./~...~.~.~,~.......~..~:~ ' ~ I0. Dot~ of Purchase ................. ~ .................................. Name of Former Owner 1 1. Zor~e/or use district in which premises are situated .......... .~..l~..~.../.~...¢,~..-ET.../,/~./.~. ....... 12. Doe.~ proposed construction violate any zoning Iow, ordinance or regulation? ~ 13. Na~e of Owner of premises .~..~.~,~..y.~. ........ E'..~...~...Address ~...~.~*~...~....~../...~..4~.~.. ......... Phone Name of Architect ...................................................... Address ............................................ Phone No. Na,~e of Contractor ..~./j/../~..~.-~......./....-~..~ ................ Address ............................................ Phone No. i PLOT DIAGRAM Locat~ clearly and distinctly ale buildings, whether existing or proposed, and indicate ail set-back dimensions f~m property lines. Give street and block number or description according to deed and show street names and indicbte whether inlerior or corner lot. /6 STATE al NEW '~ORK, COUNTY ,OF . ~ ...................... ~f ' ' ................................................................................................. being duly sworn, deposes and soys that he is the opplk i(Narne of individual signing application) obow; nan~ed. He is the L (Contractor, agent, corporate officer, etc.) of said ortner or owners, and is duly authorized to perform or have performed the said work and to make and this opplic~ation; that all statements contained in this application are true to the best of his knowledge and belief; that the ,w~rk will be performed in the manner set forth in the application~f~ed therewith. Sworn to/defore me this ........... ......,,......? Notary Pu hc, ,, aunt i n fur f SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Pdrmit No. TO wHOM st. MAY CONCERN: The sewage disposal facilities '-- (Give deed location) for a structure located have been inspected by this department and found to be satisfactory. Dtat~lct E~8tneer