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Home My WebLink About3260-zFOBM ~0. 4 TOWN OF 5OUTHOLD BUILDING D£PARTM~-NT TOWN CLERK°S OFFIC£ SOUTHOLD, N. Y. I-:.ERTIFICATE 13F FiI:II-:UPANCY No.Z...27~7 ..... Date ................... .t~. y. .... I.? .... 19.6.7. THIS CEI~TIFIES that the building located at East. P~l.&.Cent,,..Dr ........ Street ¢apt K~dd Estates Map No ............. Block No ............. Lot No. ;~.~. ..... .~..t..~A~..u?.k. .............. conforms substantially to the Apphcati,on for Building Permit heretofore filed in this office dated ............ 0e.t ..... :I./3., 19/56. pursuant to which Building Permit No..3,2/50.2:. dated u ~ 19.66, 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. Ac COS so~y..bxut, t.d ~g. 4PV.~. · Carage.) ..................................... The certificate is issued to . .~TatI~e.~ .14~ra.~es. .......... 0kuqe~. ....................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ..... 1/~.~, ............................. Building Inspector 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) NV 3260 Z D~te ........................ fi,.tolxer.....].O....., 19.66.. Permission is hereby granted to: ................. ..~....o..e....~.~.~...e.~........A~...C......~..a~....e.~....~..o..~tes ..................... ~~ ..................................... to ~ld .n...e.~.. g~'~. g~.~.~g...~#g...g.~l$.~O~ ~.1,~1~) at premises located at .....,:~,.,,~. ....... .]:.~..~..t,......C.,~.]3.t,... ~.~..~...cl:...,~.~..t,.,.a:.~..~..I. ................................................... ............... ..C..e.~.~r.~..~lZ~...);~.e.~...~.~ ............ ..~.~t~J~ .................................................. pursuant to application dated ................................ .~.0...~.~ ....... ~.0......., lC~.~...., and approved by the Building Inspector. Fee $...?.:...(~... ............ Building Inspector POEM[ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ........ Disapproved a/c~....~...: ;.~ ...... ............... ............................ (Building Inspector) k. APPLICATION FOR BUILDING PERMIT Date ........................ .0..?.~.?..b.?..?.......];..0. ......... , 19...6..6. ..... INSTRUCTIONS o. Th~s application must be completely filled m by typewriter or m ink and submitted in duplicate to the Budd~n, Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o areas, and g,wng a detaded description of layout of propertymust be drawn on the d~agrom 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 th~s application, the Building Inspector wdl issue a Budding Permit to the applicant. Suct permit shall be kept on the premises avadable for inspection throughout the progress of the work. e No building shall be occupied or used in whole or In port for any purpose whatever until o Certificate of Occupancy. shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Budding Permit pursuant to th, Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply w~th all apphcable laws, ordinances, building code and regulations. (S~gnature of applicant, or name, if a corporation) (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .............................................................. ........................................................................................................... Name of owner of premises ....~ ....... ..J.~..~..~.~..~Qr.~.t;.e.S ..................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) 1. Location of land on which proposed work will be done. Map No: ..C.~D~....~.,!~gl,.qt. .....................Lot No: ..~. ......... Street and Number ...]~a.s.~...&...CJe~%z'~.]~a~ ............ .~.~%.~.~'0x:~ ............................................................ Mumcipality 2 State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy .... .D.~f~,'k~,%~i~ ........................................................................................................... b. Intended use and occupancy ........ ~]:~..~.i.¢~...p.~.t..~az'.a~:~ ...................................................................... Nature of work (check which applicable)' New Building ..... ~ ..... Addition .................. Alteration ................. Repmr .................... Removal .................... Demolman .................... Other Work (Describe) ..................................... Eshmated Cost ...........~-.~Q.0.Q...~. ~ ........................... Fee ....... .~ o 0.0 ........................................................................ (to be pa~d on fihng this apphcation) If dwelhng, number of dwelling units ............................ Number of dwelling units on each floor ........................... If garage, number of cars ....... .9~. ........................................................................................................................... If business, commeroal or mixed occupancy, specify nature and extent of each type of use ............................... D,mens~ons of ex,st,rig structures, if any. Front .......................... Rear .......................... Depth ........................... He,ght ......................... Number of Stories .............................................................................................................. D,mens,ons of same structure w,th alterat,ons or add,t,ons: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ........................................ 8 D~mensions of entire new construction: Front ......... '1~ ....... i~ ..... Rear .-']-~ ...................... Depth .~...~ ..................... He,ght ......................... Number of Stones ..o~e ................... 9. S,ze of lot: Front ......... 9.Q .............. Rear ............ .cx0 ......... :. Depth ....... .].2~D ................. 10 Date of Purchase ........................................................ Name of Former Owner ...................................................... 11 Zone or use d~str,ct in which premises are s~tuated ....... !!~.!!...dia% ..................................................................... ]2. Does proposed construction violate any zon,ng law, ord,nance or regulation? ............... n~ ................................ 13 Name of Owner of prem,ses .~.:....~...o.~.~.e..~ ............... Address ......~.t.~q~.~;~.'l;;.l~g~ ................. Phone No ................... Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor ........ ~...~'.J.-sb.~:~ ......................... Address ..... ~..%.¢¢.~e~. ................. Phone No ................... PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether ex~stmg or proposed, and indicate all set-back dimensions fror property hnes Give street and block numbers or description according to deed, and show street names and ind~ca~ whether ~nterior or corner lot. STATE OF NEW YORK, 1 S.S. COUNTY OF ....... ~tzt'£ o.I,~ ....... f ................................... .~QS..~.i~SZ~t~:~ ................................... being duly sworn, deposes and says that he is the applio (Name of individual s~gmng applicahon) above named. He is the ..................... COZ~'C~&O.¢.O~. ....................................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, Qnd is duly authorized to perform or have performed the said work and to make and th~s apphcation, that all statements contained in this a~ph?tion are true to the best of his know~dge and bah and that the work wdl be performed in the manner set forth ~n the applicat~ filed therewith. .................. · ~0... day of .... O~ ....................... ' 19"e6' ~ ' z. ~. ~., _/~ "J .... :.'~:'"'~'~"~'F~'"'~t ........ : ......... ~;~ ........ Notary Public, ~.[.t~.~:.~~ ......... County_ ~ (~gnature/~f apphcant) ~o 52 3233J20 Suflol~ Co NOTAR " ' ' un h 30 ~9 Term Expires Marc ,