The URL can be used to link to this page

Home My WebLink About3049-zFORM NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No.. 2;..288f~.... Date ...... ~t.o. be~:..20 ......... , 1967.. THIS CERTIFIES that the building located at 8!;e:~3,~12[ .l~o~d ............ Street Map No. I~[~l~1. Block No..X~X ....... Lot No... ~:.. 4.~,..4lB.,..49~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~p~Ctl .12, 19..66 pursuant to which Building Permit No, 3.049. dated ............. ,~p~.t],. ~L2.., 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 ...~d~:~i: .t0~ .tO..o. ne. ~.~ml~-y..ql~ell.~ng ................................ The certificate is issued to .... Olg& .Cor~s ..-~. ~aeZ'. ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... ~.~. .......................... Buildi~;~ Inspector BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 30~19 Z Date .............................. Permission is hereby granted to: Lep...~.~.u..~.e..~L....A./..~...0..Z.~.~...c...o.~..~.~.~ .................... ................ ~.o~z?,b~ld ............................................. to .B.ulld...at~..~d. dit$~DD...or,..~c~..,:4t.~%.i, ng...d~et.7<l~g ......................................................... at premises located at Pt, 10.t'~, .lf.~.~ .~ .~ .~fa~,~.~t..~.*a~...~ ............................... ............................................ ~;~.~.£~g...~oa~ ....... Ctt.~ebog.~e ....................................................... pursuant to application dated .................................... ~.....'1.~. ....... 19.6(~.., and approved by the Building Inspector Fee $5...0.0. ............. Building Inspector FORM NO, 1 TOWN OF $OUTHO~.D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. / Examined ...................................... 19 ~ Approved ~ 19..~ ....Permit No..~.~... ,~,...~,, ~ ~ Disapproved a/c ..... ~. -~.y .................................................................. (Building In$1~6ctor) 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 o deCailed description of layout of property must be drawh 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 far 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 Regu at ons for the construction of buildings additions or alterations or for removal or demolition, os herein described. The applicant agrees to comp y with all appl cable laws, ordinances, building code and regular ans. (Signature of applicant, or name, if a corporation) S'outhold (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................... C.on~a~mr .................................................................................................................................... Name of owner of premises ....... 03,g~,....~o~.de, s ................................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ,, ,, Nassau Forms ., No Pt ~+7~ L~8~ ~+9 1. Location of land on which proposed work will be done Jvlop INa.: ........................... ,n ........... LOt .: ........................ Street and Number ..... ~.t...e.T...~.~ag..E.~.d ....... .C.2.t.C. hQg.~ .................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... ~.e:.]...~,~k~ ..................................................................................................... b. Intended use and occupancy .............. (.~.~.e.'...~.~...f~...~91,~.~.Q~ ................................................................ 3. Natt Repc 4. Estin 5. If d~ 10. 11. 12. 13. Locot, property Ii whether in' re of work (check which applicable): New Buildiri~ Addition ....... :X:,,~r~... Alteration ir .................. Removal .................. Demolition ..................Other Work (Describe) ........................................ ~ated Cost .... P,,P-Q0...~/~ ............. · ..................... Fee ...[~ ........................................................................ I ............. (to be paid on filing this application) lelJing, number of dwelling units ......... ~... ......... Number al~ dwelling units on each floor ............................ If gc rage, number of cars ................................................................................................................................ i ............. If b[usiness, commercial or mixed occupancy, specify nc~ture and extent of each type of use ............................ Dimbnsions of existing structures, if any: Front ............................ Rear ................................Depth .................... He j qt ........................Number of Stories .................................................................................................... ...... ......... Din" ~nsions of same structure with alterations or additions: Front .................................... Rear .............. ~ ............. Dap ................................ Height ............................Number of Stories ................................ Din' ensions of entire new construction: Front ........... 16 .................... Rear ..........1.6 .............. Depth ......... 1~ .......... Hei~ ht .................... Number of Stories ..................................................................................................................... Size of lot: Front'. ........................... Rear .................................... Depth ................................ Dar of Purchase ........................................................ Name of Former Owner .......................................... : ............. "A" dist Zon ~ or use district in which premises are situated ....................................................................................... r ............. Doe~ )topos'ed construction violate any zoning law, ordinance or regulation? ........... ~¢t .............................. ~ ............. Nar~e of Owner of premises .Q~...g.P.~.~..~.~ ............. Address ............................................ Phone No ..................... Nor~ej of Architect ...................................................... Address ............................................ Phone No ....... .............. Nar ~e of Contractor ...... .~..e...o....~...~.~.~.g .~. ...................... Address ............ ~Q.~.~Q~.~ ............ Phone No. PLOT DIAGRAM ~ clearly ond distinctly all buildings, whether existing or proposed, ond indicate oll set-back dimensipns from ~es. Give street ond block number or description Qccording to deed, and show street names andl indicate erior or corner lot. I STATE OF NEW YORK, 1 e ¢ COUNT, Y OF ..... ~.~'O '],~ .......... ~ ' e ................. i .............. .~...g...]~.~q,'l~.8..~.~ .......................................... being duly sworn, deposes and says that he is the 'applicant Name of individual signing application) abow; nar'~ed. He is the .............. ~.o..~,t.,,~?..g.,'l}..o.~ ................................................................................................................... (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make, and file this appl arian; that all statements contained in this application are true ~lthe best of,~is knowledge and belief; and that the ' )rk will'be performed in the manner set forth in the application f)fe~d therewitl)( ) Sworn to afore me this ~ / / // 12 Ap.r il 9 66 ................ ', ........ day of ........................................... 1 ......... q/~//~/'~) ,. . ....... ....... ....... ............... Notary P~bli~,~~[.~~.. County ~ (Signature of applicant)