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Home My WebLink About3067-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. CERTIFICATE OF OCCUPANCY No...Z...3/,23 ............ Date ..................... June- ......... 19, ......... , 19.6.8, THIS CERTIFIES that the building located at .~/S...T~..Dlg~l..v.e ................................... Street Mop No ....................... Block No ....................... Lot No....Sou~hol~l,...Ne~/...¥o~l¢ ........................ conforms substantially to the Application for Building Permit heretofore filed in this office doted ....................... ~.pril.....26., .................. , 19..6.6. pursuant to which Building Permit No....;.~0.~7.... dated ............. Apl~.t.,t.....~6., ................. , 19...~6, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ...... p.x..~..v..~.~. ~....~n~....~.~r~ ~,),~...¢~..~.il, ~,.~,~ ........................................................................................ The certificate is issued to ....l/'.,ttO...CgtCC, Jat/llt.....(.owlter.). ............................................................ (owner, lessee or tenant) of the aforesaid building, Health Dept. Approval June 18, 1968 ..................... .......... Building Inspector ~ ' TOWN OF $OUTHOLD BU~LDBNG DEPARTMENT TOWN CLER['$ OFF~CE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3067 z Permission is hereby granted to: ~3oltthold pursuant to application dated ........................... ..~..~.~..~ ....... ~.~. .......... 19..~...~..., and approved by the Building Inspector Fee $.....~.~..0...0. ........ Building Inspector s-9 SCHD SUFFOLK COD~I~ DEPArtMENT OF HEALTH WHOM IT MAY CONCEal.. The sewa~ di~spoeal cilitmes for a structure located at , , .... . ........(~ve deed location)/ ~ve been inspected by t~s Dep~ment a~ fo~d to ~ satisfacto~, FOEM NO. 1 ,. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit Na ............................ Application No ..... ?.....d....(¢.. ] ......... Disapproved a/c .............................................. ~z~.~,-.*~ ...................................,~ ..................... .............................. .... (Building Inspector) .... APPLICATION FOR BUILDING PERMIT Date ..................... ~.~...~.~. ......... .~. ~......i ....... , 19..~..~.~ ...... 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. S~ch 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 H.EREBY 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, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. . Att ~.r...n..e.~. Name of owner of premises ......... .~.;Lt~...l~c~hini ........................................................................................................... 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.: ....... ..~......~1~... ....................... Lot No.: ...~ ............. Street and Number ..... ~./.~'. ....... .~..~.l........~.¢tLl~.~.0.~,f~. ................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construciion: a. Existing use and occupancy ........ .~...~ ................................................................................................ b. Intended use and occupancy ......... ~..~$~...Q~e~ .......................................................................... / 3. Natbre of work (check which applicable): New Building ..~¢;~; ...... Addition .................. Alteration .............. Repbir .................. Removal .................. Demolition .............. ~.,. Other Work (Describe) .................................... 4. Estir~ated Cost .......~Q,~.O~.0,..~.~'.J~ ............................ Fee ........... ~.O. 00 ............................................................... i (to be paid on filing this application) 5. If/d~elling' number of dwelling units .......... ~ .......... Number of dwelling units on each floor .............. , .......... If gj3rage, number of cars ..................................... %W{~ ............................................................................................ 6. If I}usiness, commercial or mixed occupancy, specify nature and extent of each type of use .............. ' .......... 7. D~rqens~ons of. ex~shng structures, if any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories ................................................................................................... ! ......... Dim,,ensions of same structure with alterations or additions: Front .................................... Rear .............. i .......... Dep!h .; .............................. Height ............................ Number of Stories ................................ 8. Di~ensionsl of entire new construction: Front ....... ..~0. ....................... Rear ........ ~'0 ............... Depth .....~,~'. ......... Height ......... i .......... Number of Stories ........ .O...~..~.. ................................................................................................. 9. Size]of lot: Front ....... ~6..,~./.~ ...... Rear ............. ~t~ .............Depth ...... .[I:OQ..~..Z.~ ........ 10. Dat?'l of Purchase ............ ,,1,~.(~ .................................. Name of Former Owner ..... ~O:~;[~I/atlt~l, .......... ' .......... 11. Zon=e or use district in which premises are situated .....~.~..".....~.~t; ....................................................................... 12. Doe proposed construction violate any zoning law, ordinance or regulation? ....... ]f~ ............................................ 13. Nar le of Owner of premises .1FSfr~..~,~at~1..ll~ ........ Address ............................................ Phone No ................. Nar ~e of Architect ...................................................... Address ............................................ Phone No ................. Na~ le of Contractor ...41e~lU~ ....................................... Address ...~S.~]~l~,....~,~., .............. Phone No ..... v?"-" PLOT DIAGRAM I L.ocat, clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr~ property libes. Give street and block number or description ac?,ording to deed, and show street names and, indic~ whether in~ erior or corner lot. ~.~ t2,.~ ~ "[ J; ~ ~ ~') STATE OF NEW YORK, 1, ,, ~ COUNTY )F ..... ~13 ~..O. 1~ .......... ~' .......................... ~t.~.,..~'l~3~,l,Ct}?~'~[~ ....................................... being duly sworn, depose~ and says that he is the applice Name of individual signing application) above nam ,'d. He is the ................ ~.t,.~[~....-....ll~;el~l; .............................................................................................. (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 this appliccjtion; that ali statements contained in this application are true to the best of his knowledge and belief; that the walk will be performed in the manner set forth in the application therewith. Sworn to before me this / ~_.,,, x/ / ............... .~'~.... day of ..................... ~L~Z~,,~,I .......... , 19..(~. ~¢~r-,, .¢~,'- ; ~...~/~'"~./~" Notary Public, ..v,./~./.... ' (Signature of applicant) / 'II~ILD R~]D CHAPMAN ~OTARY PUBLIC, Slate of r]r~v ~0mmission .Expires Marcll 30~