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Home My WebLink About4269-zFOttM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~ .36.~.~ ..... Date .............. Deeeraloe:t,... ~., 19 69. THIS CERTIFIES that the building located at 81.9..LSnlaet.t .St ......... Street Map No. ~p.t, .D~..PR Block No..X~ ....... Lot No..67 .... O~eea~or.~ .~.,.~, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Apr...~0., 19-69. pursuant to which Building Permit Nm-h.~6~.. dated ........... April'.. ~0, 19. ~, was issued, and conforms to all of the require'- ments o~ the applicable provisions of the law. The occupancy for which this certificate is issued is .. P.~$v~,.te .on~ .fa~21y. d~etltn-g ...... (a~. a~r~ved...by. H,'~,uslng..Bo~rd) The certificate is issued to ... 0aear. ~old~l~ .... ~ner. ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... t~,R, ......................... ....... . 1 ......... Building ~nspector House # (Town System) FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4269 Z Permission is hereby granted to: ............... ~;~t, ~ ~.~, · · G ~;L~, .&~ .................................... ................. h~.%...~ .~..~ .................................. ................... ~,~ ...................................... to ....... ~t~;[~-. ~a.. a~ i~i~.. ~.. 3..e-~ ~.1~'.~.~.. ~e~ .:[.' .~ ............................................... at premises located at .............. J~...(~.~....~.G~gJ~O~'.+.,..~J~...[?~L~J~ ..................................... ............................................. ~j~ ....~% ~..~t, ........... 6¢,ee~x)~.~ ............................................... pursuan,t to application dated ................................. ,~.~.....~...., 19...~, and approved by the Building Inspector. Fee $.!~,t~) ............. Building Inspector ~FORM ,NO, I TOWN OF SOUT~'IOLD TOWel' CL~:RK'S OFFICE SOUTHOLD. N. Y. Approved ..................... 19 .... Permit No. ~./..~...~.. f....~W..... Application No .... ~ ./.~./ .... Disapproved a/c ..... ~..~ ........ ~ .......................... ~ ....... - ............... ........ . ,'.',. ...... .............. ............... ............... (B~ilding Inst' ~/i ..................... APPLICATIO:~I FOR ~UI~.DING P,]~RMIT INSTRUCTION. S a. This applicati,on must be c.ompletely filled in by typewriter or in ink and ,submitted in duplicate to the Building Inspecbor. b. Pl, ot plan showing l~ocation of ~t and ~of buildings o n premises, relati~n,ship t~o adj~oining premises or public streets ~me areas, .and giving a detailed descripti,on of layout of property must be drawn ~o,n the diagram which is part of this application. c. The work c~vered by ~is appl[cat~ may ~ot be commenced before issuance of Building Permit. d. Upo~ approval ,of this applicafi,vn, the Building In specPor will i~ssue a Building Permit to the applicant. Such permit shall be kept ,~n the premises available for inspecti~ through~o.ut the progress ,of the ~ork. e. N,o building shall be occupied or used ~n whole ~ in part ~oe any purp~ose whatever until a Certificgte ~ Occupancy shall have been granted by the B~ilding Inspech~. ~. APPLICATION IS H~E~Y MADE to the ~uilding Department for the issd~nce of a Building Permit pursuant ~o the Building Zone Ordinance of the ~own~ of So*uthold, Suffolk ~ounty, New ~k, and ~ther applicable Laws, Ordinances ,or Regulati, ons, for the c.onst~ction .~f build ings, additi~.ns or alterations, ,3r for re~oval or demo- lition, as herein described. The applicant agrees t,o corn pl~ with all applicable laws, ~ordinances, ~uilding code, h.~sing code, a~d regulations. - ~ ~- --~~~~'-~ ~' , O~ear ~01din ~ ~(Signature ,of applicant, o~ name if a ~rporation) G~een~o~'t~ ~7 11944 (Address of applicant) Sta~e whether applicant ~s owne~, lessee, a[en~, architect, engineer, ~eneral contrac~, electrician, p]umbe~ or builder ................... ~?~B~ ........................................................................... Name ,of ,owner of premises . 0~ga.~. ~Oi~.R ............................................................. If applicant is a oorp,orate, signature of duly ~uthorize d .~ficer. (Name and title of corp,o,rate officer) 1. Location ~of land ,o.n which prqposed w, ork will b e done. Map NoGi~;. 'D~]i'~" ~]i' ' ' Lot No. ~? .......... · Street and Number ..... 81(}-'T4.rirle~ .............................. ~lj~y~' 'I~g ................ 2. State existing use and ,occupancy ,of premises an d i~tended use and .occupancy of proposed oonstruction. a. Existing use and occupancy ............ ~.0~:~.d.e;~$~.~ ...................... .. ..... , ............... b. Intended use and ~occupancy ............. e. ..................................................... 3. Nature of work (check which applicable): New Building ........ Addilion ,~ ...... Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Co.st ....... .~..1..0..0.0. ................. Fee ............ .~.~. .................................. (to be paid ,on filing this application) 5. If ,dwelling, number ,of dwelling units .......... Number ,of dwelling units on each flo.or .............. If garage, number .cfi cars .......................................................................... 6. If business, commercial ,~r mixed occupancy, specify nature and extent of each type of use .............. 7. Dimensions of existing structures, if any: Fro'.nt .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions .of same structure with alterations or additions: Front .............. Rear ............... Depth ................ Height ................ Number of St~ories ..................... 8. Dimensions ,of entire new construction: Fr,3nt . .8 .............. Rear . .8 ........... Depth ...i,~ ...... Height . .8 ......... Number ,of S~ories ....... .~, .................................................... 9. Size of }or: Front . .'..[[0. ........ Rear ........ [~0. .... Depth .... ]1~,~ ....... 10. Date of Purch.ase ............................... Name <xf Former Owner ............................. 11. Zone .or use district in which premises are situated .......... l'ee'.' .................................... 12. Does proposed con,stzmction violate any z,aning law, .ordinance or regulation? ....... ~e ................. 13. Name ,of Owner,of premises 0.~.q~.~...G0.],d~.ll ..... Address .~.e.~l~l~'.~..~. ..... Ph,one No~?7.-..~.~.~.Q. # Name of Architect ............. ~ .............. A'ddress ...................... l°h,one No ............ Name ,of Contractm' , ........................... Address ...................... Ph,~ne No ............ PLOT DIAGRAM L~)cate clearly and distinctly all buildings, whether existing ,or ,proposed, and indicate all set-back dimensi,ons from pro,perty lines. Give st. reet and bl.ock number ,or descripti.on according to deed, and sh,ow street names and indicate wheiber interior ,or corner l, ot. · ~ddLtl0n, w~th door~&y STATE, OF NEW YORK, )S.S. COUNTY OF .............. ) ............... 0~0e~.. Goldil~ ..................... being duly sworn, ,deposes and says that he is the appli- (Name ,of individual signing applicati.on) cant above named. He is the ...0.W~'..~..~B.:~,e~r. ................................................... (Oontractor, agent, carp.orate officer, etc.) of said owner .or ,owners, and i.s duly auth,orized ~o pe~3rm or have per~orme,d the said w~rk and ~o, make and file this applicati.on; that all staIements oontained in th is application are true to the best of his kn,owledge and belief; .and that the w,~rk will be performed in the mann er set forth~ in the application filed therewith. Sworn to before me this · .~0 ........... day ,of. A~FI1 ............ 19. SUffOlk Notary Public, . ................... County NO, 52,3233120 Suffolk County Term Expires March 30, 19 ~[ .... 080.~. ~10 I~li ........ ........................ [~gnture of applicant)