The URL can be used to link to this page

Home My WebLink About318-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the build,ng located at.Q.~...t'..~.q~t,~.~.~...~,~¢..t ........ Map No..~,~.~ ........... Block No ...Z~ .............. Lot No .~Z.~..~ ............................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. .~ .~g ............................ , 19.~ .... pursuant to which Bu,lding Permit No ~.~..~ ................ doted ...~...~. .................................... , 19~.~..., was issued, and conforms to all of the requirements of the applicable provisions of the law The ~cupancy for which thts certificate ~s issued is .............. This certificate is issued to ............ .~.~9...~3....9~ ....................................................... (owner, lessee or tenant) of the aforesaid building. ~oward M. Terry FO~ NO. ~ Town ~SOUT,O,D 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? 3:18' Z Date ............... ~ ...... ZO ............. 19~8... Pen nlssion is hereby granted to: ...... ~al~ A~ ......................................... ........... ~e~, ..... ~.Z..~...~..Z. ............. to ...~ ~..~e~..a~~ ..................................................................................................... at prem,s~s located at ,~J. ~..~..~.,~r.~..~..~,..~ ............................................. ............... ~.-../.~..~--.. ~ee~..~te,-...e~e~ ~. ..... ~,.~., ................................................... pursuant o apphcahon dated ................................ ~. ~ ............. ]~..., and approved by the Building INspector Fee $.~0,00.., 'l~d,8 Bui d~ng nspector ~ ORDER No /~"'~ ~ B. I. BOLENDER, ,IR. LAND SURYEYOR, LIC. 35112 BOX 68, LINDENHURST, N. ¥. TEL. LIND. 5.4140 IOB: i CKD. BY: ~ FIN. BY. FOKM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ~ ........... ................... (Building Inspector) ! Application No ............................. · ~ ' ~- APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This opplicotion must be completely filled in bv typewriter or in ink and submitted in duplicote to the Building Inspector. b. Plot plan showing Iocotion of lot and of buildings on premises, relationship to odjoining premises or public streets or areos, ond giving a detailed description of layout of property must be drawn on the diogrom which is port of this Iocotion. c. The work covered bv this application may not be commenced before issuance of Building Permit. d. Upon approvol of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit shall be kept on the premises availoble for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any pu?pose whatever until o Certificote 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 Sot~thold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinance,s,~and regula~,~ns. __ J ,/,,~g natu re o f o~ nt, or na~me,~orpo~on,) (Address of State whether app~cant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises C)c' If applk:ant is a c~orote, signature of dul¥~euthorized officer. ........... .......... (Name and title of corporate officer) ~ ..~, 1. Location of land on which proposed work will be done. Map No~ ............................................ Lot No: ...'.~: ...... c~...... ....... ~rree, OhO ,,umoer ..,. .................................................. '~;~i~i'l~'~ii~ ............. '~ .......................................................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use ond occupancy....~~: ............................................ ~ ................. ,. ............................................ b. Intended use and occuponcy... ~ ..~..'~..~ .:~..~.~ ............................................. 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................. Repair ............ .....~..Removal .................... Demolition ....... ......... Other Work (Describe) .................... 4. Estimated Cost~...~..~...~.....'T~ ................................... Fee '~'..J.....O... ................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ......../.. ..................... Number of dwelling units on each floor ............................ If garage, number of cars..~.~ 6. If business, commercial or mixed~ occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Fron~: ............. Rear ............................ Depth ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entre new construction: Front................ ........... Rear ........................... Depth~7.--~...:..~z~ ............... Height .....~.....~.. .............. Number of Stories ....~'.. ..................... 9. Size of lot: Front ..~....~....~..'.... Rear .......'~..~....~.. ............. Depth ..../~...~.....~... .......... 10. Date of Purchase ...... '.~...~..~.~Z.~......(....~...~...~.~. ................ Name of Former Owner ...~...~....~?.'...:...~. ..................... 11. Zone or use district in which premises are s tuated .............. /~.......~..~.J;.~..~,.';....~...-...-~....~'~ 12. Does proposed construction violate ~any zq~ning~ lawj ordinance~,or regulation? ~ ................................... 13. Name of Owner of~'~' ~=~ // ~ //~'/~-~pr~mise~'~'~'"Address~%'-~°ne NO.~..~......-~..~'.~_~ Name of Architec~.~...;.~~....Addres~j(~.~.~..~...~.~.....~... Phone NO .................... Nome of Contracto~....~...~..~Z ........ Address/~.'..~...~....~..~.......~....Phone NO...~...7.Z.~.-./.f?./ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW, qY. 0P~,/.' . ,~ ) S S COUNTY OF .~) ' ....~..~~.'....'...~....~.~ ......................... being duly sworn, deposes and says that he is the applicant (fflame of individual signing application) /- above named. He is ~he~~2.~....x~..~...~.;~7`~.~.:~....*~..~Z~..~.~.~~~...~..:~;"~.~ ./....-, ,, ,,, ,--- --,. ,,.., -- .......... // /' ~ ~onrractorJJagent, corporate officer, etc.~ of said owner or owners, and/ is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his kp,owledge and belief; and that the work wJl.I be performed in the manner set forth in the opplica~o.n filed therewith./'/ Sworn to before me tl~s .~ ,~ ........ ~ ...... day~f~../.....~.....'d-mg~./......./J. .... 19.....,....,.,. ~, z¢¢,.... ~l~?l~f apphcant, Notary Pub c, ../....~./..(ff~..~.{,~.:~/.,i~..(~5..~ .......... Courft{/ 3. erin ~-- ~ ' Y