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Home My WebLink About916-zFORi~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No Z 64.6. Date ~e lS 19...6...0.. THIS CERTIFIES that the building located at~./..~....B...a.Y.....V...l..?.....~..°..~.d..:.....$..°...u...~....°.~.~... Street Map No ........................ Block No ........................ Lot No .................................................................. conforms substantially to the Application for Building Permit heretofore f~led m this office dated ~'oY~,,~,,e= 27 1~....S..9.., ....................................................... , pursuant to which Building Permit No. ......................... Z 916 dated ................. ..~..O....V~..~..~....2..~ .......... 19..~?.., wa~ ,ssued, and conforms to all of the requirements of the applicable prowsions of the law. The occupancy for which th~s certificate is issued is ................ PRIVATE 0]~ FAMILY DWELnIN~ This ce~if,cate is issued ~a ................... ~.~...W~,~...~b..9..~..~,.....o.~.e...r. .......................................... (owner, lessee or tenant) of the aforesaid buildmg. Building Inspector \ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT C['HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 916 z Date .................~X'....~... ......... 19 ~.... Permission is hereby granted to: ..... ~um~l,,...W~.. I~.~ ....................................... .............. ~e~....~.~.tr..~ .................................. to ....... ~I~..II.P~ .l~!~l~-.~'~.q~....e~......m~......e~..~..~.~..~.~....8~.e...];~.....~. ................................................................... at premises located at ...~...~i~...~'~l~.~ ...... ~.9.~..~...~..:~..;. ................................................ pursuant to application dated .................... ]ll~tl~e~...~. ................... 19.,~.~1.., and approved by-the Building inspector Fee SJ..~.,]~....~ --~.1~ Buddmg Inspector FO~EM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Approved .................................... , ]9 ........ Permit No .................................. APPLICATION FOR BUILDING PERMIT Application NO ........~..(...~.. ............... INSTRUCTIONS a. This application must be completely filled in by typewriter or in'ink end submitted in duplicote to the Building Inspector. b. Plot plan showing Iocotion of lot and of buildings on premises, relationship to adjoining premises dr pul~iic streets or oreos, end giving a detoiled description of layout of property must be drown on the diagram which is part of this location· c. The work covered by this application may not be commen~ed before issu}3nce of Building Permit. d. Upon approvol of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit shell be kept on the prem.ises availoble for inspection throughout the progress of the work. e. No building shell be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy shell hove been gronted 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 Sout,hold, Suffolk Co(~nty, New York, and other oppliceble Laws, Ordinonces or ~egulotions for the construction of buildings, additions or ~:lterdtien~, or fOr removal or demolition, as herein described. he applicont agrees to comply with all epplicoble laws, ordinances ehd regulations. (Signature of epplicont, or nome, if o corporetion) (Address of opplicant) State whether opplicant ~s owner, lessee, agent, architect, engineer, genera1 contrabtor, electrician, plumber or builder, If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ...... ../~.....,,~',..,....~.. .................. Lot No:.....~.....~. ......... Street and Number ....'~...~...,~.....~...~...~....~.~.~ ........... ~...~.- ............................ Municipality State.existing use and occupancy of premises and intended use and occupancy of~[~roposed construction: a. Existing use and occupancy b. Intended use and occupancy ....................... !.~ ................ ~....'..~ .............. ...~..~.......~.....~. _~ ................ 10. 11. 12. i3. Nature of work (check which applicable): New Building .................... Addition ...... ~ ......... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... ~/' O0 ~ Fee 6" ~ Estimated Cost (to be paid on filing this application) If dwelling, number of dwelling Units ....... ~ ........ Number of dwelling units on each floor .................................. If garage, number of cars ...................................... ' .................. ~ ........................................... ' If business, commercial or mixed occupancy, specify nature and extent of each type of Use ................................ existing structures, 'if any: Front..~ll.../...~ ............. Rear ......... /..~ ............. Depth ./......~.. ..................... Dimensions of Height ............................ Number of Stories ...~... ~ ..................... Dimensions of same structure with alterations or addle, ions:' Front ................................ Rear ..... i ........ ;.'. ............... Depth ................................ Height ............................... Number of Stories ................................ ~ ' Dimensions of entire new construction: Fror~t ...... ../..~. ................ Rear /,2- ~epth.~C/ ,,~ . . ..?~; ........................................ - .~ Height ............................ Number of' Stories ........................ ~ ~ Size Qf lot: Front ....... L~.....!. ......... Rear ...... /...~......'~.~ ....... Depth ...... ..7....~.....0.....i..~..,' Date c~f F;urchase ............ ~..~.....~..../ ............................. Name ofqFor,~mer ?(~ner .;...~...~ ....................... Zone or use d str ct n wh ch prem sis are s tuated ~ ~.~ ........................................... Does proposed construction violate any zoning law, ordnance or ragu at on? ...~.....~......O... ....... Name of Owner of premises....?..'....~.... 'u"~'":~Address~' ..... ~ ....... Phone' ~'~i"iiiiiiiiiiiiiiiiiiii Name of Architect ......................... k'. ............... : ...... JJAddress .......................................... Phone NO ..................... Name of Contractor .................................................... Address ...... , ................................... Phone NO ..................... PLOT DIAGRAM Locate clearly ond distinctly all buildings, whether existing or proposed, and indicote all set-bock dimensions from property lines. Give street ond block numbers or description according to deed, and show street nomes and indicote whether interior or corner lot. ..~./3 4 v ~,-- ~j ............................. ....... (~ome of individuol si~nin~ ~pplicotion) above named. He is the . . ............................................. ~;~k~;Tj'~fj'~;~i~i;'~i~;7,'~f~'.'~ ....................................... of said owner or owners, and is duly authorized to perform or hove ~rformed the said work and to make and file this application; that all statements contained in this applicatio~ are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in ~he application filed therewith. Sworn to before me th s ................ o, .......... ....... ..... .... ,- ~ot~ ~ublic, ..~' (Signature of opplic~nt)