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Home My WebLink About869-zTOWN OF 5OUTI~IOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ......... ~...~LO0~.. Date ....................... J,~'~l~]/t.. ], ~ ........... 19~jl,. TH~S CERTIFIES that the building located Map No .......... ..~.~.~ ...... Block No ....... .~...*..~,. ....... Lot No ...... ~.~..*. ...................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................. ~.~]~.~...~ ......... 19.5.9... pursuant to which Building Permit No ........ ..~.....~...6..9. dated ................ ~l~:.~b.~l~...9 .......... 19..5.~., 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 .......... ~1~1/~.. O1~.. P. ~l~l:t Y~¥.. l)I/~ ]Rq~ ...................................................................... This certificate is issued to ....W.~.l..~.~.a.~..ff..~k..~.~.,......o..w..~.e...~.. .............................................. (owner, lessee or tenant) of the afo~'esaid building. Building Inspector FOItM NO. ~ TOWN OF SOUTHOLD 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.° 869 Z Dote .................. J~J~J:~....9 .................... ~ ~-::~. ..... Permission is hereby granted to: · ..W/.~.]./.~..Jakow~k;l. ............................................. ..... Fa ~ .t~a'-y... · Ave. .................................................. ........ I~t.t~t~i~l~....~..! .......................................... ........... ~..~...~.~..~..~.t..e.... ................................................................................................ at premises located allJ/fS....l~&o$,f,~,~..A~r®~....~t.f.~J,t,u~cr..,-~,,Y.,, .......................................................... pursuant to application dated .......................... ~t~l~r.....~. ................. 1~¢)......, and approved by the Building Inspector Fee $5~00 ................ Building I nspectc~r'':;'''~ ...... j ........... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ...~-~,~(..../..~.., 19..~,..~..Permit No ..... ~...~..~... ....... (Building Inspector) Application No ..........~....~...~... ........... APPLICATION FOR BUILDING PERMIT Oote ............ ........ .................. 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 location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Bu'ilding Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises ava.liable 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issua,nce of o Building Permit pursuant to the Building Zone Ordinance of the Town of 5outhold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of a~'l~'l'i;;nt) ....................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises......~-- ......:~'-(~.~..~...~. ................................................................................. 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: ....... ~. .......~':'... .................. LotNo: .................... 7x, / , Street and Number ............. ~ ................ ~~..~...~.......~...."~ ............ Municipality 2. State existing use and occupancy of prem~ use and occupancy of proposed construction: a. Existing use and occupancy ............................................. b. Intended use and occupancy ................................ ~..t. .............. ....~..../.......~.....~.~ ..................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... ^Iteration ...... ~...'%. ........ · Repair ............... ~,'e, .,, ~ /'__ m ,,, zL~lRem°val .................... Demolition .................... ~-~r~ Other Work (Describe) .................... 4. Estimated Cost ....~....~....~./...~....~..~..:....-~.... ................ Fee ..~....~....~. ........................................................................... 'r ''{tO be paid on filing this application) 5. If dwelling, number of dwelling units ........ ~ ...... Numbew af 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: Front ............................ Rear ............................ Depth ................................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front' .............. ;; ................ Rear ....;..~......i ................. Depth ................................ Height ..................... ~ .......... Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ~. .................. Rear ...... ~ .................. Depth ../...0. ..................... Height ............................ Number of Stories ......... ~ ....... 9. Size of lot: Front ..... /.../....~.. ............. Rear .................. .......... Depth .....~....~'.....~.. ............ 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... ] ], Zone or use district n wh ch prem sas ore s tuoted ............... ~ ......... ,~ ....... ~?.,! ............................ proposed construction violate any('~onir~g law, ordinance or regulation? ........ ..~....O... ....................................... 12. Does o Name of Architect .............................................. .......Address .......................................... Phone NO ..................... ............................ .' ....................... Address Phone NO. Name of Contractor ' . ............................................................. PLOT DIAGRAM Locate clearly anc~ distinctly all ~b~dldings, 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 Nb'Ve~O~ ,,~ ) S S ...........................* ,//~/. ~A ~*..~.../.~.~~.C~..,~'~~-- ~ ............... being duly sworn, deposes and says that he is the applicant (N~ of individual ~, ~li~ti~) above named. He is the .......... ~..~ ............. ~ ........................................................................................................... (Contractor, agent,.corporate officer, etc.) of said owner or ~ne~, and is duly authorized to perform or have ~rformed the said work and to make and file this application; that all statemen~ c~tained in this appllcati~ am tree to t~ best of his ~owle~e and belief; and that the work will be perform~ in the manner ~t forth in ~e application filed ther~ith. Sworn to before me this ,~:.~