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Home My WebLink About614-zFOI~M NO. ~ TOWN OF' SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..,.~..3.~.O., ........ Date ................................. ,t~e..3 ........... ,19..~.9. THIS CERTIFIES that the building located at,..~.~...~J~..~...~.f~.~...~. ...... ~ ]~}~.e~l ~ ~O%l~hO]b(~ck No '~¢~ . Lot N~o~F}~&Ve~ &~ ~0%lt;h01Cl .................................................... .~. ,~.~..~f. ........................................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................ ~.(~h..;~.~. ............ , 19..~.C~.., pursuant to which Building Permit No ...... .~....~.~..~. ........... dated .......................... ~.'..~.~...~...~. ......... , 19..~',%., 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 .............. ........................................ ~..z..¥.~'P:...0..~.',..~.~:.~. ~..~.~.~',7~;[~f} ....................................................... This certificate is issued to ...~..~.?.~....~.~.~/'..~.§...~.~....~...~.~?...~.~.~.,.~.~.~.~.~....~.~.~¢. .............................. (owner, lessee or tenant) of the aforesaid building. / Building Inspector i-Io~a~d ,~. ~e~z3r FOI~M 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.° 614, z Date ................... ~l~r..~.~......2~. ~ ................... 19~.~. .... Permission is hereby gronted to: Ilar~ ~'aae..//~laa ................................................................ ............... ~.14..~1~../t..4 .................................. to B~... aew ~wel~!~. at premises located at ..~/~..~'~#~....~.~t/3..~.~.~....~/.~.~..e.?..a.....~...g..~....~ ............................................ ................... · a~..lia~e~..a:t,..~t~.l~., .............. ~tt~h~lt~,..,~.,~., ...................................................... pursuant to application dated ........................ ~t~'~]3....2~, ..................... 10.~.~...., and approved by the Building Inspector IlOT~ I ?hil dwellin~ to haw mi~mum setback o~ ~1~% o~ ~eth I%ree~l Fee $...l..0. :...0~.. ............ Building Inspector -- FOH~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. '~ E×am ned ........ 9.£.t.. · ........ Approved ........................................ 19 ........ Permit No. ............... ([~'~'ii'~l'i ng Inspe~or) I APPLICATION FOR BUILDING PERMIT Application No......~..../...~. .............. INSTRUCTIONS ~a.- This application must be completely~fiJled 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 Building Inspector will issue a Building Permit to the applicant. Such 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 HEREBY MADE to the Building Department for the issuanoe of a Building Permit pursuant to the Building Zone Ordinance of the Town of Sou~hoJd, Suffolk County, New York, and other applicable Laws, Ordinances or ~geUla:l~li~Sa, n:Oargtrhe::tConSctro~¢:il;%i~hbc~ildai~:~c:~ld:til:~Ss,O~r; ,itnearn¢ :~~11 ir derv~ )in described. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 0~ne~ h=r J~ n ~n~ gl~.l~ ~, le~. Name of owner of premises ............... ~. ....... Z/....~ ........................ ~' If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Locationof landon which proposed workwill bedone. Map~°/[~'~''~''''~':''' '~'''~'''~''~'''lL°t~N°:~"~/-r,r .................... Street and Number ...... .~,~.~,....~,~y.e..~.....~,..~...,~,..o,],~,~,,~,,o,~ ........................................... ~ ................................. Municipality 2. State existing use and occupancy of premises and intended use and occ~par~c~ ~f proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy......9~'.:l.~.~...~wei3-:L~ .................................................................................... 3. Nature of work (check which applicable): New Building ......... ..~. ........ Addition: ................... Alteration .................... Repair .................. ~.Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost..~.Z...O.~.O...0..0..*..O...O. .................................... Fee ..... .~.~ .0. . :. .0. .0. . ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... .,5.. ..................... 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: Front ............................ Rear.~ .......................... Depth ............................ Height ............................ Number of Stories .......................................... ~ .................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front.......~..~ .................. Rear ......... ~..8. .............. Depth .......~. ................ Height ......].~...~'.~., ........ Number of Stories ..... ~ .................... 9. Size of lot: Front ..~.~..0..: ................. Rear ...... .~..CR..0. .............. Depth ........... ..]...0...b. ......... 10. Date of Purchase ..... ~..~.O.A,,...~..g..b..~. .......................... Name of Former Owner ....~i~.~..~......~?..]'..~.8.. ..................... 11. Zone or use district in which premises ore situated ....... .~...e.~.~.e...~.~.~..].. .............................................................. 12. Does proposed construcfsn V0ate any zonng aw, ordnance or reaulaton? ...... ~0 .................. 13. Name of Owner of premises...~..,~.~'~.~..z?-...e...~.~..]-..e..~....Address .....]..~...~..~....~..~...:1:.~....~...~..e. ....... Phone NO ..... .0..z'.....6....~.8.3.8 Name af Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor ...... .¥~..~...]..~.~..~..~....~-.e...]:..]:.~ .............. Address .....~..o...~.~..o.~..~. ..................... Phone NO...~...o.....b..~.?..~.G PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate a~l set-bock dimensions from property lines. Give street and b~ock numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE Of NEW_ YORK. ,- ,- COUNTY OF ..~..u:.~.~.'.b..]....~. ......... o ~. ....~.. .................. ; .... be~ng~ duly s~worn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ......... .~..o.D,.~..~..~.1;;.Q~'. ........................................................................................................................... (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 file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed the;rewith. / Sworn to before me this - ,, j~__~,~}~/~ ////~/, ..... ~ .............. day of .....~J~.O~ ....................... 19.....~.~' ~ ~. v,~ture of appl cant) Nota~ Public, .................. ~.~.~.~.~ ......................... Coun~ ;~. ~: ~ :-~,: :::o~k