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Home My WebLink About1029-zFORST 1'~;0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. CERTIFICATE OF'OCCUPANCY No...$.~.6..~. ............ Date ......................... Oc.toher.._.2 ...... 19.6Q. THIS CERTIFIES that the building located a~ ........ .1~.~ ....IlXdta~l...N~,¢k-.Lar~e ........Street Map No .......XX~ ........ Block No ......... ,XX......Lot No ......~ ........ PO~01¢1t~.....]~$~ .......................... conforms substantially to the Application for Building Permit heretofore flied in this office dated ....... ,,.....Ap~..~],...-.~} ............ 1960... pursuant to which Building Permit No. Z...lO~.~ ........ ~lated ................... Aple:~1.....11 ...... 19.~.0.., was issued, and conforms to all of the requirements of the app!ieable provisions of the law. The occupancy for which this certificate is issued is ............ P.r.i.v.a~e...one...f. ami. ly..d~e~l.in~ ............................................................................................ This certificate is issued to .....Al~oe~.?6..$aG(lo ........ 0wlte~ ................................................................ (owner, lessee or tenant) of the aforesaid building. FOI~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1029 Z Dote ............................. ~:~Z'.:J.]... ,~. ~! .......... 19..6~. Permission is hereby granted to: ,~..t..e. ~ ..o~...e..,... ~...e~.....~.o..:.~. ................................. to ... ,~..~..a...:.a..e.~...o...a...e....~._a~..~r...~.~ ~ ................................................................................... at premises located at ?..,/.,~....~.~..~,~..,a~,,,.~,,,~,,~ ,]~,.~.~.~.~.....~,~..~.~.~ .............................. pursuant to application dated .................................... ~.~...'~ ...........19..~.0.., and approved by the Building Inspector Fee ~.~t.,,~ ,..~.~, Building Inspector - FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .............. . ./~'~', ~.. .......... ] 9 x~..f.~..c~d.d Per m ~ t No. Disapproved a/c .............. ;':z';'~' " __~_ . ~ ......... Application No ....../.~ .~.. ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 coYered 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 p art 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 issuanae of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southo~d, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or nome~ if o corporotion) ............... .... (Addre(~ of applicant) f State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of prem,ses......~........~..~-~' ' / * ' ' *"~" ................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of [and on.which proposed work will be done. Map No: ....~.....s.../...~..../~...~.... Lot No: ....~ .............. Municipality 2. State existing use and occupancy o[ p~emises and intended use and occupancy of proposed construction: e. Ex/sting use end occupancy....L~.¢.';;.L=;..~.'~...-..~..~.;~;.~<<.~....;'..: ...................................................................................... 3~ Nature of work (check which applicable): New Building......~.. ........... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost........~..£../. ............................................. Fee ~ ~ ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ......~ ............. Number of dwelling units on each floor...../.72:~:.%~,~ ....... 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 ........ c~T....Z ............ Rear ........ .~.:..~.. .......... Depth .....~....o. .............. ~, f ~,..~..~.:~ ........ Height ...../....7. ................ Number of Stories ........... 9. Size of lot: Front .... /....~...,~::./. ....... Rear ...../..f~....2 ........... Depth ..Z..'-~.~.f?. ............ ~'~.~C ' -in which 3'''~ ~, Fr r /~~ ~...~'! '~ ~ .~..).. 10. Dote of Purchase ........... ./..~.. ~.. ................. Name of o met Owne ,. .... ..~.,,W. 11. Zone 12. Does proposed construction viol~t~ any zoning law, ordinance or regulation?U ..... ..~..~7.....-:' .................................. 13. Name of Owner of premises).~l.:.~.~../~'~'..~...C.~..~.~z...Address ~-.'.c..u.~:~.~.~..~...Z?.z.'.~'.[..~....: ........ Phone NO ..................... · ' ~,~)f-~ ¢ ¢~ 0~.'~-'~'~-~-~,' "~'~ ~ Phon O Name of Architect... '~.... .............. .~......,~...,'~ ................ Address ........................................... e N ..................... Name of Contracto ..~.."~:.'..~..~.~.~.7 ............. Address ~.)z.~.,..~.~,.~.,,,. ,,~ .~...'~.,_,~. Phone NO~.¢..~..o~.,t'.~.-.Z,~- 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. /~k? ' STATE OF NEW/~'(~R~K.,~ S S COUNTY OF ,~Z~.., ' .~ ................................................. duly deposes and says that he is the applicant (Name of individual signing application) above named. He is the.....~ ...................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized ta perform or have performed the said work and to make end 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 appli,,c, otion filed_~tberewith. Sworn to before,me this . ............ Z~.~day of ...........~~... 19....~ .... ]u,~[" (Sign.ture of appl.cant) ~t,,, P,,hlir ~,.