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Home My WebLink About1447-zI~OB~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTI,F~IES that the building located at,.~/~..I~..l~,O~,¢} ........... ......................... Street Map No.~..~:..,.,~:.: ....... Block No ..... ~1~ .......... Lot. No..~ ........ :...~'~.t~.te~J.~.~...][~.,v"~..¥ ............ conforms su/bMontlally to the Application for B0'ilding Permit heretofore fi[ed in this office dated .................................... 3'~.~.no.....~ ........... , t9..6.~. pursuant to which Building ~ermit No...~1~..~.~... doted ....................... ~111~.....],.~. .......... ~ 19.~L., wes issued~ and conforms to oil af the requirements of the applicable provisions of the law. The occupancy for wh ch th s cert f cot~ is issued is .......... .......... ........................... . ........................ This certificate is issued to '"1~0 ",T'~c"~ ' (own e or tenant)" of the aforesaid building. TOWN OF SOUTHOLD B~/Jl-DING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ~ ~ ~--~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This opplication must be completely filled in by typewriter or in ink ond submitted in duplicote to the Building Inspector. b. Plot plan showing location of lot end 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 Bu'ilding Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shell 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 port 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 issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of So~thold, Suffolk County, New York, and other applicable Lows, 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 oil applicable lows, ordinances and regulations. Robert L. Bergen (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... :~.~ Robert L. BerEe.n.. ...................... Name of owner of ~, ...................................................................................................... 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: .ZY,~QC ................................ Lot No',7,.7,~ .............. Street and Number ~.~../~.~.~.~..D.~..~..~..~.~..-...e..]~..~.~..2..~...~..~.~..~./.~.$~Q.~.~E.~a.~.~.~.~ ............................... Municipality 2. State existing use and occupancy of premises and intended use andloccupancy of proposed construction: a. Existing use and occupancy ....... 'za. ca.s'~.t..Z,~.T~ ................................................................................................... b. Intended use and occupancy ........ ~..u.~..~..~.e...s.~....]~,~.~l,~ ............................................................................... Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair ................. Remova ........... Demo t on Other Work (Describe~ Move building to Estimated Cost ....... Fee $ ~:Q.,.0...0. (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....~USJ, r~.$. ...... Dimensions of existing structures, if any: Front ...... Z8 ................. Rear .......... ~. ............. Depth .,....2.~. ................ Height ............................ Number of Stories one Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ Dimensions of entire new construction: Front ............ ' ................ Rear ............................ Depth ............................ r Height ............................ Number of Stories ............................ Date of Purchase ........................................................ Name of Former Owner. ....................................................... Zone or use district in which premises are s~tuoted.....A../.~ ....... C]~S.~ ................................................................ Does proposed construction violote ony zoning law, ordinonce or regulation? .................................................... Name of Owner of premises..~,.L.,~.~.g.~ ............. Address ...... ~.ti.~UCk ................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all setlback dimensions from property lines. Give street and block numbers or description accord ~g to deed, ~d show street names and indicate whether interior or corner lot. STATE OF NEWsYQI~K~ ) S S. COUNTY OF ..... ..I~..~.Q,L~ ......................................... ;.:.~.9.'~).~..~..~....~,...]~e~l.~el~.....; ........ being duly sworn,.deposes and says that he is the applicant (Name of individual signing application) above named. He ' o~e~ is the .......................................... ~ .................................................................................................................. (Contractor, agent, co,orate officer, etc.) of said owner or owne~, and is duly authorized to perform or have per~rmed 'the said work and to make and file this application; that all statements contained in this application are tree to the ~st of his ~owledge and belief; and that the work will be performed in the ~nner set fo~h in the eppli¢~ filed th~i~ Sworn to before ~e this ~,~I // ' j~ / ,I ~ ~ _ ~ - av of -- .~. .. ~[~,.~tate ~f fl~ Ye~ ' (Sig~a~e of a~plicant) .............. ~.~.... d ......... ; ........................ ~t~:~.-: Ik u ' :ant)~/ Nota~ Public, ...~~~F~lr~h S0. I~&D