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Home My WebLink About2896-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located ot .~/j~....JJl~,~&t;e~.s...1;/Dad ...................... 'Street ~aassau Poin~ Club Prop p No .......................Block No ........ XX .......... Lot No .... 30.~,~..-..(~.~hOg~,.~,~ ~'~.,~,9. ........ ...... conforms substantially to the Application for Building Permit heretofore filed in this office doted ............................... .0C.to~eJt.....~ ........ , ]9..~.~'. pursuant to which Building Permit No..~..8..?..~.....~... dated ............................... O0.t,O~le...~l.., 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,i. ve~e...one...f, am$1.y..~wel.t~m~ ......................................................................................... The certificate is issued to ......... ~e~1~..O/:~lz,~d ......................... O~q~. ................................. (owner, lessee or tenant) of the aforesaid building. H.D.Approval March 30, 1966 by R, Vill~ ........... ....... ' Building Inspector / FOP. M NO. 2 TOWN OF $OUTHOLD 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? 2896 Z Date ........................ Oatobe~. ....... 11 ........ 19...6~ Permission is hereby granted to: ~k ..Z~:Le zk~.....~g...Zo~x ..C ar~d .......... to ..., MO.v~.. &n..~u.. eocl~t~-~g...d~e2,,1 ~,'~.. ~ud.. make., ad~ ~ f~Lons.. &.. J~.tera f,t.on~ ..... at premises located at ...... ~.~t..30~.t......N~sjeu...l~l.n~..e.~.u~..pl, op .......................................... ................................... ~:~e~. a..l~d ............ Cut~ho~;~ ............................................................... pursuant to application dated ............................... 00.~...]..~ ................ 19..~., and approved by the Building Inspector Building Inspector k FO~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. E om, ed ......... ......... Approved ........................................ , ]9 ........ Permit No ........................... Disapproved a/c ................................... .--'"' ~-~.':...~-'~/ ---~'"~ ....................... (Building Inspector) Application No. ~:Z..~....~-....'.'... AP,LIcAT,O, FOR BulLD,NG ,erm,t Date ......... ~?-~....~..~...¥. .............. /./. ........... , 19...~..~..... 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 application. 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 port 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 issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southald, Suffolk County, New York, and other applicable Laws, Ordinances or Regutations, 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, building code and regulotions. .................. (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. Name of owner of premises ........... ...~.e....~...~ ....... ~.£:.~....~.~...~.. .................................................................................................. If applicant__s,,/ '~ _~--?~/is a cor[ior):~ signature of du? authorized officer. (Name and titl~ corporate officer) 1. Location of land on which proposed work will be done. ,Map No.: ........................................Lot No.: ..~.....~ .......... Street and Number ~7.~ ~, -- ~ ~ ~;,~ ~unici~lity 2. State existing use and occupancy of premises and intended use and ~cupancy of proposed construction: a. Existing use ond ~cupancy .............~ ~.~ .......¢~.~.¢.~.3 ............. ~ ~.~J..~ ............................................................... b. Intended use ond ~capancy ................................................................................................................................. 3. Nature of work (check which applicable): New Buildir~g .................. X Addition ......... ....... .. Alteration .................. Repair .................. Removal. .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .........././.....~./.~.~.~.~:..~.0. .......................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... ./. ............... 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 ...... .~...}t..~.......~....~.CF.~.. ................................................................................ Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height Number of Stories 9. Size of lot: Front ....... /. .~..('. :. ........... Rear ........... ./.~.~ ................. Depth ................................ ~)~0~ ~/, - ,~,Y~ ~', ......... /..~..~...~.. ................................... Name of Former Owner ..~..././~. ...................... 10. Date of Purchase 11. Zone or use district in which premises are situated ....... ~..~. ~ ~ ~. ~...~. ....................... -- 12. Does proposed construction violate any zoning law, ordinance or regulation? ............... ..j~....~. .... 13. Name of Owner of premises ....~.o...~.~......~..o.~.~..~. ........... Address ....~..~..~.......~?...~..~. ................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ................................................... Address ............................................ Phone No..~..~..~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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ c c COUNTY OF ................................ f .... · --~.-~-~/(' ~ '~" /'~'~" ........ being duly sworn deposes and says that he is the app cant ................. ......... above named. He is the ........................................................... :~ ................ (...~.:~..~.~.....: ...... .~..L..~..~ .................... (Contract~,~c~ent, 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 therewith. Sworn to before me this . .......... .*J.(~ ........ day of .~ ...... ~~... , 19"6 ~") ~ //'~ ~'~ /'~ . .. ,--/, ,/j. _.' ........... ,~otary ru~,~r,l~....~..:../Z.(~,~.~y~n.~yft~ij .' 0~ (Signature~f.~'pplicant) .......... SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit TO 34ROM IT MAY CONOE~: The sewage disposal facilities for a structure located at have been inspected by this Department and found ko ~e satisfactory. DiStrict Engineer" ' '"''