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Home My WebLink About3874-zFOi~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICEI SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..~..3,~8.0 ............ Date ........ A~II~t:..2.~., ........................ , 19.61~.. THiS CERTIFIES that the building located at Mop No ....................... Black No ....................... Lot No. IJ~..~t~£QlJf,,...M~//...~.~ ................... conforms substontioJJy to the Application for BuiJding Permit J~eretofore flied in this office doted ..................... l~y...9., ............................... , 19..6l~. pursuant to which Building Permit No. 3.8~.~..~.. dated .......... EI~...9.~ .............................. , 19...68., was issued, arid conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ...... p~r..t va te · · ene ·. ~,a.$1. I/, · .d~e.l.1..ln~j .............................. i .......................................................... The certificate is issued to ..... ~,z'.thuzL.&..gele~..Shez'Jra~.li...(~r~elr~l .................................. (owner, lessee or tenant) of the aforesaid building. ...... /._}k:~...;;,::....: ........ : .......... .....: ......... .~. .............. Building Inspector ~ FORM NO. ~ TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ SOUTHOLD, N. Y. BUILDING PERMIT crHis PERMIT MUST B~. KEPT ON THE PR~M 545 UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne. 3874 Z Dote ........... ! ............... ~ ...... .~. ........... , 19..l~..~... Permission is hereby granted to: i at premises located at~l~..~i~.,~;~?~'...~'~ ............................. i .................. ................... : .................... pursuc~n¢ to application dated ....~......~i ............. ~i~ ......... ~..~.....~..;.., 19...~., and approved by the Building Inspector. Fee $ .~.~., .~.. .............. FORM NO. I ~ · TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examfn ~/[ 19...,.~.~ Approved ............... ~ .............. .[..(...., 19....~.~... Permit No.............................3 00 ? /~ ~ Application No...~.....~..?.....~. .......... Disapprove~ ~ ............................ 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 drOwn on the diagram which is port 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 sl~ll 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. ~ .A, ,.PPLI_CATIO~N !S HEREB. Y.MA_D~[ to t,h~ Bu. ilding Department for the issu~cince' of a-~ztlding Permit pursuant to the uua~ng Lone, ~Jm. mance at the town o~ ~outhold, Suffolk County, New York, and other applicable Laws, Ordinances or egu~ations, tar the construction of buildings, additions or alterations, or for removal or demolition, as herein descr bed. The applicant agrees to comply with all applicable laws, ordinancesy,jbuilding code and regulations. ( r~ ' / .... .~.i..~.. .................... :....:......-.~..v.....~.. .................................. V ~/x(~Signature of applicant, or~,r~am~, ifa corporation) ......................... ..... ................. State w~t i$ owner, lessee, ogent, architect, engin~r, general contractor, el~tri¢ian~ pluml:~r 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 wJ~:h proposed work will be done. Nlap No.: ....................................... . Lot No..' ........................ / ' .. . ~'- ;,, -- 1,., .,.~ ,.-,..~ ~,__ ,'", ,.'-~,, I~ Street and Number~...~.../~......./.~..~.../...~....~....~.`Z...~.~..~.~.~.~......~*~.~...~....~.~..~**.~.~.~...~....~..~..~..~..~ M(~nJcipality 2. State existing use and occupancy of premises and Jntended use and occupancy of proposed construction: a. Existing use and occupancy ~ ~' -~'/ /'b',~ ~ ~ ............. I1 eL/ b. Intended use and occupancy ................................................................................................................................. property lines· Give street end block number or description according to deed, and show street name~ add indicate whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................. Addition .......... ~ Alteration .... ~ .... Repair .................. Remo~ .................. Demolition ............ ~i¢" Other Work (Describe) ........................................ 4. Est mated Cost ~-~'-/~...' ..~.....~. .................... Fee .. . .~..'...~......~.. .................................................................. ~ (to be paid on filing this application) 5. If dwell!ng, number of dwelling units ............................ Number of dwelling units on each floor ............................ Ifge~ae, number of cars ..... . ....... 6. If L~s, ~mercial or mixed occupancy, specify nature and extent of each type of use ~.~...~...~.. · ~ i: ~'~' if Front ~.~.;...¢..~ ,t i- - ' ........................ 7. D~mensla~ot~/ting structures, any: ...... .......... Rear .. ~..¢ ;.~. Depth Heght ~., ..~.~. Number of Stores ...... ./. ................................................................................. jjjjjjjjj;jjjjjjjj;j .... Dimensions of same structure with alterations or additions: Front ......... ,~.~."..~.]i .............. Rear ....].~.!.?..~'. .......... Depth ......:~..'..~ ............... Height ~.F~..;..../..¢. ............ .N~mber of Stories ......./. ...................... 8. Dimensions of entire,pew construct on: Front ~..~...-..O..././. Rear ~1~"/- .~./~ D~,~t~ ~..c~ He ght/~.' /~. 7. Number of Stories / ~ 9. Size of lot: Front ../../.~.~...~'..~'.. ....... Rear ...... /../..~..:..~..~.. ........ Depth '~' ~ ~ 10. Date of Purchase ............... !, ii.i ............ Na me o; ' Former ' ~; ~' ~ Z7.2~.i~........L?..~'....,...4~..../~. 11. Zone or use district, n wl~iCbipremises are situated ....~.~.....~Z........?.cZ....~.....~..~/....~... i~ .... 12. Does proposed co)~struct on violate any zon ng aw, ord nonce or reaulation;~ ~"~ .................. ~ i~NameofOw~rofcremse~...~..~/~.~.JcA, ~'~'~4/~ZD ~"4~/~/ ~ ~'-'/~' ................. . P ...................... ~aaress /~. ............ ~.../-.~.:..~.~..% Phone No../~....K~..~..~..~.~. Name of Architect "'"jr'"'~' .......... ~/7'""7~/ ................... Address ...~7_,..;......y............... ....... Phone No ..................... Name of Contractor ~Z"P'"/)'"'4~'""~':'"~'"~'"~"~'?'-~-.-.Address".--(~..'~'.' .~.'"(~'..~/-~' 7u'.-~ ..................... Phone No..~..~..-...~....~...~./~ ~ PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-back d~er~rn [- STATE OF NE'Wc~DI;U¢,~ COUN~ Of ..~....J~'~' - ~ ~ ..... ................. · ;~; ............. bein~ duly sworn, d~* ond *o~s t~t ho i* th~ opplic~nt ~ame of i~i~al signing ~plicati~n) above named. He is I (Contractor, agent, co~orate officer, etc.) ~f sa[d~owner or ~ners, and is duly authorized to perform or have performed the said work and to ~ke 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 fo~h in the application filed therewith· Swam to before me this .................. ....... .......... .................. ... NoraW Public, .~.~-.~~oun,"'~" '"~:' ~"re of a~¢"c~ : ....... N~ RV pUC1 lC' Sta~~ ~o. 52-3233~20 Suffolk Count~ Term ~pires ~rch