HomeMy WebLinkAbout3895-zFO~WI IgO. 4
TOWN OF SOUTHOLD '
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE: OF OCCL PANCY
No..~..310D ............ Dote ........... i..At, I~UlI.~,...~t.7.~ ................. , 19..6..8...
THiS CERTIFIES that the building located at ~lJ~...J~JJ~.~lJJ...J/JJl~l~. ................................... Street
Mop No..291P, ........... Block No ....................... Lot No. ,~.9. {{.~11.~,~..[..~. ,...N....~9.,..~..o..:..k.. ...................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
................................. ~I~,~..2D, ................. , 19..6J[. pursuant to which Building Permit No.:~.l~.~.~...~....
dated ...................... 1/~.~...2,~., ............... , 1968..., was issued, o~d conforms to all of the requirements
of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........
The certificate is issued to ...{~,...~..~V~IA...~,~i~.JH~.~I..~I'.~.~....[~.~.~..~.). .............................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
FORM NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Ye
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 3895 Z
Permission is hereby granted to:
..:~L3,;,~..~.~;L~La.,~.j.~.....~m~',~-,e..~al~:t~' & ~tfe
............ ~u~mi~ ................................................
at premises located at ....J,O.t,..~ ....... ]~%jL.,~er~ .................. ................................ ; .........................
....................... .l~,3P~e~..:[,~ ....... ~o~t,J~oZd...~,~:~, .....................................................................
pursuan¢ to opplicotion doted .................................... i~.. .......20....., 19...~, and appro¥od by the
Building Inspector.
.Fee $.~.~)[~. .............
Building Inspec
3. Nature of work (check which applicable): New Building .................. Addition .:Z, .............. Alteration ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................
4. Estimated Cost ...~]~i~{).,~O~ ................................... Fee ..........................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units .............................. Number of dwelling units on each floor .......................... j.
If garage, number of cars ............................................................................................................................................ ~.
6. If business, commercial or mixed occupancy, specify natureo,nd exten~ of e~ch type of use ................................
7. Dimensions of existing structures, if any: Front......~ .............. Rear ....... .~.(~.! ............ Depth .....L.L~.I. ...............
Height ...1.4! ............. ~ ..... Number of Stories ....,3, ......................................................................................................
Dimensions of same structure with alterations or additions: Front ...?/~ ...................... Rear ..?13.1: ...... : ................
DepthoIl~..~,~.O..~.~/.l.. Height ....... I_~.1. .................. Number of Stories ............3, ..........................
8. Dimensions of entire new construction: Front ................................ Rear ............................ Depth ............................
Height ............................ Number of Stories ..................................
9. Size of lot: I~ront ...... 3:~ .................. Rear ...... ]r.l~l~ ............... Depth .....~;~ ............................
10. Date of Purchase '"'ll&'/""];~ ................................ Name of Former Owner ~1'~"~I~'~11 ...................................
11. Zone or use district in which premises are situated ................ l~l~O~l~ltl3~.~&~ ......................................................
~2. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~.~. ..........................................
13. Nome of C)v~'~°fl~ll~ll,~..~]~l.L'~l~,~3Jikll&,ll~t~.~lJdress ..... !~,..~,.~1113, ................. Phon~l[~.~,t~.~..~. ....... ;..
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ........ ~.~t'~i.~"~.'~l~ ............. Address --.~-.~ll~l~l. ................... Phone No..?~,~,.~,~
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail set-back dimensions from
property lines. Give street and block numbers or description according to deed, and show street names end indicate
whether interior or corner lot.
STATE OF NEW YORK. )
COUNTY OF ..~.~..~'~.~,,~ ......... ) S.S.
~J
................... ~1~.1-~,~1~,...~1~.1.~. .............................................. being duly sworn, deposes and says that he is the applicant
(Name of indiw~Jual signing application)
above named. He is the ......... ~l~,~l~ ................................................................................................................................
(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 app-l' cat on filed therewith
Sworn to before me this .~¢,I[.~ ~ot~ '
........... ..~..~...~..~.... day of ......
Pubhc,~,~..~' ~o~,-~, ~>~ ':':'~.*~ ..... ~' ..........................................................................
Notary
..................... ~o;.~oo~ug;tV~'¢' (Signature of applicant)
3. Nature of work (check which applicaNe): New Building .................. Addition .X .............. Alteration ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................
4. Estimated Cost ...tl~l..~00.~)~ ................................... 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 natureand extent of e'ach type of use ................................
7. Dimensions of existing structures, if any: Front......r/0~ .............. Rear ....... .~0.I. ............ Depth ........ .~..[~. ...............
Height ...~! ................... Number of Stories .... ~ ................................................................................. : ....................
Dimensions of same structure with alterations or additions: Front ...~O.~ ...................... Rear ..~'......; ................
Depthol~..~.llO..~L.~'/.I.. Height .......1~.1. .................. Number of Stories ...........']' ..........................
8. Dimensions of entire new construction: Front ................................ Rear ............................ Depth ............................
Height ............................ Number of Stories ..................................
9. Size of lot: Eront ...'.i.~;~1~. .................. Rear ...... ~:t~ ............... Depth ....~[~ ............................
10. Date of Purchase '"'~'"~l~tJ? ........................... i....Name of Former Owner ~'lll'~"~'~l,"l:lil ...................................
11. Zone or use district in which premises are situated ................ ll~ll.~l~l~,~.&~ ......................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~.~..~. ..........................................
13. Name pf Owl~lltoof~l~rn]~o...~.~.~:~,l~,~..~R~l~,~dress ..... ~1~...~.~.1~11. ................. Phon~'~?~.~.~ ......... .
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ........ l¢.~,~.',~1~1"~;~1~ ............. Address ...~ry..~r~l't. ................... Phone No.
PLOT DIAGRA,M
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property Pines. Give street and block numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW_ YORK, )
COUNTY OF ..~.~..~..~.O..~,~. ......... ) S.S,
................... W.'t],~.,~.~...tltl~l,.1.~i, .............................................. being duly sworn, deposes and says that he is the applicant
(Name of indiwSual signing application)
above named. He is the ......... ~B~d~F ................................................................................................................................
(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 statemen[s 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~e ap~fication filed therewith.
Sworn to before me this
............ ~,.. day of ......
.~ ~ __ ~ ~ '~ ~.~ c~ {/~,~-~ ...................
Notary Pubhc~.,~ .................................. ~v¢-~u~. '' (S~gnature of apphcant)