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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)