The URL can be used to link to this page

Home My WebLink About3993-zFORM NO. 4 TOWN OF SOUTHOLDi BUILDING DEPARTMEN~ 'I'OWN CLERK'S OFFICE SOUTHOLD, N. Y. OEI~TIFICATE OF rICCUPANOY THIS CERTIFIES that the building loc.areal at .. ~/e$.t~ .L4~e.-D~:;I, ve ......... Street Map No. ¢fld~ ..... Block No ............. Lot No.. 141. &. 142...Sou*;hold,..N..Y. · l~each Paa~ conforms substantia y to the Applicati.on for Building Permit heretof,ore filed in this office dated ..... Atlg~l~t:...16., ...... , 19.68. pursuant to whi?h Building Permit No. 3.993..Z. dated ..... /~.~IcJ~it~.~;...~,~, ....... 19. ~5.8, was issued, anal conforms to all of the require- ments rOf the applicable provisions of the law. The occupancy ~or which this certificate is The certificate is issued t,o ....~o~r~.~}~l~ ....... ' ................................ (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Hea]th App.roval ...... ./?)' ......................... FORM NO. ~ 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? 3993 Z Permission is hereby granted to: .~.~...~i~m~.. AZ~.... ~. ~ ..~,~ t,~e .... at premises located at ..... ~l~l~.....~..It~,...~...~..~.~.....l~Ji~J~ll&t~..~ll~JJ. ....... ~: ................................ ......................................... Iie~..l~Im..~..&..&..l~..~ .............. ~ ................. pursuan~ to application dated ........................ ~ ............it& ........... , 19...~J), and approved by the Building Inspector. Fee $....~..(~.~. .......... BUILDING'DEPARTMENT · TOWN CLERK'S OFFICE )~/ ~/~ SOUTHOLD, N. Y. A~li~tJ~ No ..... ~,~.~.~ ........ Disapproved a/c ..'...~ .............. ~ APPLICATION FOR BUILDING PERMIT Date ....................... 1.~...~..... ~ &. ............ 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 t6 the applic;~nt. 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 part 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 a Building Permit pursuant to the Building Zone Ordinance of the Town of Southotd, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, 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, housing code, and regulations. // ~ '"- (Signature of applicant, or nome, if a corpo~"~i'~i ......... (Address of applicant) State whether applicant is owner, lessee, agent, drchitect, erilgi.neer, general contractor, electrician, plumber or builder. ...................................... ....... i ................................ ........................................................................................... Name of owner of premises ......... ..-'~.?...~...~.. ........ .(~..~.~.[.~.+.~....~.. ........................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which reposed work will be done. JV~ap No..~.!~J~I~.~C~..CJB...~.~3.~. Lot No.: ./.~..~...~.~..~..~.... Street and Number .... ~...~..~.~,.1~ ......... ..~...~...~.~..~ ....... ..U~..."~'.~T...~.~.~...~-...~......~:,.y..~...~mL~. ...... ,....z ............... Municipall~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ............ ~ .................................................................................................... ..... ...... .............................................................................. b. Intended use and occupancy / 3. Nature of work (check which applicable): New BUilding .................. Addition .................. Alteration .................. Repair ................. ~Removal .................. Demolition .................. ,Other Work (Describe) ........................................ 4. Estimated Cost . ...q.~...~.~..0. ~. ~.O Fee ~ 0r~ .. (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 ...... I.~ ............ Number of Stories ..... ! ........................................................................................................... Dimensions of same structure with alterations or additions: Front ........ ..~.~'.!. ................. Rear ..~7..?,.: .................. Depth ................................ Height ......... I...~.. ............. Number of Stories ..... 1 ........................ 8. Dimensions of entire new construction: Front ......... ..~...~'....J. ................ Rear ....... ..~..~'...r. ........... Depth ...~....~../'. ............. Height ...I..~,.. ............ Number of Stories .J .................................................................................................................. 9. Size of lot: Front ....'~L..{:?~... .............. Rear .~.....o~.... ........................ Depth ..~..o..,O.. ..................... 10. Date of Purchase ........................................................ N.ama of Former Owner ..... .~..:....(~.~....~.~.~.~..~..6'.. ................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate~, any zoning la~v,, ordinance or ragu at on? ~J..~. ............ Name of Owner of premises D~..~. ~.~.~'~ Address ~....~..q_e,, ~.~...~.~.~ ~'~hone ~ ...................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~..~...vg...~...~...D........~...;..!!.~:.o...~...~. ...... Address ..~'~.~..~.~.~.. .................Phone No.-?..~..~..'..~...c~....? 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 descr!ption according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ! e e cOUNTY OF ................................ r"'"' ....... ........ ¢, ....... , .t~.~...~,..~. .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) , above named. He is the ............... "......~'Ct,.~....."~C~C..'.~.~ ................................................ i ................................................ (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 conta:ined 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 ....... I ............ day of ....~.. ............ ,.~ ............ , ~.~.~'. J n,,-,nn · ..... xr . ' .,,,.. ...... ................. HoTary FUDIIC, e..~...'~R':%.......~...~...;..~.....J..~unty (Signature of applicant) MARION A. REGENT /'/ - -- NOTARY PUBLIC, State of Flew Y0r~ ~ Fla. 52-3233120 Suffolk County. Term Expires March 30, ~9..~ ~'