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Home My WebLink About4123-zFOI~H NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOL~ N.Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...~,(i~tl~..&.~.,,..~l,l~...(.]~.~.~..~..~.) ......... Street Map No..~ ................ Black No. _:~ ............... Lot No. ,]I~II~....F~;t;..]~it~.[OZI....]~'~,~.~ ................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................................... '~O~' ....... 8. .......... , 19..6~. pursuant to which Building Permit No.b:,.~4~..~.. dated ................... ~I~ .......... ~ ............... , 19...6~, was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ .......... ~.r..$..v.~..t..e._..o...n..e......f.~.~..z.~....~..e..z..z...t..n..~ ....................................................................................... The certificate is issued to .}~,~...~.~.].~l,~...~.~,l~. ............... I~..~. ........................................... (owner, lessee or tenant) of the aforesaid building. House # 5~5 S. La / / , ~-:- .............. :...!..~.:...: ................. :: .............. t. ................... Building Inspector ( FOltM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4123 Z l~ovonbe~ 1{ i9.....6..,8 Permission is hereby granted to: J~o~.~.. ~,~..~{~.~J,.... AY~;.....O~I~J~o.. ~1~ ............ 2{~1~3~ ................................................ to ...~.~ .~._~...~,{Z ..{{~(~ ,~,~,;LO~..QiL~,Xt .. !~,~{~ .~,~l~t {{...~ ...................... i ............................. at premises located, at ....~{lll~..&...'T.~l~..{i~dl~ ...... ~../~ ............................................ ................................... · es&..l~e~ ...... ~,¥, .............. : .................................................................. pursuant to application dated ............................. {F.~¥ ....... ~ .............. , 19...(~, and approved by the Building Inspector. Building Inspector / Approved .., 19 Permit No. t~ Disapproved a/c ............................. A ~ "' I "F'~-~ '"""~,'~ '" Od'~/ APPLICATIg~N FOR BUILDING PER · f~-~ ~ Date ' ' . ' .. ]/.QY~I~0~... 8 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 ~r 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 B~ilding Permit. d. Upon approval of this application, the Building In specter 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 o~ in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspe~to~:. APPLICATION IS I-IE~.~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Soathold~ Suffolk Oounty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as h~rein described. The applicant agrees to corn ply with ail applicable laws, ordinances, building code, housing code, and regulations. Robert L, Hyatt (Signature of .applicant, or name if a corporation) Southol~ N,¥. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or ~ Contractor builder ................................................................................................... ~ Name .of owner of premises ...~.~.~.8....G.~..b.~. ....................................................... ~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.....~.. .......... Lot No....3~.. ........ 2. S~te existing use and ~p~ of p~mi~s ~d i~end~ ~e ~ ~p~ of ~ ~ction. a. ~ist~g use ~d ~eup~cy ................................................... 3. Nature of work (check which applicable): New Building ........ Addition .~.. Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. EStimated C~st . .3.,.Q.0.0, .+-. ................... Fee .. ~.~..0~.. ......................................... (to be paid on filing this application) 5. If ,dwelling, number of dwelling units .O..I1.~. ..... Number of dwelling units on each floor .............. If ~arage, number of cars .... !1~ ................................................................... 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 ........................................................ Dimension's of same structure with alterations ox additions: Front .............. Rear ............... Depth ................ Height ................ Number of S~ories ..................... 8. Dimensions of entire new construction: Front . .. 2.~. ........... Rear .. ~br. ......... Depth . .. ~0~ ..... Height ............ Number of Siories . .O~ ........................................................ 9. Size of lot: Front ...1. Q.0. + ...... Rear .... ..1.qQ.._+... Depth ..... ID0..+.... 10. Date of Purchase ............................... Name of Former Owner ............................. '~in dist ~L ~o~e ~r use district in which premises are situaled .................................................... ~2. Eloes proposed construction violate any 2onin~ law, ordinance or. re~ulatkm? ...... l~o .................. Name of Owner.0l prera~ses (}., .Dali ............ Address ...................... Phone No ........ Name .of Architect ............................. ~ddress ...................... Phone No ............ Name of Contractor .R.:..H.y.~.$.t ................ Address ....S..o.~t.h..o.e.d. ........ Phone No ............ PLOT DIAGRAbl 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 accordin[~ to deed~ and show' street names and indicate whether interior or corner lot. ~ STATE OF I~ 2f..Ol~l, ) S.S. COUNTY OF ?..1~..I.o...~. ..... ) .............. .R.o.b..~.1'.~...L.: .H. ~.~.~..t. ..................being duly sworn, deposes and say~ that he is the appli- (Name of individual signing application) cant above named. He is the .. ;~. ;:.~.Qlkt. l~.0.~9~. ......................................................... (Oontractor, agent, corporate officer, etc.) of said owner ,<~.,~wners, and~is duly, authorized;to perform ~r have.perfi:wmed ,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 fort~ in the application filed therewith. Sworn to before me this .8 d6y of ..... ~.O.V..~.~ .b~... 19...6.8 ...........-Y, -- ' _;..._....j....: .... .... ....... // ................ Notary Publi~,~t~; (Signture of applicant) NOTARY PUBLIC, Stj~ ,~, : /,/ - No, 52-061810BffSuffnlk Cour~t_ / / Commission ~xp~ras Marcl~ 30.,