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Home My WebLink About3841-zFORM ~0. 4 TOWN OF SOUTHOLD BUILDII~G DEPARTMENT 'I~'OW'N CLERK'S OFFICE SOUTHOLD, N. Y. OEI~TIFIOATI~ OP O00Ui~ANO¥ No.Z 3100 Date ~Tutle 10 1968 THIS CERTIFIES that the building located at . .]~/.S. A{3k~l'l;g..P~t(t. ~ .... Street Map No..~ ....... Block No...~ ...... Lot No..~ ..... ~~ .~ ....... conforms substantially to the Application for Building Permit heretofm'e filed in this office dated ............. April.. lO, 19. ~8 pu.rsuant to which Building Permit No.. ~.~'~. dated .......... *p.~$~... 2~.., ~9.~, was issued, and conforms to all of the require- ments ,of the applicable provisi~ons of the law. The occupancy }or which this certificate is issued is. P}:~Y~}P.. { ?..~RrY)..~:~$J-!~g ........................................... The certificate is issued t,o . .~. ,~9~9~., ....... ~... ~ ..................... (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Approval P.~.!Pg ................................ ...... ..... 'r:L 2...V... Building Inspector House ~ 27k0 FORM NO. S TOWN OF SOUTHOLD 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? 35~1 Z Permission is hereby granted to: to ~,~.,,...~:.,,.~.~.m~...~t~.:,.,,.~..~....a.,,~,:~,,~,,,~.~.g.~.....:.....: .......... pursuo~ to opplicofion ......... Building Inspector. FORM 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWi~ CLERK'S OFFICE SOUTHOLD, N. ¥. CERTIFICATE: OF OOOUPANCY THIS CERTIFIES that the building located at .I~. f.~...A?.k.??.~.~..P..o?l.d...~.a. ..... Street Map No....v..~.. ..... Block >~o .... ~ ...... Lot No ....... .~..... ~.0.u~h..o.l.a.,. ?.:~: ..... conforms substantially to the Applicati, on for Building Permit heretof~o,re filed in this office dated .......... .~.p.r.~.~... J. 0..., 19.6.8.. pursuant to which Building Permit No...~.~..~?.Z.. dated ...... .~1*~ .... 2.1:} ...... , 19.6.~, was issued, and conforms to all of the require- me.nts ,of the .applicable provisi, ons of the law. The .o.ccupancy for which this certificate is issued is . ,P.r..i.v.a..~.o...ag.q .e.s.~.9?y...b.u.i.~.d.~..rig..(.P..ar.t. 9.f...~.a.b. 97...e.a.m.p.)...o.n..pr.e.m..i.~.o..~ Steve Dot,ski Ownel, The certificate ~s issued t,o ................. . ...... .................. ' ................... (owneL lessee or tenant) of the aforesaid buHdinE. Suffolk County Department of Heaith App~ovai . .p.e.n. 8._.l.n.g .............................. FOIP~f NO. 1 ~TOWN OF SOUTHOLD , BUILDING DEPARTMENT ' TOWN CLERK'S OFFICE I:xamined ........ .1~...... ........................ ~ ....... Approved ........................................ , 19 ....... ./ Permit No ........................... Disapproved a/c ............................................. .... " %~,.~..~.~..~' ......................... APPLICATION FO~. BUI~DING PERMIT Application No.....~.¥./....~.~.¢/ 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 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 or in part for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southoid, 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 name, if a corporation) .......... Midd!e..l~oad ....... Southolc% ................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises "J~,~V~'"]}O~'O~ ................................................................................................................... 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.: ..... ~ ............. Street and Number "~/~"~e~"~'"~ ............ ~O~ ....... ;T'":".'"';W ........................................ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~e.~.~..~.~ ................................................................................................... use and occupancy ........ Qlte...~.~&.%~...~e&.~.~.~..~..~..~..~..~/~...~o~~_ ........... b. Intended 3. Nature of work (check which applicab!e): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolitian .................. Other Work (Describe) ..... .~..~.~.~....~.~4[[ ............. 4. Estimated Cost ... ~..,~.~ ........... .............. Fee ..J]..0.,.g..g.. ........................................................................... (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 an~: Front ...]~0~,.~. ............... Rear ......1~-*.~[ ................. Depth .......~0~.. .... Height ........................ Number of Stbries ..... ~1~.O ..................................................................................................... Dimensions of same structure with a,Jterations or additions: Front .................................... Rear ............................ Depth ................................ Height '. ........................... Number of Stories ................................ 8. Dimensions of entire new construct!on: Front .................................... Rear ............................ Depth ...,~ ................... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ...~lg0...+. ............ ~ Rear ...... .1OO..~ .................. Depth ..... $~..~...+. ............... 10. Date of Purchase ........................... i ............................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..... !!,g~..~t..~.Jt.t, ............................................................................ 12. Does proposed ~tonstruction violate dny zoning law, ordinance or regulation? ............... 1:1.O ........................................ 13. Name of Owner of premises fJ.~,.~t~.~'..J).OZ'.Cl~k~ ......... Address .......80.~b.o,~.~ .................. Phone No ..................... Name of Architect ....................... ............................... Address ............................................ Phone No ..................... Name of Contractor ..]¢J~..~:~.%~:..}.lLo~,~g..J~]~'l/~,~l~ddress ....... ~&t,~:J..~.~ek ............... Phone No ..................... PLOT DIAGRAM ~ j~,,'~\ Locate clearly and distinctly all buildings, whether existijg or~ I~ff~:)~i' ~nd i~icate all set-back dimensions from property lines. Give street and block number or descriptio~Jacc~Jng/to deep,nd show street names and indicate whether interior or co.'ner lot. ~/~ ~ '~ ~ ~, STATE OF NEW YORK COUNTY OF ................................. J~.g~.~..~..~.D~.~.~ ................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) abow,~ named. He is the ....................... .~..~...~.~..~. ...................................................................................................................... (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 a~lication filed therewith. Sworn ~.~t° before dayme thiSof ~ :~..~..~. ~' 19..~.~. ~'~~ ~ ~ ~ Notary Pubhc, ...,..d~.(,.:.,;/,.Mf~ ....... '..~,[~)..¢~6~'.:~. County ,--(,I-/~ ,~ J~ (Signature of appbcant),