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Home My WebLink About4574-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No.. Z.~)+? ..... Date .............Ja~....~.7. ..... , 19.7~. THIS CERTIFIES that the building located at 320 l~I,%%~r.S. Ws..e.t I~ Street o Map No. Nassau .,a~m~lock No.(.1.°.t...~...~. o~.. ~.t .}2. a. ~3 .... C..u.t.e.h..o .g~.... conforms substantially to the Application for Building Permit heretofore filed in this office dated .........D~c · · g ...... , 19 69. pursuant to which Building Permit No. ~57.~.Z.. dated .......... DsO ....2 .... , 19.69., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .Pr~.~ate. one. £amtl~..clw~ll~n~ ....................................... The certificate is issued to . .Mab&&le. D~mpewolf. ...... O~nsl' ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval '~l~t'' ~b~ .. ~ 97~ .. h~r .Ro..~llla .. UNDERWRITERS CERTIFICATE No... l~ndin~ ................................. HOUSE NUMBER . .~0.... B~,tt~l~.t..La ..................................... 7~0 Ho~ton P& ' * Building Inspector FOF,~[ NO. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, FI. Y. BUILDING PERMIT CI1--IIS PERMIT~MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 4574 Z Permission is hereby granted~ to: .....ita~.~:~e..l)eaTe~m~ ................................. .......... ~t~e..-~ee..~.~ ....... ~'~a~~ .... to ........... ~..n~...omL ~a~..v..~l~Ltln~ .......... ~ ............................................................ at premises located at ......... .... : ....................... t~lt.~le~aa..l~ ~-.~t~m~.~.-.~.~ ...................................................... pursuca~t to application dated ............................... ~.lj~ll ....... ..~ ............ , 19...{~.~., and approved by the B~'ilding InspectOr. ? ........ Building Inspector ~ ~' TOWN OF SOUTHOLD q/~o BUILDING I~EPARTMEFr~I . ~LD, ~, Y. ............ .................... , ......... ~ ~. ~ ~, ~ ~ ~- Disapp~ov~ a/e .................................................... · .~ .............. ................. ..... ................ (Buil~g In~po~) ~~ ~ ~ ~-~ ~PLICA~N ~R B~DING ....... . a. ~.~n must be ~mpletel7 fill~ ~n b~ tTpe~iter ~ in ~k and' b. ~ ~ ~atlon of ~ and ~ buildings on prem}~, relatt~ip m ~ ~ ~ ~ ~i~tn~ a dot.led dese~ption of la7 out of p~op~ must be ~ e. ~ ~ ~ve~ b7 ~ appl~eat[~ ma7 ~ be ~mmeneed befo~ _ d; ~ ~ of ~is applieat~, the Buildin~ Inspe~ will ~sue a Buil~g ~ ~ ~ kept ~ ~e p~mi~s available for ins~ t~u~h~t the e; N~ ~n~ ~h~ ~ ~eupied or u~ in whole o~ ~ p~ ~ ~7 pu~e Oemp~ ~ ~ve ~n ~ant~ by the Build~ng ~~O~ I8 ~.~u~ ~ to ~e Building Depa~t f~ the ~ ~e ~~ O~in~ of the ~wn of S~athold, 8~lk ~, New Or~ o~ ~~, for the ~m~lon ~ build ings, addi~ ~ ~0~ ~ h~ ~. The applicant agre~ ~ eom p17 with all applicable State whe~er applie~t ~s owner, lessee, ag0nt, ~ehiteet, engin~r, general contract, builder .................. ~.~ ~ ~ ~ .................................................................. Namo of ow~ of promi~ .... ~.~ · ~ ~. ~ ~ ~ .~.~. * ~ ~ ......................................... If applicant is a corporate, signature of duly authorize d officer. (Name and title of corporate officer) 1. Location of land on which proposed work will b e done. Map No~...~....~... Lot No...~. ........ Street and Number~(..~.....7.q...~.. ......... .~.b.~.T..0~...~..~.'...~.~ .~..~..M?..~.~. ~ ,..~..'..~., ............... ~ ~o~ ~ ~:'/' ~_~ ~ ~'/7/"~.~7..6/£G"~ /.~/~"- Municipality 2. State existing use and occupancy of premises an d irttended uae and occupancy of proposed oonstructi, a. Existing use and occupancy ......... .~.~..c.~..~.?...t?..~.q .~?.~..~..~.~ ............................ b. Intended use and occupancy ......... 10. 11. 12. Nature of work (check which applicable): New Building ....~'.... Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... Estimated Cost ...... ..~. ~..9..o..~. ? ..... ... i ..... Fee ...... '..~..?..*~ ................................... (to be paid on filing this application) If' d~velling, number .of dwelling units ...t. ...... Number of dwelling units on each floor .. ! ........ '... If garage, number of cars ..................................................... : ...... .............. If~ business, commercial or mixed occupancy, spec ify nature and extent of each type of use...'7. .......... Dimensions of existing structures, if any: Front ..... .~.. ...... Rear ..... .~. ...... Depth . .T. ......... Height ...... .7. ........ Number of Stories ........ .". ...................................... ~ ....... Dimensions of same structure with alterations or additions: Front ..... .--. .... '... Rear ....'. .......... Depth .... .--'. ..........Height .... .'7 .......... Number of Stories .... ." ................ Dimensions of entire new construction: Front .... ~..%.'..~r'..... .... Rear ...~g: .I, ...... Depth . ~.t'.~...9.... Height ,'~,.~..~.O. ~.... Number of Stories ..... I.l.l.? ...... ' .............................................. Size of,,~ot: Front . .~.~..~.'.~..~...: Rear . .1..~..~..-?. ..... Depth . ~.~..O..-.~...~... Date ~f~'Purch.ase ...... !~l..~{ .~.-) ............... Na,0ae of Former O,,,wner I.(:.../~. ~.~.: .~..'~...~?.~.'..~.%... Zone ar use district in which premises are situated.. '.~4.'i~.M...~-.'lk~..~...D..~...~..~!T.~. ~.~. ~.~..~...~.~...~. ....... Does proposed construction violate any zoning law, ardinli,nce,ar reiml_at~on? .....~..~. ........ _. .... ,. .... Nal~e ~f O~Yner~of p~t~mises~..~J~-~..'~.~.%~. A~ldress~.~.~..~..~.~. ~...~T.~4...~.?. Phone No.~.*.~...~.e.~. Name of Architect~.~t.&~i~A-4.~f---~.O..~.~..g~'......~ddress .......... Phone No .... ........ Name of Contractor~,~.~.~. 41.L~.....~, · .~..~'..~ ........ Address~..i~3,~,..~..' . Phone No.119~..~ ..'. ~.~ .~' · Na~e or PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions ~,from propertF lines..Give s~eet and block number or description acoording to deed, and show street-names and , ~.]d~l. icate whether interior or corner lot. ~i~._ A'rE OF NEW YOP,.K, ) S.S. ~,OUNTY OF .............. ) ~ being duly sworn, deposes and says that he is the appli- ', (Name of individual signing application) -~i .~allt .above ns~p.~s the ............................................................................ ((3ontractor, agent, c~-porate officer, etc.) ~ saidowner ]~t~ljl~, ~]~l~uthcl-ized to perform or have performed the said worlPand to make and ~ this application; that all Statements contained in this applica.t..~..n are true to the best of his kllowledge and ~e,f; and ~at the ~-l~l~ll~e p~ed in the manner set fort~ m the application filed therewith. ,ll~orn to beIore me this t Public,'. ..... y ... ~ (~1 ture ..... _ RUTH t. CH~CK~'~I)~oIII~I~_ ' ~ V / / // ~0. 52-5684250 z'~¥~' ~/,/~ / ( / / ' / U ~,/ * sion Exp/res March 30, 19~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH ~a~e SEP 24 lg7! B~d~, Perm~ No. TO WHOM IT MAY CONCERN: The sewage disposal faci~itte~ for a structure located Chief of General ~gineer~g Services District Engineer I 4~ / / / ,/ /