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Home My WebLink About4581-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY No..~'Q?.1 ............... Date ........................... ]).e=.....l.t ............ , 19...?.Q THIS CERTIFIES that the building located at ...WyZ~...~/CrO~...~t~..~8.~ ............................ Street Map No ~O~1.~,]~O~ Block No ...................... Lot No. ~.~. ............ 8C~1~t~CkTLd.....1~... ................. conforms substanhally to the A, pplicahon for Building Permit heretofore filed ~n this off~ce doted ............................... ~B ....... 8 ............... , 19.6~t.. pursuant to which Building Permit No. 'J~8'J'~'" dated .......................... .D~O .......... .~0 ...... , 19..~, was ~ssued, and conforms to all of the requirements of the applicable provisions of the law The occupancy for which th~s certificate is issued is ........ · .- ?~'~,~,~.. o~e.. ~'~?.. ~t~e.:~ ~.~..t~l~ ............................................................................................ The certificate is ~ssued to ..~a4~l~..~eJ~.~e~..&..~ ......... J~e~.~l ....................................... (owner, lessee or tenant) of the aforesaid building. FOltl~ NO. ~ 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) l l? 581 Z Permission is hereby granted to: pursuan4 to ?pplicotjo~ dated ....................... ~ ......... ~ ......... : ....... , 1.9..d~, and approved by the Building Inspector. ' TOWN CLERK'S OFFICE Z Examined .................. ,1 ......... Approved ........................................ , 19 ........ Permit No ......................... :... SOUTHOLD, N.Y. ! o/.~/ Disapproved a/c .............................................................................................. APPLICATION FOR BUILDING 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 descnption 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 Jn part for any purpose whatever until a Certificate of Occupancy shall have been gm. nted 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 Sou'thold, Suffolk County,'NeW'York, and other applicable Laws, O. rdinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as here,n described. The applicant agrees to comply with all applicable laws, ord!nances, building code, housing code, and regu at ons. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .............................. ~ ................................... If applicant is a corporate, signature of duly authorized officer.' (Name and title of corporate officer) · .................. ....... ....... 1. Locahon of land On which proposed work will be done. Map No.: ,.........,;;; -Lot. No ..-z'.. . / Str~ and Number ~F~..~......a~.~.....~......~.~...~z;~.~.~.Z~L~..~..~..~.~.~.~.~....~.../..*.... 2. State existing use and occupancy of premises and "intended use and 'bcCUpency of proposed construction: a. Existing use and occupancy ..,...~.~....~..'.~...~.'~.. ........................................................................................ b. Intended use and occupancy ..., ......... ~../~....~ .................................................. , ............. _(Signature of applicant, or name," "'~f a corporahon) ~ ........... .............. ...."7., ......................... (Address of applicant) ~, 3. Nature of work (check which applicable): New Building; ................. Addition .....~ ....... Alterotior~ .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...................... ,,~,~.r...~... ................... 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 nature and extent of each .type of use ............................ 7. Dimensions of existing structures, if any: Front ...... ~.~...~.~ .......Rear ........... ~.~..~i ....... Depth .~.~... ....... Height ........ ~....~...,.. Number of Stories ....... /.. ....................................................................................................... Dimensions of same structure with alterations or additions: Front ...... ~ ...................... Rear ..~.... ........ ~ ........ Depth ....... ~.~ ..................~.. ................ Height ....~-.;~.. ............... Number of Stories/'...~. .......................... / 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........ /...3~? ........... Rear ............. /...~..~. .............. Depth ....... /.~.~...7~;... ...... 10. Date of Purchase ..... ~ ...................... Name of Former Owner .....'~ 11. Zone or use district in--which premises are situated ...~.,.q~z3~s~.~'4~.....-: ............................................................ 12. ~ Does proposed construction-'~,iolote an~ zoning law, ordinance or regulation? ....~..q.~ .......................................... 13. Name of Owner of premises . .L~,..~~...Address .,.,~,,/,r'~..~4::a~9..~. ........... Phone No/~faa..~.~..'3~....~.~l~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name Of Contractor ..~/.~.......~.....Address ,.5'~r~..e;~L~ ................... Phone No.,7..fe~.....'...z~.~,T. PLOT DIAGRAM Locate clearly, and distinctly oil buildings, whether existing or proposed, and indicote all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, ! c e COUNTY OF ................................ .f"'*"' '....~r:.~,~,.~..l:~..~lf~a~...~.:.~ ...... ~ ................ being duly 'sworn, deposes and, soys that he is the applicant · ' (Name of individual signing apl~?~cati6n) above named. He is the ...~.~~.me~......(~./~../.~.(.~--il~. ....................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform ~ot have 1~erfo~-med .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 m~nner set. forth in tho appli~afion filed therewith. Swam to before me this ~ , ~ . ........ ............................ Notary Public,~/.~l~ff/..R_J~tbg~..L~... Count¥~e'~Ll~ (S~gnature of applicant) ~/ I~LIZAB~H AN. NOTARY PUBLIC, State of f.lew York No. 52-8125850, Suffolk Cou~t.v ,Term Expires March 30, 19~