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Home My WebLink About4589-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No.l[. 39.~.. Date ............ ~,tlg . .1~ .... , 19.70 THIS CERTIFIES that the building located at ... l~0at'a~ ..~ .......... Street Map No.R~ Sh .... Block No.. SeC..I..Lot No..1.~ ..... (~'.ee,~palrl~.. 1~,][, .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Dee. ~ ~- .... , 19 69. pursuant to which Building Permit No...1~(]~. dated . ·..Dee.. · ~ ·. , 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 · Pl~.iva~ .Olte..f.a~i~.~iwetlll~g .................................... The certificate is issued to .Pa~ Ye~rgal~o~ ..... ~)w~e3~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ............... ~y. R,. Vl~l~ .... .......... ..... FORM 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) No. 4589 Z Permission is hereby granted to:P ......... ~ ..~.L ~.,~.~...~.~.~ ............. ~-.--~e~r em~--ao~ ........ .................. ~a, ea, ...... Z,~Z, .............................. to ........... ~s~..~..,~.. ~,,~.~..~t~ ........................................................................ ot premises~, located at ................ ~..:~....J~l~.-~ll~e~e..~..~ ......................................... ...................................................... ~.4,eze ......... o,.~,.~lf ........ .lt..~ ............................ pursucm¢ to opplication dated .............:..,?.,/....:,~,~t- ......... ~..~...~...., 19..~., and approved by the Building Inspector. ~J~ii~ ~ ~!I~IL~IIL~ Illtl~ I Budding inspector $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed location)~ have been inspected by this department and found to be satisfactory. Engineer District Engineer Examinea ....................... ,..... .......... , ^ppmved ........................................ , 19 ........ Permit No. ~. " .. Disappr°vnd a/c ............. : ................................................................................ BUILDING DEPARTMIIG' ~?,~ TOWN CLERK'S OIIFICl SO!re, fOLD. 1,4. ¥,, Application I'~,....~...~...~ ...~.. .... ~1~ ~ ~ -- ~ ...... ~ .................. ~.....I ...... ~.~.~.~ ............... .................... ~ - T'~ ~ ~ ~ ~ ~ ~ ~ ~. ................... ., ............... ~.=..~.~....., INTRUSIONS - ~ ~: ~1~ ~lication must be completely fill~ in by ~ewriter or in ink a~d submi~ed in ~plic~e to ~e Buildin~ I~o~. · b. PI~ plan showi~ I~aflon oJ lot and of b~ldings on p~mi~, ~lationship to ndjoini~ p~mi~ or p~lic st~ or ' a~s~ =~ g~ ~ ~lnd ~ription o~ I~out ~p~ m~ ~ dm~ ~ the diagram ~cb is · :,c. ~e~ c~e~ by this application m~ ~t ~ come,ed before I~e of Building Pe~lt. d. U~ ~al of ~is applic~ion, the Building Ins~c~r will i~ue a Buildi~ Pe~it to the applicant: Such ~rmit ~all ~ k~t ~ ~e pr~i~ ~allable for ins~ction thmugh~ ~e p~ of ~e w~rk. e. No ~ilding s~ll ~ ~cupi~' or u~ in whole or in pa~ for any pu~e what,er until a Ce~ific~e of ~cupa~y s~ll h~ ~ gmn~ by the Bulldi~ Inspec~r. ~PLI~TION IS ~REBY ~DE to the Building De~ment for ~e i~uance of ~ Building Pe~it ~uant to the Budd~ ~ ~t~ of ~e Town ~f ~thold, Suffolk C~n~, N~ York, a~ q~er ~phc~ ~, O~i~es or R~ul~i~, ~.~ c~mction of buddings, additions or alterati~s, or for mm~al Tar demolition, as hemin.~ri~. ~e appllc~ ~ to comply with all applicable la~, ordinal, building c~e, h~sing c~e, ~d ~ulat~ons. . (Sig~atu~ of ~llc~nt, m ~, if a ~i~) ..... .................. ~ ~r~ of ~l~ant) State whether aPPlicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................................... ~..e.~.e..~.z....9..o.~.~..o,~ ............................................................................................... Name of owner of premises ................................. ,l~l.l~,..[e=&l~3.t.~u3. ............................................................................... If applicant is a corl~orate, signatur? c~f du!~, auth~orized .officer~ ........ .Ia3.az~d....w q,~e ~...Tn C ............................................... ~ (Name and title of corporate officer) '~'1~ ~ ~'~ i j' ~021 .. ~.~: l~ 1. Location of Iond On which proposed work will be done. Mop No.: ........................................ Lot:~,: ......;.,,..; ........... Streef.~and Number ..}~e..~.nam...:[~e~te ....................................... G~*ee~]~¢~ ....... ; .............................................. 2.' 'State existing' me and' occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... ,,,ndedu, andoccu cy ............ .................. ............. ...... ....................... 4. 5. 6. 10. 11. '12. 13. Nature of work (check which applicable): New' Building .... ~.. .......... Addition .................. Alteration .................. Repair ................. Removal .................. Demolition .................. Other Work (Describe) ........................................ Estimated Cost ............................................................ Fee ............. L ................................................. L ........................... (to be paid on filing this application) If dwelling, number of dwelling units ..,~ ..................... :~.,Number of dwelling units on each floor ............................ If garage, number of cars ..................................... :.......~:. ............................................................................................. If business, commercial or mixed occupancy; .specify nature and extent of each type of use ............................ Dimensions of existing structures, if any: Front .........~.. ............... Rear .~.~ ................ Dept~ .......... Height ......... ~ ....... Number of Stories ....~l~. ................................... ~ ............................. ; ............ ~ ................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ Dimensions of entire new construction: Front ....... ..,~..~. .................... Rear ..~...~. ..................... Depth ....~.?. ................ Height .....~. .......... Number of Stories ....].,~ ......................... L ................................................................................... Size of lot: Front ].!~ Rear ].10 '1.~]. ................................................................ Depth ................................ Date of Purchase ..... ~.9 .............................................. Name of Former Owner ........................................................ Zone or use district in which premises are situated .............................................................................................. : ...... Does proposed' construction violate any zoning law, ordinance or regulation.;' ............................................................ 1~ Ye~nn~ am -.. Name of Owner of premises ............... :~;;.~; ................ ~aaress ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....~..n..1....a~....d.....H..o...~..e...~. .................. Address............................................Selden Phone No ..................... 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 description according to deed, and show street names and indicate whether interior or comer lot. _ _. g. 7 I/~ - ,~ p~. ~ ' 0 STATE OF NEW ~OP,~ , fl J-- ,. ~/ .................. 1~ ............................... ~ .......................... beinO duly ~worn, d~oses ond m~ t~t he i~ the ~a~ofindividuals~ing~p~tL~) n t~ ~ , . ~, , · --~--' ~h --~ . ". ,he ......... ....... ............ above ' ~ (Contractor, agent, co~orate--~--officer, ~c.)-- of ~id ~ner or owners, and is duly authoriz~ .to perform or have perfo~d the ~id work and to ~e ~d file this application; that all ~atements contained in this appli~tion are tree to the best of his knowledge and belief; and that the ~ will ~ performed in the mannfr ~t fo~h in the applicati~ fil~ th~i~. Swom_~ ~-, ~t~fere me this ~ ~ / ~ ~ -- ~. ......... .......... ........ .... - ................ .............................