The URL can be used to link to this page

Home My WebLink About4288-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No J, .36~6 ..... Date ............ Oct... 28 ...... ,19~9. THIS CERTIFIES that the building located at .~elal~8. ~ ............ Street Map No. l~ee,..Remes Block No ........... Lot No. 8 ...... Peeml~e .... ~o~[., ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .April · · i~, 19 '69' pursuant to which Building Permit No .... br2[~.[~ dated ............ ~ .... .~.., 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 ... P.~iva.te · one .fa~i. ly. dYelt:[n~ .................................... The certificate is issued to . .I~lge .Clausen .... o~r .-bl~.l~lel~ ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .0or. ~8~..1.~9...l~y. I~ .¥~]J.& ..... I~(~TE: ~indo~ variance approved by Housing Bd, FOI~V~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFIGE SOUTHOLD, N. ¥. BUILDING PERMIT CTHI$ P£K~I~ ~UST B£ ~£PT ON TH£ PRF.~I$£$ UNTIL FULL COMPLGTiON OF THE WORK ^UTHORIZ£D) Permission is hereby granted to: at premises located at .................. ~l~t..a ....... ~1~111~..~0111~ ....................................................... ..................... iem~...s.. Zae~.....l~mm.~ ..I,Zo ....................................................... pursuant to application dated ............................ ~l~1~ ........ .~ ....... , 19..~, and approved by the Building Insl~ctor. Fee $10,~00, ........... Building Inspector / S-9 SCHD RECEIWFn I%,3 JUL -3 ,~i~ t0:19 DEPARTF~E I,l r 0[: ti', Ju~ i i RtlERHEhD SUFFOLK COUNTY DEPARTMENT OF HEALTH Eldg. Permit No. ~ / TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located deed location) have been inspected by this department and found to be satisfactory. IFORM ,NO. t Examined . .z.... ~-~ ........... 19 ,, ,, App~s, ve~ ..................... ~9 .... ~e~it ~o .................... Disapproved a/c .................................................... __ ..................... APPLICATI(~N FOR BUILDING P'F..RMIT Date ........... ~; · .~. ........ ,9~I. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Pict plan showing location of lot and of buildings o n premises, relaticamhip to adjoining premises or public streets or area~ and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work c~vered by this application may n~t be commenced before issuance of B~ild]ng Permit. d. Upon approval of this application, the Building In spector 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 pa~ for any purpose whatever until a Certificate of Occupancy shall trove been granted by the Building Inspec~oY. APPLICATION IS I-I~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S~uthold, Suffolk Ck~unty, 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 com ply with all applicable laws, ordinances, building code, h~using code, arid regulations. ~~.., ~ '" of .applicant, or name if'a co'ratiOn) ....... '/(Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ............. ~..~., .~/. ~ ~... ~..~ .~'.0. ~ ............... ~ ...... .~ ...................................... (/,v6, ?q, Name of owner of premises ............ ~-/a .... t..~ ..... -~ ..................................... If applicant is a corporate, signature of duly authorize d officer. (Name and title of corporate officer) 1. Location of land on which proposed wor~k will be done. Map No...~..{ .~..~. ..... Lot No... ~ ......... Street and Number ....... ~ .P.~...-~..~..q' ............ ~. ........... '-...5." '~:: ........... .......... ' ' I~,~r~ 'S ~?~a-~ lVlunlclpan~sy 2. S~te exis~g u~ and ~p~cy ~ p~mises ~d intend~ ~e ~d occu~ of ~ ~ction. Existing use and occupancy ....................................................................~ Intended use orcupancy 3. Nature of work (check which applicable): New Building . .~.~.=~... Addition ........ Alteration ........ Repair ......... Removal ........ Demoliti,on ........ Other Work (Describe) ...................... 4. Estimated C,3.st .... .~.. [(~..~A ? ................. Fee ................................................. ' (to be paid on filing this application) 5. If ,dwelling, number ,of dwelling units .......... Number q)f dwelling units on each floor .............. If garage, number ,of cars .......................................................................... 6. If business, commercial ,c~r mixed occupancy, specify nature and extent of each type of use .............. 7. Dimensions of existing structures, if any: Fr...mt .............. Rear ............. 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 ...]Z. ~..~'~ . Depth . .~..~..~..~.: . Height ...I. ~..~..~- · Number ,of S~ories .... O..~....F_. ................................................. 9. Size of let: Front . [.q.0...(~.~..'... Rear i.. f.q .~.. '.{'..~.'. Depth ... ~.. 9. 0...~..~ ' 10. Date of Purchase ....... .~.~..Q ..~ ................. Name cfi Former Owner ............................. 11. Zone or use district in which premises are situated .................................................... 12. Does proposed construction violate any ~ning law, ,ordinance or regulation]? ~ ......................... .__ 13. Name ,of Owner .of premises ~. ¢.[...~..(J~..~..5 .~...~. A, ddress ~t.,..~ t.c.~ .~{ &.//~.~./-J. Phone No. '~ ~. ~. :. ~--. Name of Architect ............. .~..~..~...[. ....... -~ddress ..... 5..[ .c..~.(..~/.. ..... Phone No ............ Name of Contractor ........... .~/5 .~. { ........ Address ...................... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from p.r~perty lines. Give s~eet and block number or de scription according to deed, and show street names and indicate whether interior ~or corner lot. ' (~ N,~ary Public, . .S..u.f.f..o.l.k. ......... Gounty 9th day of Ma~, 19. 69 STATIg OF NEW YORK, )S.S. COUNTY OF Su. ffoJ. k ..... ) ..... I.N..G?..~.....C.L.~..U.S.S..N ............................ being duly sworn, ,deposes and says that he is the appli- (Name ,of individual signing applieation) cant above named. He is the ...C.°..n.t.r..a.c.t. 9.r. ............................................................ (Oontraetor, agent, corporate officer, etc.) of said owner or ,owners, and is duly authorized to perform or have perfiormed the said vcork 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 vc~rk will be perf,'meal in the mann er set forth] in the application filed therewith. Sworn to before me this