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Home My WebLink About4370-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southo]d, N. Y. Certificate Of Occupancy No. S~0~. ...... Date ............ ~l~r~ .... ~ ~ .... , 197~. THIS CERTIFIES that the building located at I~O~1~..1~% .Rom~ ........ Street Map No. ~ ......... Block No...ll~ ..... Lot No. ~lag....~1[$.~...~!.O~....~.~.~.,. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~I~ ..... .~ .., 19.6~ pursuant to which Building Permit No..~37~ · dated ........ JlO~' ..... 1~ ·.., 196.9., 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'&~t,~ .~tn&p s" .(~e~llsol'lr. ~1~) ............................ The certificate is issued to . .. L~lk .lkg~ ...... 0vll~l' ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ~I.R, ........................... UNDERWRITERS CERTIFICATE No....]~,R, .......................................... HOUSE NUMBER...311,~0 ..... Street ....,11~..1~0t n-t, .]~sO&~, ......................... Building Inspector t FOR~ NO, ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN C:LERK'$ OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4370 Z Permission is hereby granted to: ............... ~.Jk~u~& ................................... .................... Ea~t..~a~o~ ................................. at premises located at ........................ ~,,Y,~.-~Oe~..~:~liLl~..Jhl~& ................................................... ........................................... {4m~..M~;L~ ......... 11.;~, ....................................................................... pursuan¢ to application dated ................................ e~q~ ........~{~ ...... , 19.~1~.., and approved by the Building Inspector. Fee $..5~.00 ............. Building Inspector TOWN Of SOUTHOLD BUILDING DIFARTMEHT xam,n ..... .......... ........................... .......... , .rmit Disapproved a/~.::'. .............. ,.. APPLICATION FOR BUILDING PERMrT INSTRUCTIONS L/ 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 o detailed description of layout of pragerty must be drawn on the diagram which is I~rt 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 a Certificate of Occupancy shall have been granted by the Building Inspector. jjj APPLICATION IS H.EREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southald, Suffolk County, New York, and other applicable Laws, Ordinorices 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 cod~ regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) /~~applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ' Nome of owner of premi~~.....~l~'....~~.. ................ ' ........................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) , 1. Location of land on which pralx~eed work will be dg~e. MapNo.: ........................................LotNo.:. ....................... Street and Number ~ . ........ ' .......... ~ ............................. ~"j)/-- ,~, '.-/~ ~) ~/ . Muni¢il~lity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing us~,, and occupancy ..~~ ....................................................................................................... b. Intended u~ and occupancy .~ .......................................... j .......................................................... 3. Nature of work (check which applicable): I~lew Building .................. Addition .................. Alteration .................. Repair .................. Remov~i~ .................. Demolitior ...... ,.'j~'.... Other Work (Describe) .................... 4. Estimated Cost ................. /...~..* .................... ......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 ................................ Depth .................... Height ........................ Number of Stories .................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Pear ............................ Depth ................................ Height .,, ....... ~,. ........... ..~umber of Stories ................................ 8. Dimensions//of e~re new construction: Fr°nt~'''~''/'/x_ ..................... Pear../.~...CC .............. Depth ..c~...~... ........... Height ../..~. .......... Number of Stories ~ .......... ~' ............................... ._. .............................................................. 9. Size of lot: Front ....~.~. ............... Rear ....:..../Z.(<Z. ................... Depth ............. 10. Date of Purchase ..../..~....d.''-'~ ....................................... Name of Former Owner ~..,~ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction ~t~ing/~,~ ~_/_~'~l~ ~~ ~ . ~_~.~.~ance or regulation? ......~.. ................................................ 13. Name of Owner of premises ...~x..~ress ~~ ........ Phone No/,,'/..~?....F... Name of Architect, ~_~)...._,~ ....... ~;~ .... ~,~-~ ....... Address ............................................ Phone No ..................... Name of Contracto'i~7..~.l'-~...-4~....~:..,~ ........ Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indite all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lat. '.OF N ............................... (Name of individual signir~ application) above 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 .ma~e accel file this application; that all statements c0ntoined in this application are true to the best of his knowledge and belief; and that the work will be perforr~ed in the manner set forth in the application filed therewith. Swam to before me this /I /'1 - ................. ,-~. day of ..f~...'..~.~ ..................... ,19.?.~f.... ............ Notary Public,. ............... '' '~ .......... ! .......................... Cou~t~ .................... i~i~';ature'~;F' ~:~ii~)' .............................