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Home My WebLink About4373-zTOW~ OF SOUTHOLD BUri.I~ING DEPARTI~NT Town Clerk', O~iee $outhold, N. Y. Certificate Of Occupency THIS CERTIFIES that the building located at. ~q~.~.. ~.,.:~. ~.i..~.¥.e .......... Street Map No...x~ ....... Block No.. ~ ...... Lot No... ~... ?.~.~k.. i~:.Y.: ...... conforms substantially to the Application fa~ ]~ttln_.a Permit heretofore filed ia ibis aEEice d. ,6/~ 1,16E ~ ? ff9 ff69 e 9 /2~/?~O ~. ~ ar~l ......................, ~ ....parp~t to which B~dlng P~t No. Z dat~ C./i ~/.(.~,7~/69.~/~5~ .... , was ~u~, ~d ~o~ ~ ~ of ~ ~ m~ of ~e appUcable pm~io~ of ~e ~w. ~e ~up~ for w~ ihk ~~ ~e ce~ficate ~ ~u~ ~..Frcfl..¢~ps ....... ~aar .............................. (o~er, le~ or ~t) of ~e ~ores~d b~dlng. S~o~ Co~ty Dep~ment of He~ Ap~v~ . .. ~...~ ~ ............................ U~I~RS CERT~ICA~ No..~.~g ................................... HOUSE NUMBER ...1.} ~p. ...... S~ ....(9~!t. ./}Y~ ............................ Building POma NO. ~l 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) N? 4373 Z Permission Is hereby granted to: ........... J~ecl...,T~..&..WJ.£a ............................. ........................ S~uz~..Aza .................................. ................... Me,.~l~:Lt, l~J: ....... ~7~ ...................... to .............. ~'a,i,14,.. ~ &e ~,eGd. ) .. G&'.e eG)ZGGSe. ............................................................................... at premises located at ..' .......... ~./.~......~.g.l~l~..~..V.~ ............................................................................. .................................................................. .~.~J,t~....]l.,.~., .......................................................... pursuan* to application dated ................................. ~1~.~. ....... ~ ........ , 19..~J., and approved by the Building Inspector. ,FORM ,NO. I TOWN OF SOu-ri/OLD BUILDING D~PARTMENT TOWN C~.~qll:'S OFFIC~ SOWI~IOLD, lq. Y. Approved ... LZ .............. ,19 .... Permit No. q~ ~ Application No ................. Disapproved a/c ........................... . ........... APPLICATIi~N FOR BUILDING PERMIT Date ....... ~.~t .... ~. ....... · 19.~'. 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 iocatio.~ of lot and of buildings on premises, relati~aship to adjoining premises or public streets or areas, and giving a dctailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may n~t 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 pregrees of the work. . __e. No building shall be occupied or used in whole ox~ in part for any purpose whatever until a Certificate of O~cuPah~5; shall have been granted by the Building Inspectce. APPLICATION IS 1-1/~.l~!qy MADE to the Building D epar~ment for the issuance of a Building Permit pursuant ~o the Building ~one Ordinance of the Town of South0 Id., Suffolk Oounty, New York, and other applicable Law~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo- lition, as he~eein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, a~d regulations. (Signature of applicant, or name if a corporation) .... l.f./..5¢?...v. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder..O..(f4. ?.. ~. ~ ..................................................................................... Name of ,owner of premises. ~7. ~ .~...~..d .~.//~ .~...C, .... .~. ~..~. ,~ ..................................... If applicant is a oorporate, signature of duly authorize d officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No .... './~ ......... Lot No..~ ........ ~ Street and Number..l(~./...3..O.U../1/.. ~....~.~?.~ ....................................................... 7~ / - //.~ 0 Municipality 2. State existing use and occupancy of premises an d intended use and occupancy of proposed construction. a. Exisiing use and occupancy . .l.e,$l de~.C_E..o~. .~. ~o.~e,e~. ~ c~e [..ffZCva ~ ~Y.5~--~. .................... b. Intended use and occupancy ........ ~..~.f~. .................................................... 3. 4. 5. 6. 7. 11. 13~. Nature of work (check which applicable): New Building .. ,ZX... Addition ........ Alteration ....... Repair ......... .P~moval ........ Demolition ........ Other Work (Describe):. .................... Estimated Cost..8.'~2~ ~ .................... Fee ...................... :':J. '.' ................ (to be paid on filing this application) If dweiling, number of dwelling units .......... Number of dwelling units on each floor .............. If garage, number of cars .............................................. ~ ........... · ....... ,rov6 7- If business, commercial or m~xed occupancy, specify nature and extent of each type ~o~se'/.~KTr.,,~..f.//~ Dimensions of existing strVctures, ff any; Front ~. ............ Rear . .Jo ......... Depth .t~ .......... Height ~x' Number of Stories b~.~...~ ................... Dimensions of same structure with alterations or additions: Front .............. Rear ............... Depth ................ Height ................ Number of Stories ..................... Dimensions ,of entire new construction: Front .... ~..~..~ ........ Rear ... ~..~. f ...... Depth ./~..~...:... Height ...].5/. t. ..... Number of Stories ...0..N..~. .................... r ............................... Size of lot: Front .. ~1,.0..0~ ........ Rear ... L P.~. f'.'. .... Depth .$?..f. ......... Date of Pureh.ase .... ~.'/-.. '.t(.~. ................. Name of Former Owner .. ~... 6~.g.~.~. ~[~/ ............. Zone o~ use district in which premises are situated..; ........ ~ ........................................ I~es proposed construction vjo~late any ~aning law, ordinanCe'or regulation? .. 4.~.G ................. :. Nameof ownerof pPemiSes ~.~. ~.'~,C:~.~..~/.~....A, ddress l~[..~H..~'.~..~F~./YfffUl~phone No.Z~.~Z.q~.~. ~ Name of Architect ............................. .~ddress ...................... Phone No ............ Name ~f Contractor ............................. Address ...................... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly an buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or de sci'iption according to deed, and show street names and. indicate whether interior ~r c(g-ner lot. STA'x~ OF COUNTY OF .................... /..V..~.. .................... being duly sworn, deposes ~nd saya that he i~ the applt- (Name of individual signing application) cant above named. He i~ the ............................................................................ (Oantraetor, agent, oovporate offiCer, etc.) of said owner o~ owners, and kq duly autho~qzed to perform or h'ave pergerm~ the ~dd w'~k ~md to m~d{e and file thl~ applieaUon; that ~1 st~tomertt~ contained in this application are tree to the best of hl~ lmowledge and belief; .and that the wo~ will be perf-o~med in the mann er set fortl~ in the application filed therewith. ~worn to befo~ me tht~ ............... %, .......... i . Notary P~b]ic, Re$igli~8 In ~uffolk Cous~ No. 52-7031050 Gemmi~sien E.~ir~s M~r~h 30~ 197G