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Home My WebLink About4167-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE DF DCCUPANCY No.. · .$5.04... Date ......... ~T~Ge ..... .3,0, ......... 19.6~. THIS CERTIFIES that the building located at I~. ~U~Lk .~k~..e~e ....... Street Map No ............. Block No ............. Lot No...~l.t;~l~.~. ~.~1..~0~ ........ conforms substantially to the Applicati. on for Building Permit heretofore flied in this office dated ........ ~.~lttl~... ;i,~., 19.~[ pursuant to which Building Permit No..4;[~. ~- dated ........ ~13~'¥...11~., 19~., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .occupancy ~or which this certificate is issued is . .p.~.~..~.a.~.~..~13~..~;[~.. ~.~l~.l,~ltg ......................................... The certificate is issued ~o . ..1~..~.~.~...~.~..~.].,v ........................................... (owner, lessee or tenant) of the a~oresaid building. .Suffolk County Department of Health Approval ~1'~. ~.~. ;!,~1~.,..1~1]~3¢t. ¥.~;[l& ...... .... · ..... l ...... Houle ~ - Z2455 Ney SuffoLk Avenue TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~67 Z Permission is hereby granted to: o...e..e....~.tL~..2~.~r..~.~ .................. ................ ~ .t...e..~.~.g?.~..e. .......................................... B1Ltl~ n~w e~e fam/l' ~..w..e..i.1..~.n.g ................................. to ............................................... ~*....., ............................................... at premises Iocoted at ....~..~.......N.~.~./....~..'g.?:..f..~.]~../~,~..~ ............................................................................ ....................................................... .Cut~ ...... XoX. .................................................................. pursuon¢ to applicotion dated ........................ I~..~ ......... .1.~ .............. . 19.~,., and approved by the Building Inspector, Fee $.~..0.~,,.i~... .......... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date t,9~J Bldg. ~rmit No. TO WHOM IT MAY CONCERN: The sewsge disposal facilities for structure located have been inspected by this department and found to be satisfactory. District Engineer District Engineer Disapproved a/c ..~ ........................................................................................... APPLICATION FOR BUILDING PERMIT 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 o detailed description of layout of property must be drown 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 throug.~.out 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. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southald, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ell applicable laws, ordinances, building code, housing code, and regulations. (.S'gnoture of apl~Jcant, or name, if o corporation) .................. ....... (Ad~/ess of applicant) C,/ State whether applicant is owner, lessee, agent, ar%ec~er, general contractor, electrician, plumber or builder. ............... .......... ................................... i ........................................................ Name of owner of premises ................... .'~...~.~ ........... ~ ........................................................................................... If applicant is a corporate, signature of duly authorized ofi'i~:er (Name and title of corporate officer) 1. Location of land on which proposed work will be do.3.e. Mop No.:........ .................. ...........,..~.ot No.: ........................ ........................ ............. .... ........... : ..... Street and 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ExistJng use and o~cupancy ...................................... ~~ ........................ ~.., ......... · .................. ' .......... b.Inert nt ded use a d occpUanCcy ~ .......~ ....... ~ ...................... ~~~..,r~..~ .................................. ~..., ...... ~ ................... 3. Nature of work (check which applicable): New B~ildlfi~ T....?........... Addition .................. Alteration .................. Repair .................. Removal .................. Demolitio~....,...,~ ...... ;. Other Work (Describe) ........................................ 4. Estimated CoSt .......................~...0.~. ................. 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 ond 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 ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ~...~.. ................. Rear ........ ~...~.. ............ Depth ...~..~.. ............... Height ......... /..~.. ..... Number of Stories ................ ./ ..................................................................................................... 9. Size of lot: Front .............. /....~. ....... Rear ....... ~..~ ..................... Depth ........ /...u~..~. ................ 10. Date of Purchase IZ,///, ./.~. ......................... Nome of Former Owner 11. Zone or use district in which premises are situated ............................... ~.. ................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... ~'4~.......;~ ........... , ............................. 13. Name of Owner of premises .:L~.~'..~.~'/~ ..................Address ..~.u//........~l.~./..... ............... l~hone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~...[~.~...C.......~...~../~..~ .............. Address ..~...~..~..~..~.S.......~...~"',~,. Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil 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 corner lot. ! O0 · STATE OF NEW YORK, [ S.S. COUNTY OF .............................. ........................... ~ ........... ~i .................................. ~...being duly sworn deposes and says that he is the applicant (Name of indiV~ual signing applicat/j~p) above named. He is the ............................. .-~,2..~ .................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make ond 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 performe~ in the manner set forth in the application filed therewith. Sworn to before me this ( ~ .......... ....... ......... Notary Publ~~.J..~..:..L~ County ..................... "-d'"~[~l'~re';~"~p;[i~;;~')' ............................. MARION A. REGENT ~/ NOTARY PUBLIC, Sta~e of New York No, 52-3233120 Suffolk Count~ Term Expires March 30,