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Home My WebLink About4219-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . .~r~' .&~. Street Map No. y~ ......... Block No..~ ..... Lot No...~..~l. · ~,~ .......... confoms subst~tially to the Application for Build~g Permit heretofore filed in this office dated ...........A~W~. · ~.., 19. ~ p~su~t to which Building Pemit No..~. dated .........~$.~.. ~ .... , 19~., was'issued, ~d confoms to ~1 of the r~re- ments of ~e applicable pro~sions of ~e law. The occupancy for w~ch this ce~fficate is issued is .. ~.~. ~. f~ly. ~Vsll.~ ..................................... The certificate ~ issued to . .~a~. ~l~t ...... ~ ............................ (o~er, lessee or tenant) of the afores~d b~l~g. S~olk Co~ty Dep~ment of He~ Approv~ .. ~.~. ............................. Ho~e 22~ B~l~g I~pector / FORM NO. ~ TOWN OF $OUTHOLD 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) J'('L/~ 7T pursuan,t to application dated / A /~/~' L 19.....~...~and approved by the Building Inspector. Building Inspector FOEM I~'0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD, N. Y. No..~. 31~'.1 .... Date ................ !~ ..... 8 ..... , 19. THiS CERTIFIES that the building located at *~1'8,~'"A~ .................. Street Map No ............. Block No ............. Lot No .......... L&qll~ · · ~,~.,- ........... conforms substantially to the Applicati.on for Building Permit heretofore filed in this office dated ............ &l~l~t]... :L.., 1969. pursuant to which Building Permit No. dated ........... 'Apl"tl" '¶ .... 19. ~), 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 . ~l'lV&te -one' f'nmt"ry' d~re'l"l llig .......................................... The certificate is issued to ..kirlwai, d. t~l~et;-- ~er, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...lq.olt, ................................. 'FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. Examined .......... .~...~.~...~..,19 .... ~ Approved ......... ..~...~' .~..~. ~"~ . ., 19. e.~. Permit No..~f..~.. f..~...7..:.. Disapproved a/c ....... . .~ ~...~~ ................... ....................................... 22 ...... ........... ............ (Building Inspect(n') Application No...?. ?.. (. f ..... APPLICATIO,N FOR BUILDING PERMIT Date ................. /....~.~.. · ....... 1~..~. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and .submitted in duplicate to the Building Inspector. b. Ptot plan showing tocation of [,at and .of buildings o n premises, relationship to adjoining premises or public streets ,mc areas, .and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this applicatkm may not be commenced before issuance of Building Permit. d. Upon appz~)val of this applicatkm, the Building Inspector ~vill issue a Building Permit to the applicant. Such permit shall be kept ~n 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 .o~ Occupancy shall have been granted by the Building InspecfxTr. APPLICATION IS ~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Sauthold, Suffolk Oounty, New Y. fTrk, and other applicable Laws, Ordinances or Regulations, for the construction ~ build ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, h.ousing code, an, d regulations. ................. . ............ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .......................... Name of owner of premises ......... ~.-~).~-~,~-~ ..... /~.. L.. ~.--.-.-~..-~- ................................ If applicant is a e~rperate, signature of duly auth.orize d .~ficer. (Name and title of corporate officer) 1. Location .of landman wh~h proposed w,ork will b e done. Map No ................. Lot No .............. Street and Number ........................ ~.~ .... ~ ~' ';'' ~.l~F.~e--z ~ ......... 2. State existing use and occupancy :of premises and intended use ~d .occupancy of proposed oonst~ction. a. ~isting use and occupancy .......... ./.. ~ ~.J .~.~ ..... ~.[. .......................... b. Intended use ~d occup~cy ........ ~ .~'~- ...... ~/.~ .... ~. ~D~.t'.~-( ........... 10. Nature of work (check which applicable): New Building ........ Additi,on ........ Alteration ........ Repair ......... Removal.,~ ....... De~o~ition ........ Ot~/y/ork (Describe) ...................... Estimated C3.st ........ .~...g/.~. ~.....~7. ....... Fee ....~....~.. .......................... [ (to be paid gn filing this application) If dxvelling, number of dwelling units .......... Number .of dwelling units on each floor .............. If garage, number ,of cars .......................................................................... If business, commercial .~r mixed occupancy, spec ify n~u~e and extent of ~)type of use .... ~ .~ .... Dimensions of/e.~ti~g structures, if any: Frvnt ........... /,2 y~R~ar- ............. Depth ............. Height ................ Number of Stories ........................... ~ .~.:. ............ ~ · ~ ..... Dimensions .of.~structure~.~. -. with alt~c~.ns or ~dditions: F~ont .............. Rear ............... Depth .............. Height ................ Number of S~ries Dimensions of entire new construction: Frant ................. Rear .............. Depth ........... Height ............ Num2 : S ories ................... ........................ '- . ........ Depth ............... Size of lot: Front . .. Re)~7.~.~ Date of Purchase ............................... Name of Former./~)w, ner ............................ Zone or use district in which premises are situated ................................. ~ .............. Does proposed construction v, jg]~ate ~.py .~g,. law, .ordinate o~ ];~g~,~a~t~p~? O~v'~"e- ......... '~/'/-'??~'-'~'~2 Name .of Owner of premises . .~..~...../(.~../'.° .... ./... A. ddress /~,,q 7¢.~177~.~..~..¥phone No ............ ..... Name of Architect .-~ ........................ ~ddress ...... Name .of Contractor ..~.¢.A.a/../~.....Z.~./_.L.:?.~.! ....... Address ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, ~vhether existing or .proposed, and indicate all set-back dimensi,ons from property lines. Give street and block number .er de scription acoording to deed, and sh<)w street names and indicate whe$her interior .or corner ,i STATE OF NEW YORK, )S.S. COUNTY OF .............. ) ,;// /'~'~ ' being duly sworn, ,deposes a~d says that he is the appli- (Name ,of individual signing application) cant above named. He is the ............................................................................ (Oontractor, agent, em-povate officer, etc.) of said owner ov ,owners, and is duly authorized to perform or have performed the said v~yrk and to make and file this application; that all statements oontained in this application are true to the best of his knowledge and belief; and that the ~q~rk will be perf,'meal in the mann er set ~orkh in the application filed therewith. Sworn to before me this ....................... .... .... .,,crt' % ..................... N;~ytary Public ........... ~e~.~. · .~nty (Sign~f applicant)