The URL can be used to link to this page

Home My WebLink About4249-zFORM NO. 4 TOWN OF SOUTHOLD BlYflJI~ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No~ .~g&G ~... Date ........ July.... 11, ........ , 1969.. THIS CERTIFIES that the building located at 8,/~. llld. Ma~.n. i~c~5 ....... Street ~e Application for Building Permit heretofore filed in this office conforms substantiail~ dated ..... ~pr;[1 ... 1~, ,.., 19~9.. pursuant to which Building Permit dated ....................... , 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 ..... .B~s&nemm. bu~.l&ing .............................................. The certificate is issued to ...... ~c~d.H., ~h~Ll~ .............................. (owner, lessee or tenant) 'of the aforesaid building. Suffolk County Department of Health Approval .................................... Houme ~ 1~3 - 62610 Old FORM NO. ~ 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? 4249 Z Permission is hereby granted to: .............. ~l~..,~,l.,i.... a~/~..a,~,e~...~t sl~iaj ~tati~ ........................ 8~tt,~l, .................................... at premises located at ............................................................................................................................ pursuar~t to application dated .............................. .&p~'~l~l; ....... ~l""', 19..~, and approved by the Building Inspector. Fee $...~0 ........... ,FORM ,NO. I TOWN OF SOUTHOLD BUILDING D/F. PART~ENT TOWIq CL~RK'S OFFICI~ $OUTHOLD, N. Y. Approved ..................... 19 .... Permit No ....... .~-.. · · Disapproved a/c . ....~f77~... ............................................ (Building Inspector) Application No..~..~..~..~--... APPLICATION FOR BD~LDING PERMIT Date ................................. 19. INSTRU(3rtONS a. This applicati, on must be completely filled in by typewriter or in ink .and submitted in duplicate to the Building Inspector. b. P~ot plan showing iocation of lot and of buildings o n premises, relatimmhip to adjoining premises or public streets .or areas, .and giving a detailed description of layout of property must be drawn on the diagrm-n which is part of this application. c. The work covered by this application may n~t b e commenced before issuance of Building Permit. d. Upon approval of this application, the Building In spector wili issue a Building Permit to the applicant. Such permit shaU 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 f~r any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS l-m~Y MADE to. the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S~athold, Suffolk Oounty, 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 herein described. The applicant agrees to comply wit~all .applicable laws, ordinances, building code, h~using code, and regulations. ~ __ ,~' ~'~ /, .................... (Signature of .a~pl~licant, or, name ff a corporation) ..... ............. State whether applicant is owner, lessee, ~agent, arehitect, engineer, general contractor, electrician, plumber or builder ~ ~ '~'~"~' Name of ,owner of premises :.....~..'~. · .~...~. ............................................................... If applicant is a earporate, signature of duly authorize d officer. (Name and title of corporate officer) , ~..]/ 1. Location of land on which proposed work will be done. M.ap Nol ~'~ 5~- Lot No. ] b Street and Number ......................................... ' ................... Municipality 2. ~tate existing use and occupancy of premises and in'tended use and occupancy of proposed construction. a. Existing use and occupancy .................................................................... b. Intende~ use' ~ />eeul~mey ... . ~..~. ............................................ 3. Nature of work (check which applicable): New Building ........ Addition ........ Alteration ........ Repair ....~..... Removal ........ Demolition ...: .... Other Work (Describe) ...................... 4. l~stimated Gost .... t..~-,, .... : .................. Fee ...~,..-. .......................................... (~o 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 ....~...o ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............. 7. Dimensions of existing s~ructures, if any: Frc~t .............. Rear ............. Depth ............. Height ................ Number of Stories Dimensions of same structure wi~h alterations o~' additions: Front .............. Rear ............... Depth ....... .~. ...... Height ~..~ ............ Number of Stories ./.' ................... 8. Dimensions ,of entire new construction: Front . ~.~.... Rear .~. ........... Depth .].Q ......... Height .... 8. ...... Number of S~eries 9. Size of Sot: Front . ./.~.0.. ff.. ?. .0. .O Rear Depth ......... ~ ..... 10. Date of Purchase ..... ./.~..~. ............... J ....Nan~e of Former Owner ../~.:.~..F...c.~.?..,~.. ............ 11. Zone or use district in which premises are situated..,d2-~....~ ................................... 12. Does proposed eonatruction v,~j~a~e .any ~z~g law, ordinance or regulation? ....."J~... 13: Name of Owner,of premises/.~..Z~...4~..~...~.... '.~?.~. A, ddress ./~..,gf.~f..~..~. ........... Phone No. ~../~.. ~ ?..~. ~ Name of Architect ...... ff:~'...TT.: .............. kddress ...................... P1K~ne No ............ Name of Contractor ~ ... Address ' Phone No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or de scriptlon according to deed, and show street names and indicate whether interior or corner lot. ..... ~.. f .*~ .~ .............. being duly sworn, de~s~ and ~ys ~at he is the appli- (Name of ~divid~ signing application) e~t a~ve n~ed. He is the ..... (~on~a~r, a~t, ~t~a~e ~icer, etc.) of ~id owner ~ ownem, and ~ duly auth~iz~ to p~arm or have pe~ ~e ~ifl ~k ~d ~ make and file ~ appli~t~on; ~at ~ statue,s ~ntain~ ~ ~is applicu~n ~ ~e to the best of his kn~w]~ge ~d ~lief; and ~at ~e ~k will be p~ in ~e mann er set fo~ ~ the applieat~n filed ~emwi~. ~wom ~ ~fom me ~is ..... ....... .... ...... Or, hA N~ ~blie, ....... ~.. ~nty (SJ~u~ of applier) ~m · ~ * ~ ~ ~i I ~LIZAB~H ANN NEVILLE ~ermN°' 52 8z25850, Sufou.~ k . folk Cou ~psres March