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Home My WebLink About4901-zFOBM NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CE:RTII=ICATE: OF OCCUPANCY No. Z,~.O.1O ............... Date ............... i .......... .~et~t .......... 2.g....., ]9..~3. THIS CERTIFIES that the building located at -.Dee[0..l{o~e,.D~,. ...................................... Street Map No...'~X ............... Block No....~e~ .............. Lot No ..... Z;~3C ...... ~.t,~,ti,t~.,.,~e¥.~ ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....................................... A1L~ ......... .1..it'....., 19.~.0... pursuant to which Building Permit No..I.~D.I.~.... dated ........................ .~,~. .......... .1.~,[- ....... , 19..~.0.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ..... -F~-~'¥e~'e-.e.~cess~...(.s.l~L~e.) ..-~tt4..~ .~.t ~ ..................................................................... The certificate is issued to ....~o~.,~,~,~,.'t_~t ............ ~.'~X'~,c3~. ............................................................. (owner, lessee or ter~3nt) of the aforesaid building. House # 1900 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL 4901 Z Permission is hereby granted to: _ .............. ,~...~..-..,~.C.././...~../,...~..7. ........... to at premises located ot .................................... ........................................................................................ /,,~..~.~...~u**~.~,~ .............................. pursucn¢ ,o application dated ................................ /....~.. ........ ~.'~.~'~", 197~,.j and approved by the Building inspector. .Fee $,,. ,,~,, ......... ', ...... Building Inspector FOBM ' NO. 1 'TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .... //7~ ~ 197/~ ^~roved ............................... ....~.., 19.?.....~.. Permit No. Disapproved o/c ...~................._~......... ................................................ (Building Inspector) APPLICATION FOR BUILDING PERMI'r INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pub c streets or areas, and giving a 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 throughout the progress of the worE. 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 iVY, DE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of South01d, Suffolk County, New York, and other applicable Lows, 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 all applicable laws, ordinances, building cede, hous!ng code, and .regulations. (Signature cf applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, If applicant is a corporate, s!gnature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ ~' / /oe Stree and Number ........................................................................................... ~'~'1~'~'""~ .............................. ;'-- 2. State existing use and occupancy of premises and intended use and occupancy of propos~ construction: a. ~isting use and ~cupancy ...................... ~ ..................... ~ ....................... b. Intended use and occupQne, . ...........................................................~ ................................................ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair ......... '.~i"' Removal ..................Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cos~.~J~.~.., .............................................. Fee ........... :.....~e~.. ............ ; .................................................. [to~e paid on fi,lng 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 oltorations or additions: Front ....................................Rear ............................ Depth ................................ Height ................... ~......Number of Stories ................................ 8. Dimensions~Of entire new construct on Front ./. ..................... Rear ....................... Depth ...~... .................. Height~ ~...... ........... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner .............................................. .. ......... 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Doe~ proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and nd cate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and Indical-e whether interior or corner lot. 3+- STATE OF NEW YORK, tee COUNTY OF ................................ ........................ .~....~'....~...../~...~../..-~.. ............. ..~.....~'....~..../~.../....~....7~... ....... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .................................................... ..~...../~.....A;./...E.....~..~ .................... ;, ........... i ........................................... (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 and file Notary Public, . ........................................................... County (Signature of applicant)