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Home My WebLink About4904-zNO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...~l~t,~l..~ ................................. Street Map No~[~l~,t,..l~r..~l~l;k No ....... ~ ............. Lot No....~ ...... .O:~,~.~t~....~.~., ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................... AI~.....~t. ............. , 19..~.O.. pursuant to which Building Permit No.~l~O~ ..... dated ............................ A.I~ ......... '~'7'"'", 19...70, 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 ....... ; .... Pz~&4~ .~ae..~,.. &~e~..~ ............................................................................................ The certificate is issued to ...~.I~'~..P.e...~..~;....~.~..~......(~II~9.~I. ................................ (owner, lessee or tenant) of the aforesaid building. Building I n~ee/r FOKM NO. ~ TOWN OF $O~THOLD BUILDIHG DEPART/v~E~IT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 4904 Z Permission is hereby granted to: at premises located at ............... ~..~....~...~...l[~il. ....................................................... ..................................... .~e~...~.~...~...~...~..~..~. .............. ~ ........................ pursuan¢ to application dated ..................... 4~'jl~ ...... .~. .............. :~..., 19...~...; and approved by the Building Inspector. lrOB~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHO~D, N. Y. Disapproved o/c .......................................................... -- ^pp,, ,t,on ,o. ........ APPLICATION F. OR BUILDING PERMIT ~ "t (~,~ £ f-7 ,9.~.....~.....~. ~U~ a. This application must be completely filled in by ~ewriter or in ink and submitted in ~plic~e to the Buildin~ [ Inspector. ~ ~ b. Plot plan showing I~ation of lot and of buildings on premiss, relationship to adjoini~ premiss or public struts o~~ areas, and giving a ~ailed ~ri~ion of lay~t of pm~ must be drawn on the diagram which is ~ of this applicatJ~. ~ c: ~e work covered by this application may not be commenced ~fore iss~ce of Buildi~ Pe~it. d. Upon' approval of this applicati~, t~ Building Ins~ctor will i~ue a Building Permit to the ~plicant. Such ~rmi~ shall ~ kept on the premiss a~ilable for in~e~ion th~ghout the p~r~ of the work. e. No building s~ll be occupi~ or used in whole at in pa~ for any pu~ose whatever until a Ce~ificate of ~c~ancy shall have been granted by the Building Insp~tor. APPLI~TION IS HEREBY ~ to th& Building De~ment for the issuance of a Building Permit ~muant to the Building Zone Ordinance of the'T~n of ~uthold, Suffolk C~n~, New York, and ot~r applicable L~ Ordi~nces or Regulations, for the construction of buildiggs, additions or alterations, or for removal or demolition, as heroin de~ribed. The applicant agrees to co~lywith all appl~able la~, ordinances, building c~e ~d r~ul~ions. (SignatUre o applicant, or name, if a corporation) (Add~;ess' of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Narne of owner of premises .~.:..~. ~ ~ 4~, /~, If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1, Location of land on which proposed work will be done, Ma?No:.4~..~.....~..~l~.....~LotNo,'.,.,..~....~.. ........ ..... ....... Str.. a.d ......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ExiSting use and occupancy ...~...~ ................................................................................................................. b. Intended use and occupancy ...........................~ .............................................................................................. 3. Nature of work (check which applicable): New BuiiCHn~ · Addition .... ...~'... ........ Alteration .................. Repair .................. Removal..................~ Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............. ..~......~.....~ ....................... 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, speci~ nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...........~....~'..~'. ......... Rear Height ~-O Number of Stories Dimensions of same structure'with alterations or additions: Front Depth ............ ~...~...~. .......... Height .......... ..~....O..! ......... Number of Stories ....... f ....................... 8. Dimensions of entire new construction: Front ........ /..~....~. ................... Rear ~ ~ ! Depth .....~..? ' ...... Height ...,,~,...O...~ ...... Number of Stories ...... /.. . ............ ... 9. Size of lot: Front .......~../...O...~. ........... Rear ...... /.../.~....~ ................... Depth ../....~..~.--...~ .............. ]0. Date of Purchase ....' .................................................... /~q~l,e_ of Former Owner ...'~...~.~.'~...~ ! 1. Zone or use district in which premises are s tuated ~: .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulatign? ..~ ................... 13. Name of Owner of premises ...~...:....~..~..~ .......... Address .... ..~...~ ......... Phone No?...~...~.,,',~...~..'~..~...,~ Nome of Architect ..~ ................. ~.;..._~._ ~.. ........ Address ....... ~....~ ......................... Phone 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 description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~ORK. ~ ¢ e COUNTY OF ...~..~4~../~'.~.~,... ~""~- ....................... Z'..~....41'..~.......~...~...~..~.~...~..../~'.. .................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ................................................... ../?..~.../.~..~....~....'~... ................................ ~ ............................................... (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 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 performed in the manner set forth in the ppplication filed therewith· ............ ..................... Notary Public, ~.~.,.Z...~./~.n ~y. puy~,;~., stt~a~eGo~]Nue~Till ............. "~"~'~i~'~'r~at~;;':~";~p'i~;i .......................... No. 52-7267800 Suf[olk Co~lnt~ Term Explr~ March 30,