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Home My WebLink About4906-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy 1~ Z6272 Jan $ ... o ............. Date ............................ , 19.7.% THIS CERTIFIES that the building located at ~./.$. H.o.~'~01~..AV~ ........... Street XX Map No ............. Block N.~X ......... Lot No. ~ .... .Ma.t?.~.t..u.~k.' . .N:.Y.: ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... A..u~....~.?..., 1~0... pursuant to which Building Permit No..~9Q.6.~. dated ........ A.x%g .... 1.{) ..... , 1970.., 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 ...P.r.~.?.~.t.e..9.n,..f..~m. $.l.y..d.w.~...lSn. [...w. $.~.h..~.n..a. dd..~.%.$.q .n ................ The certificate is issued to . .~..1.a.5.~$...K..t~#~. ....... .0w~e.r ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N :R.' ................................ UNDERWRITERS CERTIFICATE No. P.?.n.d.t~..1~ .................................... HOUSE NUMBER ...5?.0 ........ Street ...H.o.r. ~;Q.n..,~¥.~ ............................ ..... ........... Building Inspee~r l~)~'N OF SOUTHOLD BUILDING DEPARTMENT ~.~ TOWN CLERK'S OFFICE S~THOLD, N. Y. rr ............................................ , .......... r'errmT INa. :.I....'~ ................... O'sopproved a/c ........................................................... ~ · '"1 ' ............................................................................... ...... - -- AP L,CAT,0N - oot, ........ ....... :. a. This applicatian must be completely filled in by typewriter or in ink and submit~icate to the Buildiog°~ Inspector. · b. Plot- plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or 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 application may not be commenced before issuance of Building Permit. d. Upon r 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 work. r. 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 Department 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 all applicable laws, ordinances, building code, housing code, end regulations. ~'~'-~ V/ ~ - H/(Signature,cf/6ppli t, or naM,,JdaAorporatlon) . ~ ~ .~ (Address of applicant) (' .4/~ ~'~ State whether applicant is~owner ._l.,.~se_~. gent, architect, engineer, general contractor, · ectr c an, plumber or builder If applicant is a corporate, signature~ duly authorized officer. (Name and title'of corporc~te officer) 1. Location of lend on Which proposed work will be done. Map N .or~. ~G.~:?..~.f'.~.'.-:.°..~....~.'L.r.4..?..~.~.~.. Lot No.: ........................ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Na~r~ of work (check which applicable]: New Building .................. Addition ..~ ......... Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) 4. t mated ost ........... , ................................................ Fee ......................................... :.'. .................................... (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ....L ...................... 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 ../../.i ................. Number of Stories / Dimensions of same structure with alterations or additions: Front ....~...~...i ........................ Rear ,..~.,~...~ ................ Depth ....~....~.~ ...................... Height ~.~'. ...................... Number of Stories ,..../. .......................... 8. Dimensions of entire new construction: Front ....Z.~ ........................... Rear.7.. ........................ Depth ........................ Height .~...~ ............ Number of Stories / . · ...... - , 9. Size of lot: Front ../....~... ................. Rear .../..~..~.'.O~..J..- ..................... Depth ..... /7.. .~'2 10. Date of Purch.~se x//'/~..~..~'/~....'~-.~../.~.,.~..7~.. ......................... Nome of Former Owner . .~...-~...~.~.....~...~....K...~£.~ .......................... 11. Zone or use district in which premises are situated ..~.~.~...~ 12. Does proposed construction violate any zoning law, ordnance or regu at on? .'~..e .~....7~?....'?~..~....~(.'~'° ~/~ .~?...~F.~ .............. 13. Name of Owner of premises .~.z.~...~.~......~.<.'~...~.(x~...~.. ....... iAddress2..?~.~..~./&°...~..~.Z,~..~-./.~.:.r..~..~/..,~Phone No../~...~..~.~...~(.7..~...~ Name of Arch~tect$..~..~.~.~..~....~..~.~.v~.c~.~...~.....~...~.~.~..~...~.~"..~..~..~/(~Address ~)~r/x-,/4~,~ Phone No ..................... Name of Contractor ............................. : .................. A&:lress ............................................ Phone No ...... : .............. PLOT DIAGRAM Locate clead¥ and dist[l'tCtJy_ ot~ buildings, whqther existing or~:)roposed, and indicate all set-bock dimensions from .T I~-Io' (cOntractor, agent, dorporate otticer, 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 ti.or the work will be performed in the manner set forth in the application filed therewith. Swam to before me this Nato r'! Public,. ........................................................... t. OUnty