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Home My WebLink About4991-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk'sOffice Sou~old, N. ~ Certificate Of Occupancy No. Z1,1.~2 ..... Date ........... J&l... -28 ....... , 19.71 · THIS CERTIFIES that the building located at R~&~lml' 'Patio' .......... Street Map No..~ ........ Block No.X~ ........ Lot No. ~.. flotltholS., lqo]/o .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. 0et-. '7- ', 19.70 pursuant to which Building Permit No..I,991.7.. dated ........... 0~t .... '7 , 19.70' was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this ~ertificate is issued is ... -Pl'~.v~.t®. olin. family- th~l-l~£ ......................... ~ .......... The certificate is issued to .. K&.th®l'lno.. t~x'&5~...~- ................ ~- ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 'Jalg '2~' 1'971' ' ~b~'R'.' '¥~I1'~ ....... l~ou~. ~ 19~ .... ~....c:.~,..~,...~../.~.~ ............. Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4991 Z Permission is hereby gronted to: to ~ld n~ o~e f~ a~e~ ............................ at premises I~ated at .................. ~.[~~..~ ............................................................. Building Inspector. ouilding Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. P~erm±t ~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ~Give deed location) have been inspected by this department and found to be satisfactory. IPOB,M ' LqO, I TOWN OIr souTHOLD BUILDING DF. PAliTMIMT TOWN CLERK'S OFFICl SOUTHOLD, N, Y. 7 Examined 19.... Approved ..... ................................... , ~9 ........ Permit No ............................. Disapproved a/c ......................................................... " ~ (Building I nsp~/tO~r) APPLICATION FOR BUILDING PIRMI'I' Date ..... .0...C-..~.. ........... ~ .............................. , 19..~.. ....... INSTRUCTIONS ~- a. This application must be completely filled in by typeWriter or in ink -,nd submitted in d~pllcate to the Buildin~~ 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 de,ailed description of layout of property must be drawn on the diagram whlch ii part of ~le appllcation.~) c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Bui d ng nspector wi I issue a Building Perm t to the applicant. Such permit~~ shall 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 for any purpose whatever until a Certificate of Occuponcy~ shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ssuance of a Bul d ng Permit punluant to the~ ~Build!n.g. Zone. Orfl. !nance of t~he To,~. of Southol. d, Suffolk Count, New York, end other app cab · Laws, Ordinances o~ ~.egu~aT ..runs, .mr me constructi.on et t)uildings, additions or alterations, or .for removal or demo t on, as heroin described. .ne app,cam agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. Slmet~n --( g u · of applicant, or nOme, if a corporation) ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prom sos ~.r..~..~..~./.../~...~....~...~....'~.. 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. Map No.: .....~../...~.. .........................Lot No.: ...' .................... Street and Number ~/.~'.~.....~/..~...7'~...~..~..~....~...~/....~.../~.. 2.~tote existing use a~d occupancy of premises and Intended use and occupancy of proposed construction: a. Existing use ond occupan~ ................................................................................................................................... b. Intend~l use ond occupon? . ................... ~.~........~.....~.. .......................................................................... / 3. Nature of wink (check which applicable): New Building ?....Y[....... .... Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... - ................................................................. 4.Estimated Cost .......................................................... Fee (to be 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 busine~, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, Jf any: Front ............................ Rear ................................ Depth ........... Height ........................ Number of S~ories .................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ........................... Depth Height ........................... Number of Stories ................................ . .~ ~ ..... 'Z'~,"~' ................. 8. Dimensions of egtire new construction: Front ....,...~...~.... ..................... Rear ...~....'~.. ................... Depth .~.'.,4~t(:..~...?..~ Height ...../...~...~. ..... Number~ of Stories ....... :..../......) .............................../-~&7~'~'/"~x~W'7'/~'$]~ ............................... 9. Size of lot: Front ..... ./...~...~... ........... Rear ...... ./....~...~.. .................... Depth ../6~..~....$~,~..~'...5'/P'~ 10. Date of Purchase k)U~l~- ./..~. ,./.?.~0 Nome of Former Owner 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner ,,,~ .... ~,~)",~T,/-y/~,~A/'~' /~R~joY A,4d,,~<,/~JT~ ~',~3 ,~.Z-/_/~.,~', ..A/..)~h~n, ' /.)J,4~ $-o.:F"$~ Name of Architect ......... F. ........................................... Address ............................................ Phone No ..................... Name of Contractor ....................................................................................... PLOT DIAGRAM i-~ate clearly and distinctly oil buildings, whether existing ot proposed, a~t indicate all set-beck dimensions from pmpe~y lines. Giv~ street and bilk number ar description a¢oording to de~l, and sh~ street nam~ a~l indicm'e whether interior or comer lot,/~1/~1 w,~T~,~ ~A~Th/ j ~7~_.~,101~ I-Or co,/r,.l.Y Fiz. O STATE OF NEW,Y. OR~,,',I e//' tee COUNTY OF ....~~.?_....~' / , ..... i ........................ ~- .~.......~...~;..:.'..;...~...~.....being duly sworn, deposes and says thor he is the appJicant (Name of individual signing application) ,. . above named. He is the ............ 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 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 application filed therewith. Swam to before me this · ........................... .................. r- . ............................ .~ ................... .~ :. ...................................... hlotar't Public, ...... Counh, (S gnature o app icant) No. 52-8125850, Suffolk Term Expires March 30, 19~1~ L