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Home My WebLink About4604-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificste Of Occupancy No.~.~7..~. ...... Date Dec 11~ 19 73 THIS CERTIFIES that the building located at .. I//~ .~/e~ .$1~f£o.~..A?$... Street Map No. XX Block No. xx ...Lot No. xx V, attituck N,Y. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........J.a.n... 7.6 .... , 19. ?.0. pursuant to which Building Permit No...b~..0~..Z. dated ............J.a.~....~ ..., 19.7.Q., 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..~.v.a.t.e...o.n.q..f.a.m.$..1~,..d.~..~.1.1..t~.g..¥.~..th..a~...a.d..d.l.t.$..o.~. ................. The certificate is issued to . .H.~e..h~.s.1...lg.~p.~.~ ...... 0.'~/r~.~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Nolq. UNDERWRITERS CERTIFICATE No.P.~..n~..~P/~. .................................... HOUSE NUMBER ...~Q~ ....... Street ....Ng.~...S.u.f.f..o.1~...A..v.~ ..................... Building Inspector TOWN OF $OUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~60~1 Z ~ ....................... ~....,~. ..... , ~'...~ Permission Is hereby granted ~b: ; / Budding Inspector Building Inspector. ' / ~:e, ,.....~..,.~ .......... pursucu~t to application dated ......................... ~ll~--..~ .................. , 19....~, and approved by the at premises located at ...................... ~j~IL..~..~.~I~11~..A~ ..................................................... ............................................................... htt4~....J,,~,...'. ......................................................... Approved ........................................ , 19 ........ Permit No ............................. Disapproved a/c ...~,. ........................................... i .... (Budding Inspector) ? ,.-. IUILDINt DEPARTMENT SOUTHOLD, No ¥o APPLICATION FOR BUILDING PERMIT D~te ............................. al'~lFl~......~.6...., i 9..~1~ ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationsh p to adjo n ng prem ees or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port of thi~ 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 work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy sholl have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to the ~Build!n.g. Zone. O[..dinance. of ~e To, .wn .o.f. Southol. d., Suffolk C. ounty, New York, and other appl cable I. crws, Ordirmnces or ~egu~at~ons, tar the construction o.? Duilaings, a~l t ohs or alterat OhS, or for remora or demolition, as herein described. The applicant agrees to comply w~th all applicable lows, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, if a corpOration) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~er - b.~.~.de~ Nome of owner of premises If applicant is o 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 .................~.....~..~l~...~.1~.~'.Q~r~ .A..~j~ ..~. ~t,i.t,...~....a~... Municipoli~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............. ..~...e....~.[~...~.e..~.~...~.~y~ ...................................................................... b. Intended use and occupancy ................... ..~.~.....1~....~.~......~.......~..~..~..~.~.~.0...~. ........................................................... 3. Nature of work (check which applicable): New B~ilding .................. Addition 3E3[~1~ ......... Alteration .................. Repair .................. Removal .................. Demo ition ................. Other Work (Describe) ........................................ 4.Estimated Cost ' Fee .......................................... ' .................. 5. I~ 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 alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ~ .................... Rear ............................ Depth ....... ~3 ............. Height .................... Number of Stories ..............~ ................................................................................................ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ...................................................... Name of Former Owner 11. Zone or use district in which premises are situated ..................... ,~:,..~.~, ............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ aa 13. Name of Owner of premises ..... ~J~...l~l~Le,~l~ .......... Address ...~,~.~.~.~lg~ ................... 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 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 YORK, 1S.S COUN~ OF ...~O~ .......... '..~ ' ............................. ~.....~ ............................. ~ing duly sworn, d~es and says that he is the applicant (Name of individual signing application) above named. He is the ........................... ~Z..m..~e~. ......................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authoriz~ to perform or have perfo~ed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. Swam to ~fore me this ~ / ~/, ................... ................... ................ , ~1, ~.,~ / i~ ~ . ,, ...... ~ ...... ~ ........ ~.~.~Z~...~.~~. ....... ~ ............. Nota~ Public,~.~..i~ ..... Coun~ ~ (Signature of applicant} ~ NOTA~ PUBLIC, S~ate of New York No. 52.8~25850 Suffolk CouA~ ~erm Exp res March ~, 1~