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Home My WebLink About4852-zFOR~ NO. 4 TOWN OF SOUTHOLD~ BUILDING DEPARTMENT TOWN CLERK'S OFFIG~ SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ....HO~..t, Ol~.'r~,~le. ....................................... Street T Map No..~1[ ...............Block No. ~g ................. Lot No..3:~ ......... i~.O.U,t,l~,o~L~, ......... .~.~.~. .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. · T.u~.~ ....... .~$ .......... , 19...~.0. pursuant to.which BuildiNg Permit No..~.~2~, .... dated ........................... ~T~,l~r. ....... ~.~ ........ , 19....~.0, was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .......... P~ i.v.a.t,.e., one.. family..~ell t~g .......................... ~ ............................................................ The certificate is issued to ...... ~,~.,U~&~.eS ............~,e~..i ........................................................... [owner, essee or tena.nt) of the aforesaid building. House # 2160 FOR~ NO. ~ TOWt4 OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~ Iq, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4852 Z Permission is hereby granted to: ........... ~.~J.~ea ........................ .................... .............. 8e~th~Za .......... i~. ....... : ................... to .............. ~.~,~..~n..~n..on...e~$~,-~n~-.~P-~-;~ ................................................ at premises located at ............... ~/~....~0~.~.~.. ~ .......... ............................................................ ........................................................... ~a~'ho'ld ......... '~'~'Y ~'": ............................................................ pursuan~ to application dated .............................. .~.:%L~ ......... .~,~......, 19....~.0 and approved by the Building Inspector. Fee $'""~'*'~}0 ......... Building inspector TOWN OF SOUTHOLD:~ ~UILDING DEPARTMENT TOWN CLERK'S $OUTHOLO~ ~. Y, Examined ........................ , ~9 Approved ........................................ , 19 ........ Permi~ No ........................ (Building INspects4'~) Dote "i ............... ~.._:.......~....t: .............. INSTRUCTIONS a. 7'his application must be completely filled in by typewriter or in ink end subrnitted ia duplicate to the ~uildingO Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adioining premises or public streets or areas, and giving a detailed description of layout of property must be drawn ca the diagram which is p~rt of this application. c. 'The work covered by this application may not be commenced before issuance pf BuiIdin9 Permit. d. Upon approval of this application, the Building Inspector will issu~ a Building Permit to the applicant. Such permit'Z~ shall be kept on the premises available for inspection tFroughout 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 shall have been granted by the Building inspector. APPLICATION IS HEREBY MADE to th~ Building Department for' the issuance of a Building Permit pursuant ~o the Bu~ d ng Zone etd naace o~ the Towl~ of Sauthold, Suffolk County, New ~ork and othe- app cab e Lows, Ordinances or Regulahons, for the construchon of buddings, addmoas or alteratams, or ~or removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, buifd~ing code, housing code, and regulations. ...... .................................. (Signat6re cf oppliCant, or name, if a corporation) .... ..................... ~ (Address of applicant) State whether applicant is owner, l¢)ssea, agent, orchffeci, engineer, genera) contractor, electrician, plumber or builder ...... ......... ..... ....................... : .......................................................................... If applicanl is a corporate, signature of duly authori×ed officer. (Name and title 'of corporate officer) 1. Location of land aa which proposed work will be done. Map No....~, ..... ~ .......... Lot NJ ' ~ Street and Number ................ ~j~..fm.~ .............. ~~..~- ................................................ 2. State existing use and occupancy of l~mises and ig~ended use an8 occupancy of proposed construction: o. Ex~stmg use and ~.upgn~y ............................................... ~.,,...~ ........... ~ ............................................................. 3. Nature of wo~k (check which applicable): New Building .................. Addition ................. Alteration .................. Repair .................. .~Removal .................. Demolition ............ ~.... Other Work (Describe) ........................................ Est mate'" ' ~'/~' '~ ~ - 4. , a LOST ............... ; ............................................ kee .......................................................................................... (to be paid on filing this application) 5. If dweIHng, 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 e×/sting 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 .....~.... ............. Height .................... Nurnber 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 ............... 4'~T.. ............................ 12. Does proposed construction viol~te'/agy/zonin~' law, ordinance or regulation? ............................................................ y...~..___~..~ ................../Z~ Address ...~.~.-/~ ." .~../...~...'"~'... J~. .'.. Phone No.../~....~...~..~..~ 1;3. Name of Owner of premises 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 ~,hether interior or corner lot. STATE OF NEWCCJ2R,,~, ~[2/, cOU,T',' ¢~ ....,~¢¢~ .......... _ ~'.'~.,~ ~,~/~ L,'~....~ ..... ~'j~ heine d~oses and says that he is the applicant . . . . ~..~...., . ......... - duly sworn, ~ (Name of mdwMua~gmng appllcah~n) 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 staternents contained in this application are true to the best of his knowledge and belief; and thru the work will be performed in the manner set forth in the application filed therewith. Sworg to before me this , ~ , ................... ';¢" ,, "~"r'~' ~7'1"~'"':';:~)'"," ...... ~~~.~... · l~l.~ft~J~-4D~..~///.'~Z ~ ] "~t~.¢: "~ ..... ,': ....................... No,.,~ ..b,,~. '"::.r'": ........... ;' .......... :.../~,...,...,,.... co,,W,. *.,,.,,. ~ ..... ~~" NOTARY pUBLiC State of New Y0r~ ]erm ~gires March 30,