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Home My WebLink About4858-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CL,ERK'S OFFICE SOUTHOL. D, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ........ ~/~...H~I~..Ro~ ........................... Street Mop No. ~/ & G Block No. Lot No. X~X i (~reeTt~,,or~, conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................... ~lj..~ .......... .1..l~......., 19..~..O.. pursuant to which Building Permit No. dated ...................... .~....~t .......... .1.~ .......... , 19.~...0...., 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 ........ ............ .?.~.%.~...~.~.~.e.......(..~.e. ?.,.~.s..~p. ~... ~..z.~.). ............ : ........................................................... The certificate is issued to ..g.~.~....}.~;~.~.~.*~ ......... ..0~..?~.e.~. ......................................................... (owneh lessee or tenant) the aforesaid building. TOWN OF $OUTHOLD BUILDING DEPARTMENT 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 4858 Z Permission is hereby granted to: ............... 4~e~*~?~ ............................................. to ................ ~tX~ ~t~ · ' ~:1-i' · X~r~.t'~: ~.~'Xl' "~il~' "~.5: ~ %'~yg ' ' ~'~ $Va ~ ' ' '~a~ ~ ................................ at premises located at ............... ~.~,,...kg~.~h*,.~c.,.q~ ......................................................................... .......................................................... ~e~o;~t~ ......... ~*r~ ............................................................. pursuan,t to application dated ........................... ~.~. .......... [~...;....., 19 ...... ~,Oond approved by the J3uiJding Jnspector, Fee $'"'~li~.~, .......... Building Inspector , 0 Application NO ...... *,,~.~-,,, .......... ~ (Building In~) APPLICATION FOR IUILDING PIRMFI' INS"I'RUCTIONS a. This application must be completely filled In by typewriter or In Ink and submitted In duplicate te ~t lulklinglb Iml~'~r. b. Pl~ ~n ~v..inli I.ae~lon of lot and of I~.lldlngs on prem!Ns~ relatlamhlp t~ adj~inln~ pmmle~e areal, aha g. ng a ~m,e~ aelcrlptlon of layout at properS/must be dm ~ thi diagram whlch Ii I~ff ~ ~tb ~Ndlc~i~ c~ The ~ covered by this appllcotlon may not be commenced before issuance of Building Permit. ma. ~e Kq~T an mi prlmllll available Tar inlpecrlon throughout I'nl pl~grlil or ~nl w~m, _e:..No .building ~al! .be ..ocouj~led or u.~ecl In whole or In part far any puq~ee whatever until a Cefflflcotl of ma, nave mn granma ay me aulldlng mspeator. R.~.A..P. PLI_CATIO_N !S HEREB, Y,/~_DE to .the B~ll~l~.~nment ~ ~e Juuance of o Bulldlq N~lt u.a~ ~ ~l~ m me ~ m ~no~ Suf~lk C~n~, N~ ~ork, a~ ~r ~ll~ble ~ u~m~, mr me c~mctl~ o~ building, addition, ar alterations, or for mmpi er demolltl~, .I ~n ~Ji~nt ~ ~ c~ply with all applicable la~, o~lno~fl, building emi, h~llng c~e, and ~latl~l. ........... ....................................................... (SIg~tum of o~ll~ant, oe ~, If a ~1~) (Addreu of al~llcont) State whether applicant Il ~vner, lee~co, agent, archlte~t, engineer, general contmator, elKtrlclon, plumbe~ or I~llder. ........................................... .............................................................................................................................. Name of ~wner af ~remllee ,(~,l~,~'&,,~L,~,~e~,£~l,~l. ............................................................................................................ If applicant 18 o coq~rate, slgrmmre of duly authorized officer. I Laontlon of and ~n wh ch -m~aled v~rk w 1 ~ d~e Man N~ ' 2. ~ ~1~ ~ a~ ~¢u~ =f Pmml~ and Intln~d use a~ o. Existing me and cocupa~,'y .........t~1~.~l.t,e..~a3:a~e ........................................................................................ b. Intended me and occupant,* .............. .s~me..~t~l~..~..a~l, cl~l,l;~l,eG ............................................................... 3. Nature of work (cHeck whici~ applicable): New Building .................. Addition ....]QIiZ, ...... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....................... .br.Q0...~. ......................... Fee ..~..~.g.g. .............................................................................. (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ...... ~no~ne ............ 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 s~'ructures, 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 ............ ~CJ ................... Rear .......... ~g. ............. Depth ....... ~ .............. Height .................... Number of Stories .............ozle .................................................................................... ,' ............. 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date uf Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ...............~.tA~...(J.~.l~ ................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .............. ~O' ........................................ 13. Name of Owner of premises ..C.o...~J.s.sel:~J~e~,~ ...... Address ......~.Q1Z~Q].I~ .................. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ......... ~T.,..H&.~OI~.~I.I~. .................. Address .......~g~.~Q~ ..................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 Jot. STA~E OF NEW yoRK, .... COUNTY OF ...... ~ f.o].l~ ......... )' ' ............................. ~OZIZI..,T~]:IOII~.~I ...................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ................. .O. Oll~X'.~g..t..o.~ ....... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 · 1.bf da,, of ~Tll.l.~'. Notor/ ELIZABETH ANN NEVILLE NOTARY PUBLIC, State of New York No. 52-8125850. Suffolk CountY_ Term Expires March 30. I9~