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Home My WebLink About5415-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sou~hold, N. Y. Cerlificate Of Occupancy THIS CERTIFIES that the building located at Deep. llole. D~ ............. Street Map No.D. eep .Hole .C~lo~l~o ........... Lot No. I~ ..... ~a~;.t.i~uck..I~..~.~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... J.~Y...]6.., 19.~.. pursuant to which Building Permit No...~.$ ~... dated .............. J~J,2...1.~ 19.7.~., 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.~'lva~, garage, l.aec~zsery. Butlcl.~ng ) ........................... The certificate is issued to . .]~1~1,a175. l~c~..~¢ ....... 0~r~e.r ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Building Inspe~or FOR,~ NO, ~' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Sou'rHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5t15 Z Permission is hereby granted to: ~ ]i~1111~11 ~ to ..... l~q~l,..~l~te...~e...I;~e ~ ~se~...~dl;.. ,1 .......................................................... pur~u~n~ to opplicotion d,ted ............................ ~tI~ .......... ~.~. ....... , 19...~!8., and opproYed by the Building Inspector. Fee $...~.e~l~ ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ' (Building InspectS) ' APPLICATION FOR BUILDING FER~IT a. This application must be completely filled in by ~pewriter or in i~ and submiffed i~ duplicate to Jhe Building~ b. Plat plan showing I~ation of lot and of buildings on premises, relationship to odjoinin~ premises or public streets or areas, and giving a detailed description of layout ofpr~e~ must be drawn on the diagram which is c. The work co~ered 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 p~ress of the work. e. No building shall be ~cupied or u~d in ~ole or in part for any pu~ose whatever until a Ce~ificate of ~cupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY ~DE to the Building Department for the issuance of a Building Pe~it pu~uant to the~ Building Zone Ordinance of the Town of ~uthold, Suffolk County, New York, and other apPlic~je ~s, Ordinances or Regulations, for the co~truction of buildings, additions or alterations, or for removal or demoliti~, as herein described. The applicant agrees to comply with all applicable laws, ordinances building c~e, housing c~e, a~d ~ulations. · (Signature of applicant, or name, if a co~omtion) (Addres~ of ~pplic~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................................... x, ............. ..................................................... Name of owner of premises .......... ....~..~......~...~.~.-~ ..................................... ~ ..................... iiii If appI, L~nt is a corporate, signature of duly authorized,officer. . (Name and title of c(t~l,~rate officer) 1. Location of land on which prOPosed work will be done. Map No.: .....~'....~....,~....,~. ................. Lot No ..... .~....~.. .......... Street and Number ...... ~'"Z/~D~''''''''~''~- '-~ -(z~_~' ..................................................................................Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ........ !..7........~...~.......~.~~ ............... ~ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ................ ~.~r.g..~ ............................ Fee .......................................................................................... (to be paid on filing this application) 5. If 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 .....d~...~ ....................... ~ ¢ Rear ...... .~...~ ............. Depth ........................ Height ...~....~.~ ........ Number of Stories ! '~ >~ ..... .4...~...~.. .............. 9. Size of lot: Front ..../...~....~'.......e..~/..... Rear ..../..~.-~...: .................. Depth 10. Date of Purchase ..... ~...~/~..:..~.../.. ............... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction vi~,te any zoning law ordinance or reg~ation? ........ 13. Name of Owner of premises .....-~.~.~Address-- ..... ~'..~-~w....~ ........... ........................................... Phone No ..................... Name of Architect .............. ..~....~ ................. Address ............................................ Phone No ..................... Name of Contractor ........... ~..c:;:~cw:~e~ ............ 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. 34" STATE OF NEW YORK, J~ ' ~ COUN OF ............... ' ................................................ ~~ ................. ~ing duly ~orn, d~o~s and says t~ he is the applicant (Name of individual s~ning ap~icat~) ~ _ ~ named He s the above . ........................................................................................................................................................ (Contractor. agar. co,orate officer, etc.) of said'~wner or owners, and is duly authorized to perform or h~e perfo~ed the said work and to ~ke and file this apP~n; that all statements contoined in this applic~i~ are t~ to the best of his knowledge and belief; and that ~he wd~'will be pe~or~d in the manner set fo~h in the ~pli~filed ther~ith. Swe~re methis J I a ~ . .... ..... ...... ..... ..... .............. ....................... ~Ull~ in Su~lk ~ ~ N.Y. ~. eib. & ~ ~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~aA/~ ! Bldg. Permit No. TO WHOM IT MAY CONCERN: ~The sewage~disposal.facilities~.~ ~ ~f°r ~o~a structure~_~.located ~ (Give deed location~ have been inspected by this department and found to be satisfac, tory. Chief of General E~glneerlng Servi'ce~ D~strict Engineer 1971