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Home My WebLink About5803-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Cerlificnte Of Occupnncy No..~...~9.~ ..... Date ............ ~'~...29 ....... , 19.~.. THIS CERTIFIES that the building located at . l~l,~t~, lie~s~-I,~. (PV~ .Itl)) Street Map No. ~ ......... Block No... xx ..... Lot No...lac ...$o~thol~l... li.,l[. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ liaroh.. 2.7..., 19..72 pursuant to which Building Permit No...~08~. dated .......... ~p~Sl...~0.., 19..~ was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certifieate is issued is .l~'i~r~e. olle. f~l~tl~r. ~(e~_~J.Ilg ....................................... The certificate is issued to ...liarol.(i .~,.-¢~olr ....... 0w~ ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. II,l~, ............................. UNDERWRITERS CERTIFICATE No .... ~[.*R. ......................................... HOUSE NUMBER..~ ....... Street .....:~gh~O~.l~ .I~ ............................. ~O~R~ ~/0. 2 TOWN OF SOUTHOLD 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) N? 5803 Z Permission is hereby granted to: at premises located at ............ ~,~..~O13~e...Tl~.l~lL.(.l~/.~..]~1).~)...l:~'.-.~j~..-I~.-~-~I~...~flL4M~ ................................................ ~D.~.t,~e:l,~ ....... ~,~.~., .......................................................................... pursuant to application dated .................... ~J~l~....-,~.~'. ............. , 19..7~..., and approved by the Building Inspector. ...... Buildin~tor / -~:: TOWN OF SOuTHOLD /'-/ ~.~~...12~7.,v~'~ .., ~ BUILDING DEPARTMENT · TOW. CLER,C'S OmCE Disapproved a/c ................................... d~ '~ AFFLICTION FOR BUILDING PERMIT - P L ~/Z ~ , ....... D.te ~. lhi~ ~pplic~tion mu~t b~ compl~t~l~ fill~d in b~ ~writor or Inspe~or. . b. Plot plan showing location of lot and of buildings ~ premises, rel=tionship to adjoining premises or public stree~ or oreos, and giving ~ detailed description of Ioyo~ ofpr~e~ must be dr~wn on the diagram which is p~ of this application. c.:. The work c~ered ~ this ~ppticotion m~y n~ ~ commenc~ before i~uonce of Building Permit. d. Upon opprovol of this ~pplicotion, ~e Building Ins~tor will issue ~ Building Permit to the oppllcont. Such pe~it shell be kept on the premises ov=iloble for ink,ion throughout the p~s of the wor~ e. No building shell be ~cupi~ or u~ in whole or in ~ for any pu~ose whatever until shall hove been granted by the Building Insp~tor. r APPLICATION IS HEREBY ~DE to the Buildi~ Depo~ment for ~e issuance of ~ Building Pe~it pu~uont to the Building Zone Ordinance of the To~ of ~uthold, Suffolk Count, New York, and other =pplic~ble Lows, O~in=nces or Regular ons, for the construct on of bu Idings, ~dd t ~s or ulterotlons, or for rem~ol or demo ition, os heroin d~crib~. The applicant agrees to comply with all =~lic=ble lows, ordinances, building c~e, housing c~e, end r~ul=ti~s. . ....... ~..~. ..................... ,..,,... ~ ~m of ~pplicont, or name, ~ ~ co~or=tion) Stat~ whether ~pp~ic~nt ~ owner, I~e, o~nt, ~mhit~ct, ~n~in*~r, oon*rol contractor, electrician, plumber or builder. ....... ................... · I{ ~pplicont is ~ co,orate, *i~notum o{ duly outhori~d .................. ......... 1. koc~tion o~ land~umb~.~..~.~.~.~L~.~..~.~.Q~...~...~.~.~.~on which proposed work will be don*. ~p ~o.: ........................................ Street ond ...... ~2..1., .................... ~ ~ Municipali~ · 2. Store existing use and ~cuponcy of premises and intended use ~nd occupancy of p~osed constr~tion: ~. Exisiting use and occuponcy ~T~ '~ ~ 3. Nature, of work (check which applicable): New Building ............. ~ .... Addition .................. Alteration .....~....::.~ .... Repair ............. · .... Removal ........... ... · · .. Demolition .................. Other Work (Describe). ............. .. . : ..................... . 4. Estimated Cost ....... ~ .............................................. 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 .................................... Rear ............................ Depth ........................ Height Number of Stories .............................. 9. Size of lot: Front ............................ Rear '. ................................... Depth ................................ 10. D~te of Purchase ..... .----~t.l~.J~...~,.!.~'/-~ Name of Former Owner I 1. Zone or use district in which premises are situated ......................... 12. Does proposed construction violate any zoning law, ordinance or regulation;~ 13. Name of Owner of premis~i~m.0..L,.~..~.,..~.P..~...~.. ..Address ~.1~..~.~.~.....~.. ...................Phone No.~...~...'...~...~/~. ~0~'rM~b rd, , 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 fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. I STATE OF NL:W ~)R)~,//..,~ tSS C O U N Ty~OF/-~,~,~/r-~C~ ..~ · '-[Name of individual sigrj~g application) above named. He is the ............ ~ m ........ ...................... ~ ......................... , (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 thor the work will be performed in the manner ~et forth in the application filed therewith. Swam ~,ore me this //~ , . ~/~ .~ ~ ....... .............. JUDITH T. BOKEN (Signature of applicant) Nolow Public, Stc~te o~ New York Ne, 52-0344963 SuffoJk Cour~.~ ~mmJ~ion Expires March 30, 19~_~ V