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Home My WebLink About6831-zFORM NO. 4 TOWN OF $OUTHOLD BUH,DING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at ...l~al~oke..&~e. & .Pla'ct.l~treet Map No... ~x ....... Block No ....x,, .... Lot No .... xX .... 0~nt.. ]~.Y, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............AV~..28.., 19.73. pursuant to which Building Permit No. dated ...........A~a~- .~ ..... , 1973.., 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.~ivate. one .fatally. ll~mll~ .................................... The certificate is issued to . .l~e~ll. ~lford .& l~if®. OeMI'S ...................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) .I~oRo .............................. UNDERWRITERS CERTIFICATE No. l~o~dlnl ............... /'i .................... HOUSE NUMBER .... 8S.~ ...... Street ..,. ]hlly. cfl~e. Are. 2t~00 Platt R5 Bm 1~01~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTltOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6831 Z Date ........................... A~I~S $ .......~9", 19'2'3"' Permission is hereby granted to: ................ Or&en~; ................................................. ar premises located at .Ha~'.ok~..Alre...&..~.3,af,,~.,~d ...................................................................... ............................................................. 9~t~,~t .................................................................................... pursuant to application dated ....................... A~2~ .................... , 1~7.~...., and approved by the Building Inspector. Fee $...1...~..'..9..0. .......... "' ..... --~--.---. Building Inspector PERMIT INCLUDES APPROVAL TO ; EMOVE EXCESS FILL FROM ABOVE PREMISES BY R£CP*DING LC.T FO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C;LERK'S OFFICE SOUTI-IOLD, N. Y. Approved ........................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This apphcat~on must be completely filled m by typewriter or mmk and submitted ~n trlphcate to the Budding Inspecto[~[w 3 sets of plans, accurate plot plan to scale Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adlmmng premises or pubhc streets or giwng a detmled description of layout of property must be drawn on diagram which is part of th~s apphcat~on c. The work covered by this apphcat~on may not be commenced before issuance of Budding Permit d. Upon approval of th~s apphcat~on, the Budding Inspector wdl ~ssue a Budding Permit to the applicant Such permit,shall be kept the premises evadable for inspection throughout the work. e. No budding shall be occupmd or used m whole or in part for any purpose whatever untd a Certificate of Occupancy shall have granted by the Budding Inspector. APPLICATION IS HEREBY~AJ3E to the Budding Departrrent for the ~ssuance of a Budding Permit pursuant to the Budding Ordinance of the Town of Sou, thold, Suffolk Count,/, New York, znd other apphcable Laws, Ordinances or Regulations, for the construct~o~ buildings, additions or atterat~ons, or for remover or demohtton, ss hereto described The apphcant agrees to comply w~th ordinances, building code, housing ,c.o~de, and regulations, and to adm, t authorized inspectors on premises and m buddings for necessary mspectlm (SignatUre of apphcant, or name, if a corporation) (Address of applicant} State whether applicant is owner, lessee, agent, architect, engineer; general contractor, electrician, plumber or build Name of owner of premises ..~.:....~....~.....~.~....~.. .............................................. If applicant is a corporate, signature of duly authorized officer. IName and title of corporate officer) Budder's L~cense No .......................................................... Plumber's License No .... ~.?....~:......)~.. .................................. Electr,c,an's License No .....~.....~..~./..~.-. ............................... t ' ' O her Trade s License No 1. Location of land on which proposed work will be done. Map No ........................ 1~.'~. .............. Lot No ............... ~/ MunicilSality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..~ ................ ~;~ ........... ~.~ ......................................................................... b. Intended use and occupancy ...~ ...... ~ ...... .~..~r.~ ................................................................. 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... t ..~ff.~ (Description) ,...2/. "- 4. Estimated Cos -.%v...%..::.... ........................Fee ....... .................................................................................... (to be paid on flbng th~s apphcation) 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 occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .... ~i.~......~.. ..... Rear ....~..~...~..~...?. ....... Depth ....,~....?..~.?.~..~r. ............. Height .............. ; ............................................ Number of Stories ..... ~ ................................................................ Dimensions of same structure with alterations or additions: Front .... ..~'...~....~ ......... Rear ......................................... Depth ..... . ..................................... Height ......................................... Number of Stories .......2-~.. ............................... 8. Dimensions of entire new construction: Front .......... ..~:.....~..~ .... Rear ....77....~'...! .............. Depth ~...~... ..................... Height ......... ~..P. .................................. Number of Stories ........................................................................................ 9. Size of lot: Front ..... (..~....~..~ ...................... Rear ....... ./..~..~?...r. ...................... Depth ...../....~....~.-.....r. ........................... 10. Date of Purchase ..................................... Name of Former Owner ....~..z...~..~ ......................................... 11. Zone or use district in which premises are situated ..... ~.~:~....a .............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ,.~ ............................................. 13. Will lot be regraded ---~ ..................... Will excess fill be remo_ved from p, remises: [~0 Yes [ ] No 14. Name of Owner of pren~ises :..~.~-~'...-2K-~.~..~.~ ............... ~.....~..~...;7..rTr.,~..~.~.. ..... ~' (Address) (Phone No.) Name of Architect .................................................................................................................................................... ~ /~ /~ (~,ddress[ (Phone No.) Name of Contractor ...~...~.. ....... (Address) (Phone No.) PLCT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-ba~k dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate whet er interior or corner lot. STATE OF NEW YORK, ) SS ~ ~ '> COUNTY OF ~.~.~./~'~....~r. ........ ) j. .... ..... .............. be,ng duly sworn, deposes and says that he ,s the appbcant above nam (Name of tnd~vtdual s~gntng contract) He ,s the ..................... ~.~.4/~..~.../~..~.. ............. ( Contr~zitor,' ff~ent, '/;'~t~:/a'te offi;er,'e't'c. ) of smd owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and file th~s apphcatmn; tha statements contained m th~s apphcabon are true to the best of h~s knowledge and behef, and that the work wdl be performed m the ma set forth In 1.he application filed therewith ... ...... day of ...... ,-~,d:?~, _~,~_ ~.. ~taW Public State of New Yor~ ~~ ($~gnature of appffcant)