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Home My WebLink About7578-zTOWN OF SOUTHOLD BUH.DING DEP~ Town Clerk's O~iee $outhold, N. Y. Certificate Of Occupancy No...Z.6.6..~ ..... Date ............8..ep.t....2~ ...... ., 19.~;. THIS CERTIFIES that the bui}&ing located at .]/a~.=o~. l~v®r..l/o~,d, ...... Street Map No. Xx ......... Block No, xx .......Lot No, .x2c...0e~t.. ~oY, ............ conforms substantially to the Application for Buil~i~g Permit heretofore ~ed in thi~ office dated ..........0c.t.. l ..... , 19Y.~. pursuant to which Builrllng Permit No.. 7.~8Z. dated .............OCt .... 1~[., 19.7~., was issued, and con/otto, to all of the require- ments of the applicable provisions of the law. The occupancy for which thi~ certificate is issued is . krivate, one. family, twel 1 in~ .w~.t~h: f~n~lng ...................... The certificate is issued to P~t®r. l~o~cb, to ....... .~nev ........................... (owner, l~e or tenant ) o! the aforesaid buildl-~. Suffolk County Department o! Health Approval . I~,t1° .............................. TJNDERWRITERS CERTIFICATE No.. it.Ho ...................................... HOUSE NUMBER ...... %1 ~. .... Street ...liar=ow. lttver./~oa~. .................. I~O'R.M NO. ~ 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.o 7578 Z Permissi°n is hereby granted to: .......... ......... ......... at premises located at .~.C'/.~' .~'..A~T~OI~ ~/~ ~ -'~b ........................................................................ :. ....... ~.~.L~.~.~ ....... ~.....~.~ ................................. pumuant to a~lic~ion ~ .................................... ~...~ ~.............., 1~.., and approved by the Building I~tor. ~. ~.Z.~.~ ........ ...... ;.~.:.~--..-.~..,.....-.....:....:-~..-.~ .................. Building In~tor Examined ......................................... 19..~ ..... ~Ul~DING DEPAItTMENT~ TOWN a. ERK'S · ~O~TI4OU), N. Y. Application No..,/...--~.~...../..~. ............. ~- Approved 19 .. permit No. ' -- Disapproved a/c ........................................ ~. ................................................ / (Building Inspector) APPLICATION FOR IUILDING PERMIT Date ........ (~I~II, B~...~... ~.~.~t, 19 ............ INSTRU~I~S d. Upon a~roval of this application, ~e Buildi~ Ins~tor will issue a Building Permit to the ~licant. Such ~it~ shall be kept on the premiss ~ailable ~r insp~ti~ ~rough~t the work. e. No building shall be ~cupi~ or u~d in ~ole or in pa~ for any pu~ose wh~e~r until a ~ific~ of ~cu~ncy shall have ~en granted by the Building I~p~or. ~P~LI~TION {S HEREBY ~DE to the Building ~ment for ~e issuance of a Buildi~ Pe~it pU~ant to ~l~0~o~[~t~~ ~i~n~th~ld,. Suffolk Cou~, New York, and ~er ~l,cable O~i~ or The a- Ii ........ g~ a~it~ms or ~Iterat~ons, or for m~al or ~litim, pp con[ agr~s ro comply wire all ~l~Caole I~s, orainances, buil~ c~, h~si~ c~, admit authoriz~ in~,to~ ~ pmmlses and in bulldl~ ~r ' (Signatum'"' - ~ '"~F--~~ ~' 'i~' '~ ' ~'~'~i~ ........ (Address at applicant) State whether applicant is owner, lessee, agent, arChitect, engineer, general contractor, electrician, plumber or builder. ................................. ................................................................. . Name of owner of premises .~.~J~...~..n...~l~[f.~.~,~r~,....~.~.e. ......... . ............... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ~ ' ....................... ~: ............... Lot NO ......................... Street and Number ...... ~,~a..J~..~,3~ll..,i~&~....~l¥..~lr~llt...~'4Ml~ ............ ... .......... ,'......i .... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............................. ~ ........ ~'...~.~.......~..l~..~.~Jl~ ................................ Intended use and occupancy .......... .~t..,~**~ ...............!:./.-- ........ ~,;.~..~ ............................................ b. 3. Nature of work [check which applicable): New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ...~1~.~...~...~1~'~. ............. (Description) 4. Estimated Cost ........... ~...~...~..~.. ..................................... Fee ..~...~..~.R..~... ........................................................................ (to be paid on filing this ~plication) 5. If dwelling, number of dwelling units ........ ~ ........... Number of dwelling units on each flor ........................... If garage, number of ~rs ....~.~ ................................................................................................................................. 6. If business, commercial or mixed ~cupancy, speci~ nature and extent of ~ch ~pe of use~..~ ...... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ................... Height ........................ Nu~er of Stori~ ...... ~ ................................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ........................... Number of Stories ................................ 8. Dimensions of entire n~ construction: Front .................................... Rear ............................ D~th ........................ Height .................... Number ~[ Stories ...~ ....................................... ~ ........................................................................... Size of lot: Front ............. ~..~. Rear ...... ~Z~ ....................... ~pth ...II~eJB.~ ........... Date of Purchase ....................................................... Nome of Former ~ner ...................................................... Zone or use district in which premises are situated .................................................................................................. Does proposed construction violate any zoning law, ordinance or regulation:~...~...~..~~ ....... Will,~ot be ~raded ............................ Will excess fill be.rem~ed fr~ promises: ( ) Y~ ( ) No 10. 11. 12. 13. 14. Name of Owner of premises ...~l~l~J...~..~..~.~l~Z~l~A~ddress~l~l~. ................. Phone No~.~... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...... ..~..~..~...~1~.. ........................................... 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. sTATE OF NEW.YORK, ~ c c COUNTY OF .~~;..;-----( .... .... :~.i.~.~17~i!:~..~.~,.....~..i~ ................... ; ........... being duly sworn, deposes and says that he is the applican, (Name of individual Signing' cOntract) above named. He is the ....... ~..~...~..~..R...;-. .......................................................................................................................................................... (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 tha~ the work will be performed in the manner set forth in the application f~d therewith. ,~ Sworn~/~Lr~ore me this ~ / / ........ ........ Notary Publi~~~nty ..... · ./.~......~f~ · ..,.,~~~. .......................... ~ T, eOKEN N~faW Public. Sm~e oE Ne~ Yad*