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Home My WebLink About7579-z FOILer NO, ~ TOWN OF SOUTHOLD BUH.nlNC. DEPARTMENT Town ~k'~ ~ Sou~ol~ N. Y. Certificate Of Occupancy No. Z61~ ..... Date ............. ~oVembel' .... $, 19~. THIS CERTIFIES that the building located at .......F~ead~m.I~ae ....... Street Map Noi~tto .~s.l~.. Block No ...........Lot No. Ill .... ~tti~;~lfl~...]I,Y.~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........0et, ... 7..., 19. ~. pursuant to which Building Permit No. 7~?~Z. · dated ...........0et ....~;..., 19~..., 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 . l~rl~at~..one. I~1J~ .~i~.~]Li~I. xith. ~d~,i.t.J,O, ...................... The certificate is issued to .P&.~.~C~..He~e~ ....... .'.l~m,~ ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. |~.~.i~, ............................. UNDERWRITERS CERTIFICATE No. 11,~. ........................................ HOUSE NUMBER... ~.~.~ ....... Street.. ~e&cLa~. Lmm .......................... ....... . . . ffOB~ NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE. SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON 'THE PP~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7579 Z Permission is hereby granted to: at premises located at .............. pursuant to application dated -') ~7~' 7 19 .... and approved by the Building Inspector. Fee $.../..~. ............... Building Inspector TOWN Of SOUTHOLD IUILDINe DIPARTMINT TOWN CLIRK'S OFFICl SOUTHOLD, N. Y. Examined .. Approved 19..' .... Permit No ........~; ....... :,~. ................ Disapproved a/c .............................. :;.; , ~.:..~ .................. .~ ........ (Building Inspector) iPI~UCATION ~0~, lUlLDIN6 I~E~,MIT App ication r~o .......... ~ .......... · ........... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building ~ Inspector, with 3 sete of plans, accurate plot pldn to scale. Fee according to schedule, c~ b. Plat plan showing location of lot and of buildings on premises, re ationship to adjoining premises or I~blic streets or ( areas, and giving a detailed description of layout of Praperty must be drawn on the diagram which is part of this application. c. The work covered by this application may natbe 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 work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy .~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Build!ng Permit pumuant to the ~BeUildln.g' Zon.e O..~linonce. of the Town.of Southol,cl., ~uffolk Cou.n. ty, New York, and .otherapplicable Laws, Ordinances or , , ng coae, housing coae, ancl regulotiort~, and to admit authorized r inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ J. ...................... Name of owner of premises ~-~/~ "/1~ I ~.~ ~J~-~ ] S~ ............................................... If applicant is a corporate, signature of duly authorized officer. Builder's Liconse No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ..................................... '... Lot No . Street and Number ... ./.... ....... /......~.....~ ....... - Municipality 2. 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 ....... ................................... '~ ........ ~ .......................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .......~ ........... Alteration ................. Repair .................. Removal .................. Demolition .................... Othei~ Work ..................................................... (Descriptioe~ r 4. Estimated Cost ............................ : ............................... Fee ....z..~. ................................................................................ (to be paid ~t filing this application) 5. If dwelling, number of dwelling-units ............... ............. Number of dwellir~ ~m~ts ae~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. Date of Purchase ..................................... .~ ................ Nome of Former Owner ..~/ .................................................... 11. Zone or use district in which premises are situated ............................................. ; ...................................................... 12.~ Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( /~J'"l~o 14. Name of Owner of premises ......... ; .................................. ~ ....... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .............................................. ' .............. Address ..~'...;~!...~':./...~/.../.../.~.. Pho~ I~ ................... .~.. 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, I ¢ ¢ COUNTY OF ............ ~ ................... ~'~ ..................... ~ ...... ~.~ ........................................................... being duly sworn, deposes and says tl~t he is the applican! (Name of individual signing contract~ above named. He is the A r. ..................................... (Contractor, agent, corporate offmer, ~c.) 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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~'day of Notary Public, . .............................. ~,~ .................. JUDITH T. BOKEN Notary Public, State af New Yor~ i No. 52-0344963 Suffolk County Commission Expires March 30, (Sig/laeure of applicant)