The URL can be used to link to this page

Home My WebLink About7505-zFORM NO. 4 TOWN OF $OUTHOLD BU/r,F~ING DEPARTM~,NT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .~/.8. J.o. ek.~..~_k. D.F ....... Street Map No.~ .......... Block No. ~ ...... Lot No... m~X.. South~ld.. Jo¥.~ ....... conforms substantially to the Application for Building Permit heretofore, fried in this office dated ...........AU~.. 28.., lg.7.1~, pursuant to which Building P ~ennit No..7.~O~Z. dated ..........&~.. 28 .... , 19.7~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ,~ (owner, lehsee or tenant ) of the aforesaid 'building Suffolk County .Department of Health Approval N.:R.: ................................ UNDERWRITERS CERTIFICATE No. ~t~. ' ? ? FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 75O5 Z Date ....................... A~t~IIMI~.....~ .......... 19.~1~k.. Permission is hereby granted to: ....... .e.~.o.,...~,,..,,.~ ....... ..~.[.,.,$.~.~.~.....mumk lh~3~! au add~t;ta~ on · t~n d 1 to ....................................... ~.~. ..~......~....~.~1~ ....................................................... at premises located at ........ ~.~...l~t~[.,i~l,~..T~..~;..j~l.~lOZ'.~..~[ ........................................ pursuant to application dated ..................... ~tt~ ......... ~,8 ............. , 19..~.~., and approved by the Building Inspector. TOWN OF IOUTHOLD BUILDIN~ DEPARTMENT TOWN CIARK'~ OFFIC, E Iou'rHOLD, N. Y. Application No......~....~...~.....~.. ........... ..~ D,sapproved o/c ................................................................................ ~ __ APPLICATION FOR BUILDING PERMIT "~ Date INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building,~ Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets of areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered 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 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 Buildina Permit oursuont to the,~ udd~ng Zone Ordinance of the Town of Southol,cl., Suffolk County, New York, and other apfllicoble Laws, Ordinances or~ Regulati.o. ns, for the construction of buildings, addftions or alterations, or for removal or demolition, as here n described. The opphcant agrees to comply with all applicable laws, ordinances, bui!ding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~.,'~...~..'~.~'-~..~...~:Z/~.~......~..~..~/--~..~-~... ........................................................ 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 Trade's License No ............................................... 1. Location of land on which proposed__ ~w°rk will be done. Map No.: ....................................... Lot No ......................... Street and Number ................... ~/..~t~.*~..~.....~1~' .... - Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building.. ................. Addition ...L ....... Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... ~1. ~, (Description) 4. Estimated Cost .....~.,..~...0.../. ............................................ 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 extents.of, each type of use .............. ~ ........ ~ .... 7. Dimensions of existing strvct, ures, if any: Front ...,.~.../. ................ Rear ....'~..../...~. .................. Depth . .~.....~.. ........... Height .../.....~...~ .......... Number ~ Sto,ries ,. ....... ./.,..~...~..~ ................................................................ ,.~. ................. ' .... ~. ~ / ~'/ Dimensions of sa/ne structure with alterations, ar 13dditions: Front ....RJ .......................... ~ Rear ....,/..~.. ................. Depth ....... ~..~.....'. ............. Height ...."1/,~...i..".· .......... Number of'Stories .../.~..: ............... 8. Dimensions of entire new construction: Front .................................... Rear ....... ~...~....~ ........ Depth. ..~.~.._ Height ../.~ .............. Number of Stories ...... ~'..~ ................................................................................................. f ,~ r 9. Size of lot: Front ..... J..~... ........................................... Rear ../...O....0. .............................. Depth .~..~....~.....-.....~...]...O. ..... 10. Date of Purchase ............... ..'~.....~.'....: ........................... Name of Former Owner ..... ~ ...................................... 11. Zone or use district in which premises are situated ...... ]~...(.~.1~..~...~ 12. Does proposed construction, /,violate any zoning law, ordinance or regulation: ............ ..~.. ................. ~. .......... ; ...... I3. Will lot be regraded ..........Z~...I:Z ........... Will excess fill be removed from premises: ( ) Yes (K) No 14. Name of Owner of premises J~.f~.....~.LAI~ff/.¢,/~. ........... (icl ss ..~/.~l~'~t'.~./ff~Phone No ........ .~. Nome of Architect ......... ~,.~.~..; ....................... , .................... Address ................................ / Phone No ....................... Name of Contractor ~././/~.~/ ....... .~.~...J~/~'~ ............ Address .~?~..{ .F..~.....E~.....:... Phone No.Z.~...~...'.~.../...-~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and bio,ck, n~mtzer or description according to deed, and show street names and indicate whether interior or corner ' I -'4 ' STATE OF NEW. Y~.R.K/~// ( ¢ ¢ ............... .~(~/~..~'~..~~ ................. being du~y ~worn~ d~ose~ ond say~ ' {Na~ of i~ivi~ sing c~tmc~ above name. , He is the ........................ ~Z./~.~ ............................................................................................................. ~.. (Contractor, ag~t~ co,rate officer, etc.) of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; ~ all sfatements contained in this applicotibn are true to the best of his kn~ledge and belief; end tha~ the work will ~ perfor~d in the manner set fo~h in the application filed therewith. Uoto, .... ......................... .................. JUDITH T. BOKEN Notary Public, State oF New No. 52-0344963 Suffo k County Cornrnlss on ~=xpires March $0, i9_~