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Home My WebLink About7369-Z~ NO. · TOWN OF SOU'~OLD BLm.nING DEPARTm~T Town Clerk'~ O~iee $outhold, N. Y. Certificate Of Occupancy Date ................. NoV .... ~..., 19.76 THIS CERTIFIES that the building located at .. 3eeond .Ave .............. Street Map No. P. eoon~e, l~,Block No ........... Lot No.. 1.1.~ ..... I~eeon~e... ~.Y.. ...... conforms substantially to the Application for Building Permit heretofore filed in thi~ office -~ dated .............. Jtm®. · - ........ J~y...$ ..... , 19.. 74t was issued, and conforms to all of the reqmre- ~,~'x,~ dated . ~019..Tbt pursuant to which Building Permit No .... 7~.6~ .ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is issued is .... l~lvate, o~ .fa~],y. d~el'ttn~..~tk &dd~,tio~ .................. The certificate is issued to . .tLtchard. ii., .l)~v~.s ..... '.°~er ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~.:~: ............................... UNDERWRITERS CERTIFICATE No. ]I,1t, ....................................... HOUSE NUMBER ..... 3.~{1 ..... Street ...... Second. AIs ....... Peeon~e ......... 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) 7369 Permission is hereby granted to: J .G ,.l~rk~ .... ~..G ..~'t~mun~.. ~,~t~J,~ ............... ......... gzo.e~.~r$ ................................................. el t~.on (deck) ~ ox~.st~.nl~ d~elling to .~..~..~...~....~. ........................................................................................................................... at premises located at ....L...e.~...~.~..~.......~.e....~..q~..e.....~...~..z'...e..8.. ................................................................ ........................................... .~.~...0......~..,..,...=..~....,.~ .......... ~....?.~..,. .................................. pursuant to application dated ..................... ..~.~........~.. ................ 19...~....., and approved by the Building Inspector. Fee $ J[ ~..a ~1~ ........... [ ' Building In~,~tor [ ~amin~ ~. ~ ...... , 1,..~..~: ~~ ~ ....... ............. ....................... ................................ ...... ........... . IN~RU~I~S~ a. This ~lication m~t ~ completely fill~ in by ~ewriter ~ in i~ o~ s~mi~ in tripl~ In~6r, with 3 ~ of p~s, ~cum~ p~ plan ~ Kale. F~ ~co~J~ to Kh~ule. b. P(~ plan s~[ng I~otion of lot and of ~ildings ~ premiss, relationship to adjoining promises or ~blic stre~ ar~s, and givi~ a detail~ de~rJpti~ of layout ofpr~e~ must be drown on the diagram which is c. The work covered ~ th~ a~lieation m~ not be comme~ before issuance of Building Permit. d. U~ appeal of ~is application, ~e Buildi~ Ins~tor will issue a Building Permit to the ~pllcant. Such permit s~all be kept on the premi~ ~ailable ~r inaction ~gh~t t~ work. e. No building shall ~ ~cupJ~ or u~ in ~ole or in po~ ~r any pu~se ~ever until a Ce~ificate of ~cu~n~' shall have been gmnt~ ~ the Bulldi~ Ins~tor. APPLI~TION IS HEREBY ~DE. ~ the Building Depa~ment for the issuance of a Buildi~ Pe~it pu~ont to the ~uild~ Z~ O~i~nce of the To~ of ~hold, Suffolk Count, New York, and other applic~le Kegu~ob~m, tot the co~m~ion of building, ~iti~s or al~ra~s, or for m~al o~ demoliti~, as ~e applic~t agrees to Comply with all applicable laws, o~inances, buildl~ c~, h~s~ c~e, a~ ~ul~i~ a~ admit au~riz~ in~to~ ~ premiss and in buildi~ ~ n~a~ i~ti~s. ~ ~ C~ ~ (Signat~ of applicont~r ~m,, if a co~mti~, (A~ss of apphcant) -- ~ Stotewheth~r~pplicont~n~e,~ont,~mhitect, enoineer,~.~.[~ ~enoral contmctor, ~lectrician, plumber or bu,ld,r. ......... ................. ...................... z ............................................................................................................ ,~ o, o~r o, p~.~se, ......... [i.~.k~.~.... ~ ', ~aa~X ....... If applicant is a corporate, signature of duly authori (Name and title of corporate officer) ed officer. Builder's License No .................................................... Plumber's License No ................................................ Electrician's License No ............................................ Other Trade's License No ............................................ Location of land on which proposed work wilh done. Map No.: ..~,.....~...'~.....?~.....~....~...~.. ....... Lot No..../../..~.. ........... Street and Number ....,.~..~.~. ...... ~.~.~L~..~.. ....... .~.. ....... .~..~...~,.~.~,Z.(..~ ................................................................ Municipalit~ State existing use and occupancy of premises and intended use and occupancy of preposed construction: a. ~xisiting use and occupancy ...... ...~.~.~../~.. ......... .~.....,./..'....~...~.,.'./~. .................................... t ....................... b. Intended use ond occuponcy ..................................................................... £ .c~ ../~. $..~.~'.(,~.~..~.(..~...A~......./.9... ~..~'.... Nature of work (check which applicable): New Building .~.: .............. Addition .....~ ..... Alteration .................. Repair .................. Removal .................. Demolition ................. ,. Other Work ...................................................... , ~ kT-O (Description) 4. Estimated Cost .....~./..~.~..O...O..t...°...~. .................... : ........... 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 ....... AJ~ ...... .~...~ .~....~.~...~, .................................................................................................. 6. If business, commercial or mixed occupancy, speci~f~, nature and extent of each type of use ....~ .............. 7. Dimensions of existing structures, if any: Front ..... ~...~... ............ Rear .....~,..~....~.. .............. Depth ....~.~,.~....::.' ' Height ....X~..~.~...~.'. ...... Number of Stories ..... ;~.x~?.~ .............................................. i .............................................. Dimensions of same structure with alterations or additions: Frqnt .... 2...~...~. ................... Rear Depth .....~...~....~..~:. ........... Height ...;..J.~'../..°...~~. ...... Number of Stories ..... ~...~..~,,, .............. 8. Dimensions Of entire new Construction: Front .:....~,~.,~;..~...,~,?....:i~'~:~.~.~4~:~ .~, ....... DeptE ..../.~.../.q.~. ...... Height ....~-....q. ......... Number of Stories ....... ~..~...~..~- ............... . ................................................ ~....)~g~.9.~ .......... Size of lot: Front ........ .~'.~... ...................................... Rear ..... .~.~.~.,~.~ ..................... Depth ...~..-.J.,'l.~.,.~.~ ....... Date of Purchase ............~/.~.~./.~..~ ...................... Name of Former Owner .....'~..~.~J...~.~,,J~l,~'~.~t,~.~..... ' Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ...~.~ ............................................. Will lot be re~gradek~ ...~.~...CD ............... Will excess fill be removed from p.,m?ises: ( ) Yes (~) No Name of Architect¢. ............................................................. ,Address .......... ...................... Phone No. L.; .................. Name af Contractor ...................... Address PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~stmg or proposed~ and mdmate all set-back d~rnensmns ~m/ .roperty lines. Give street and block number or description according to deed, 0nd shew street names and jj~ic~ ~hether interior or corner lot.~ 10. 11. 12. 13. 14. dbly sworn, deposes and says tl~t he is the applicant STATE OF NEW YORK t ~ ~ COUNTY Of "...<~- .~.~1/~.....~'~ , .................... i,~¢...i..~...~......~......~....~..~ ..~....~..~v.,.....~ ........... :.~.being (Name of individual signing cont~ocf) above nam~ He is the ......... ~.~.~.~.~.~ ........................... ~ ..................................................................................................... (Contractor~ ag~t, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements cont~in~ in this application are tree to the best of his knowledge and belief; and tha~ the work Will be perfOrmed in the manner set fo~h in the apPlication filed therewith. ~ Sw0m tO ~m me this ~ ~ / / ~ / / ......o+ .......................... . / ///J / , Noto. Public, ~'..~.., ......... C~n~ ....... ~~.. .// (Signatur~o~plicant) M I LD'RIED ,P~R~ E ~ No. 30.3078515 , Gemmiislen ~pires March 30, 19~ :.