The URL can be used to link to this page

Home My WebLink About296-zFORM NO. $ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, bi. Y. CERTIFICATE OF OCCUPANCY No .. ~ l~J~ ...... Date .............. ~ep.Cemb. er. ~6 .... 19.%t5... THIS CERTIFIES that the building located at ..O~C~..~!~O ~ ................................ Street Map No ..,~JJ~ .................. Block No .... conforms substantially to the Apphcation for Building Permit heretofore flied in this office dated .......... ~p~.~,. 38 .................. 1~'~..., pursuant to which Budding Permit No ....... Z..~.~ ......... , dated ............. ,,~p~:J~....2J~ ....... 19.~'~.., was issued, and conforms to all of the requirements of the apphcable prowsions of the law The occupancy for which th~s certificate is issued is ............ ......................................... ~-~F,. I)l~iI~L],~r~T~ ....................................................................... This certificate ,s issued to .~l:~t~..~,e~.~/~ ...... ~...o~'~...) ................................................. (owner, lessee or tenant) of the aforesaid budding Building Inspector 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 296' Z Pern~ission is hereby granted to: ,~fm-don ~l.e~,~.. ~/¢.... Z,~,~t..z~.:klm ......... at premises Iocoted at "'~d.'**~l"tL'le ']E~:I~II ............................................................................ ................................................. XattJ, imo~r ~ .... R,./:., ............................................................... pursuant ~o apphcahon doted .................. A]~,~..~..j~ .................... 19~8..., and approved by the Buddm§ Inspector FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No......~..~..~. ............... Approved ........................................ 19 ........ Permit No ................................. Disapproved o/c ../J..,.'].....,."l.......,/.~l ...... ,zJ ....... ,..~. ....... ~ ....... ~J ....... ::4 ......... ............................. ........ (Building Inspector) ~ APPLICATION FOR BUILDING PERMIT Date ........................ ~.......~.....o~.... 19...~..] .~.~.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is part of this location. 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 o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of 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 Building Permit pursuant to the Building Zone Ordinance of the Town of SouthoJd, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of' al~plicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. ....................................................................... j .......... Name of owner of premises ........... ..J:.~..]~,,,~.J~.~.l~.l~. ....... ...L?..~....~.....W....~...../~....~....~...../~I .................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No ................................... Block .................................. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: b. Intended 3. Nature of work (check which applicable): New Building ..... ~....Add't'on ....................Alterahon ...... '. ........... '.. Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ...... ..~'..:~.1~::1~..¢~.. .............................. Fee ............. ~....J.¢~.~..~;~l~ .......................................... (to be paid on filing this application) FEES: 5. If dwelling, number of dwelling units ....... ~.~.~ ........Number of dwelling units on each floor....O~l~'. ............ If garage, number of cars ................. ~:~.1~..~- .......................................................................................................... 6. If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front ........ .~z.........: ......... Rear ...... ~ ............ Depth ....~ ............... Height ........... ~ ....... Number of Stories ..........~ ................................................................................................ Dimensions of same structure with alterations or additions: Front ............ t ................... Rear .~ ...................... Depth ......... ~ ........... Height ....... ~ ............. Number of Stories ..: .......... : .................. 8. Dimensions of entire new construction: Front.....~'~)~.Q.*.p. ...... Rear ....~..1~....~.].~. .... Depth ....~..~.~..".'. ....... _Height ..... J.~.[.~_~;l#..l~llC~/Number of Stories ..I..M~..Ik'.L~.~.~..~, 9. Size of lot: Front ...... J.~'~.~.. ........... Rear ...... J...~.-~'. ............ Depth .....~....~...~.. ............. 10. Zone or use district in which premises are situated.....~.......~...~...~ ............................................................ 11. Does proposed constructio~ violate any zoning law, ordinance or regulation?...J~o..'[.....'r.~..../~..~...~_,~,~'~,~..w~: 12. Nnme of Owner o~Dremises.~.~g~Address ....~x~9...~.~~ ......... Phone NO. .................... Nome of ~.....~~..~.~.~ddress ~~~...Phone ~0.~.~=.. ~me of Contr*ctor.~.~.~l~ ................ Addross .~&~l~..~.~.....Phon~ ~0. ~[~l.la... PLOT DIAG~M Locate clearly and distinctly oll buildings, whether existing or praised, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. I i STATE OF NEW ~RKm S S.. COUNTY OF ..~~ ......................... (Nome of individual signing application) obovo homed. He is the ..................................................................................... (Controcto~, ooent~ cor~rote officer~ etc ) ................... o{ sold owner or owners, ond is duly outhorized to perform or h~ve per{ormed the sold work ond to m~ke and file this opplicotion; thoI ond that the work will be p~fformed in the m~nner ~ot {orth in the ~pplic*tlon filed th*rowlth. Sworn to before me this ...... ..... Notary Pub ..:.County ~esiding in ~uffo~k (Singature of applicant)