HomeMy WebLinkAbout310-zFORI~I NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLI:RK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the budding located at .]~V:...'~le.~ .~;~], &. ~;~.~.~,d...l~r. Street
Map No ................................ Block No ...........................
conforms substantially to the Application for Building Permit heretofore filed m th,s office dated
............................ ..~_a.~...~;. ....... 1~. .... , pursuant to which Building Perm,t No .Z..,~IQ .............. ,
dated ........................ ~...~.....?. ......... 19~...~. ., was issued, and conforms to all of the requ,rements
of the apphcabte provisions of the law The occupancy for which th,s certificate is issued is ...........
............................. .L...L.Z. ................................................................................
'l'h~s certificate is issued to ...~.:~;["y ~.,, .~C,~i~. .......... ~...0',,~'~,t~..) ............................................
(owner, lessee or tenant)
of the aforesaid building
TOWN OF SOUTHOLD
BUILDItiG DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, ti. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°. 31o, Z
Dote .......................... II~.-9 ............. ~9.~...
Permission is hereby granted to'
...]~y...~ I~..&..li~L6~ ~. ~ .........
................ ~m~l~l~[~ ..... g..l~. ......................
to ...3~.1~. ~n.~L.t,~oa..en...m~..e~tin~ /l~lt .t~n~, ..................................................
ot premises located at ,~...~¥..~..~C-.-~l~l.l~__l~ -I:1~ ...................................................
................ i ................................. ~...V. tev ....................................................................................
................ i ......................................... ~m~t.~sel~ ~ ..... ~.L% .............................................................
pursuant t? application dated ................................. ~.~ll .......... 19~8.., and approved by the
Building In, spector
F~ $.~.~ .............
............ Bu,]ding 'lns~~ ....
FORM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
SOUT"OLD, N.
E×om ned ........
i · ~, ~t . ~ ........... ~ [ ~,~ ..........
Approved ........................................ 19 ........ Perm t No. ,.~
Disapproved a/c .../ ....... y..,':.~:?. .......... :;~,.~[ ........... ,;,~J ........... ~j ........... :~,~'/
.............. ' ............... ...... ...... ......
Application No ..... .~..../....~ ..........
APPLICATION FOR BUILDING PERMIT
Date ........................ J&~. ~'...g..t..~.. ..................... 1 9..~..8. .......
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 a detailed description of layout of property must be drawn on the diagram which is port of this location.
c. The work co~ered by this aDplication 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 progress of the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy
shall have been grante~J by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or a Iterations, 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 applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
premises ........................... ~.. ........... '~. .......................................................................................................
Name of owner of * llarr !. Ir~
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed worJ~-will be done. Map No: ........................................ ~:.. Lot No: ....................
Street and Number ...~x~.../;...~...../..~......~....~....72.~.: ............... ~-..~?. .......................
/ Municipality
2. State existing use and occupancy of pr.emJses and intended use and occupancy of proposed construction:
a. Existing use and occupancy.....~.~.~.e....~..°..m.,e. .......................................................................................................
b. Intended use and occupancy......D~:l..~.~..~l~e..~.t~..~..~.o~.e,.l~ ....................................................................
3. Nature of work (check which applicable): New Building .................... Addition ..~ ............... Alteration ....................
Repair .................... Removal .................... Demolition ......... 'i~ ...... :.Other Work (Describe) ....................
4. Estimated Cost ........ $~ .............................................. 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 extent of each type of use ..............................
7. Dimensions of existing structures, if any: Front....6~.~ ................... Rear...~l .................... Depth .,gg~...g/..~ ............
Height ......].,~-~.~. ............. Number of Stories ...... ~za .................................................................................................
Dimensions of same structure with alterations or additions: Front ....... ~.~.e...~.~.! ......... Rear ....e~.e...6~.! .............
Depth ........~." ................. Height ...... J~.~.q..~.~'.~! ....... Number of Stories ...oza .......................
8. Dimensions of entire new construction: Front....~.~.L .................. Rear ..... ].4_! .................. Depth ....12,1 ...................
Height .....D..! .................... Number of Stories ....9.~,~ ..................
9. Size of lot: Front ..~.6.! .................. Rear ...2B.~! ................. Depth .....g.?.! ..................
10. Date of Purchase ............... ,~,17r.[~...6.,...].9.~,~ .............. Name of Former Owner ............... ,¢~Li~.~zL& ......................
11. Zone or use district in which premises are situated ............... .~....~ .............................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ......... l~'~ .......................................
13. Name of Owner of premises...i~'~'~'.Z..~...J[~ ........... Address [lg.,..~..:ke.~.~ ................ Phone NO. ~O,D.-.~,~?J~...
Name of Architect' ........................................................ zone Address ............................................ Phone NO .....................
Name of noze
Contractor .................................................... 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 btock numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
~)Avl~
STATE OF NE~YOI~K.~ . ~, ) S S
COUNTY OF~.~ '
.~ - ~ .............. being duly sworn, deposes and says that he is the applicant
................
above named. He is the ....... ~~ ..........................................................................................................................
(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 that the work will begerformed in the manner set forth in the appli]~i~n/,Nled the~,,~it~-
~Sworn to before me this // ~ .. ~.
· ...... ~ ............ dayof"/', /r--.i-'""-""~ ......... ~'"
Notary Public, ....../~:::':,.~..~..~...~- ' ~ ........ ~.~~' $2-2034700 Suffolk CO.tlf~