HomeMy WebLinkAbout379-zFOI~V~ 1~O. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
.................... ........
THIS CERTIFIES that the building located at ...~l~'zt_~t~ ....A.V.~ ............................ Street
Map No .~_~.~.
conforms substanhally to the Application for Building Permit heretofore filed ~n this off~ce dated
................... ~.~r ....8 ......... I9...~8., pursuant to which Bu,ld,ng Permit No ........ ..Z....~.Z? ........ ,
dated ................. ~1'.~. ...... 9 .......... 19~J~..., was issued, and conforms to all of the requirements
of the appl~cable provisions of the law The occupancy for which this certificate is issued ~s ............
.................. PJlTI~TCI O, ARAGE ..& ..GA ~OL,T.~ E-F~LLtlIG.. ~. AT~Ot~. ...........................................
This cerhficate is issued to ... W~l.t~...~.~...~.~;~l~.~..O~...~rJ.C, ....(..OtJ~9~..) ..................................... (owner, lessee or tenant)
of the aforesaid bu~ld~ng
Bu,lding Inspector
FOB2~ NO. 2
TOWN OF SOUTHOLO
BUll. DING 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.° 379 Z
Permission is hereby granted to:
Date .................. .,T..l~...?'... ~ ............... 19.~..~.....
<~t premises located at ...]~.~....(]~'l.t,~.~,]...,~.~ ...............................................................................
............................................................ .~h~r..~....z.~.~mn.d. .........................................................
pursuant to appi,cat~on dated ........................................ .~.~t~....~. ....... t9.~.~.., and approved by the
Budding Inspector
Fee $...~',.0~ ...........
Build,rig Inspector
FOKM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD; N. Y.
(Building Inspector)
Application r~o ............................
APPLICATION FOR BUILDING PERMIT
Date .......... .~...~. ...................................... 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 drown 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 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 port 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 o 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 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 oppl)cont)
State whether applicant is owner~ lessee~ ogent~ architect, eng)neer~ general controctor~ electricon, plumber or builder.
~*ral Contractor
Name of owner of prem ses .W.e..~..t.. ,.E~...d. ~ 0o~ Ilie.
Location of land on which proposed work will be done. Mop NOl .~....~. .................... Block
Street and Number ................................................. .~..~
State existing use and occupancy of premieses and i,n,t_ended use and occupancy of proposed construction:
al Existing use and occupancy ......... ~),~..~...~...t~..~l,q.q...&.....~$..t~.......J~..~..~.e.
b. Intended use and occupancy ................... ~ ........................................, ....
3. Nature of work (check which applicable): New Building .................... Addition ...][. ................ Alteration ....................
--Repair .................... Removal ............. ' ....... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost ~'/~0.0~.. .......................................... Fee $~ 5' ~ ' -
(to be paid on filing this application)
FEES:
5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................
If garage, number of cars ........................................................................................................................................
6. If business, commerical or mixed occupancy, specify nature and extent of each type of use..~l~B~l~ .............
7. Dimensions of existing structures, if any: Front...../~...? .................. Rear ........ ./~...~. .............. Depth ....4~.~....-~...". .............
Height ....1.8..~. .................... Number of Stories .....1. ........................................................................................................
Dimensions of same structure with alterations or additions: Front ....4~0.~. ...................... Rear ...../~..? ......................
Depth ..,~.?~.". ................ Height ...1.1ii..". ..................... Number of Stories ...'l ............................
8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................
Height ............................ Number of Stories ............................
9. Size of lot: Front ...lcd.? .................. Rear ...J~.? .................. Depth ..... .'1 .~..? ................
· 10. Zone or use district in which premises are situated ................. ...~.....:~....~...J. ...............................................................
1 1. Does proposed constructian violate any zoning Iow, ordinance or regulation? ........... .//~....~. ................................
12. Name of Owner of premiseJlU%.,~lc~,..J~lJ..g~i ....... Address .ki~,liJ~#~l~..~T-It~l,~l~..~l.,~.,...Phone NO .....................
Name of Architect~'J,~l:l~.a..~[aJ~l~.~.~J~lll,..~l~l~A.Address ....? ...............".. ...................... Phone NO...~.1. .............
Name of Contractor~.llJ~s..ZJl~16..l'n~"i~Zl~..Address ...~ .............. ..". ...................... Phone NO..~ .................
PLOT DIAGRAM
Locate clearly and distinctly oil buildings, whether existing or proposed, 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.
STATE OF NEW YORK, ) J~ "'~-~' ''~
COUNTY OF ~..'~'..E..o.,1,,)I: .............. ) S S.' 7) ac
................... ..H..*...~..Jl'~....l~....°..~.,e...~.~.ff. .................................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is the ........... .I/~,~*~.~l~t,..,..krt. lSJ~l:~"..~]~l~l.~"il~,..!"~,~ .........................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said wort~ and to make and file
this application; that all statements contained in this application are true to the best of h,i~ knowledge and belief;
and that the work will be performed in the manner set forth in the app,ication fil~Jd therewi~.
Swornl~ef°re me this ~'' ~
........................ day of .............. ~ .................... 19 ........... ' J/
,~ ~, _/~ (Singature of appli~:ant)
Notary p ult..~..'~l:l~;~. ~k,~....~. ~ ~ ................. County
~uali~ed in Suffolk CountT
Term expires Maxch 30, 195 ~