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HomeMy WebLinkAbout828-zI~OR~M I~0. 4 TOWN OF SOUTHOLD ~,UILDING. DEPARTMENT .'I'OWN CLERK'S OFFICE $OUTHOLD, N. CERTIFICATE OF OCCUPANCY THIs CERTIFIES that the building located ats/~..I~c~l~..~d,.,. S.O~.l~l~o~,.d.... Street Map No..._.~..~.? ............. Block No ........ ..~..~..~ ......... Lot 1No ............ .?..~.~ ................................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..............S~]~I~b~¢...3 ........ 19.~.9. pursuant to which Building Permit No....~....~...~..~.....~ dated ............ ~.~]~.~..~_..e~...~ ......... 19....~...9., was issued, and conforms to all of the require- ments of lhe applicable provisions of the law. The occupancy for which this certificate is ~ssued is ..................... D~LYl;I~t..iL~ID.. O~X.C:I~ ................................................................................ This certificate is issued to .... l~le~,l~.~..I-la.s~.,...O...W~ ....................... : ............... (owner, lessee or tenant) of the aforesaid building. Building Inspector FOE~ NO, 2 TOWN OF $OOTBO£D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 828, z Date .................... ~,~t~.e~]O~Z'......,~ ............ 1 ~ ..... Permission is hereby granted to: ~e:~,~..~ ............................................................. ....... .~..~.~.~.'9~ ........ .~.:~.? ..................................... at premises located at ..,~/~...$~.~?~h.~c~d..f..~;b..~TA.) ......................................................................... .................................................... ~au.'thold, ....}~,:~:, ............................................................................... pursuant to application dated .......................... ~I~¢o~B~.........~ ............ 19.~.¢)...., and approved by the Building Inspector Fee $10.,~;~ .............. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ....... ~....~... ....... 19...~.../~/Permit No ...... ~..~..~...~... ...... Disapproved a/c ................................................................................. ~.~ ......... .................. (Building J~ctori ....... ^pp"cot on No ........... INSTRUCTIONS a. This application must be completeJy filled in by typewriter or in ink and submitted in duplicate to the Budding Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoinin9 premises or public streets or areas, and giving a 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 a Building Permit to the applicant. Such permit sha]l be kept on the premises available for inspection throughout the progress of the work. e. No building shaJl be occupied or used in who~e or in p art for any purpose whatever until a Cerdficai~e 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 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) .......... ~%K.),,~:¢.:;;~'Z4.%'.':;. ~ ....... ~.~..:./..~ ................................ (~ddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......... /...~¢:,,:~,;.~:~....-r ................. ¢.¢:: ¢ ........................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. bocatio, of land on whic~ p;oposed w,ork wi, ll//be don~. Ma(? No: ......... :.:~...~......~ ........ , ...... Lot No: ......~.:...L~.. ...... Street and Number ..... )/ ........... , ............ : ............... ~ .......... ,' · ...~: .... ~ ......... Municipality 2. State existing use and occupancy of premises and intended~us~ ,and occupancy of proposed con~struction: · , a. Existing use and occupancy ............. ~", ....... :.'...;.~.~'.: ............... ~..: .................................................................... T.~ b. Intended use and occupancy ..................... ~,.77¢...,-..~.~. ....... ....................... t ................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................. ~Removal .................... Demolition .................... Other Work (Describe) 4~ Estimated Cost ....... ..~.'.'...~....~ ......................................... Fee .~..~...T.~. ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... {.~.":.;i'i~'(~'.q~tT.....Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specif~,y naturell and extent of eachjr type of use....~.~..¢~...~.~.~.,... 7. Dimensions of existing structures, if any: Front .......... ~.:..~. .......... Rear ....... ~..~.. ......... Depth ....~.~...[:~ ............... Height ............................ Number of Stories .......... f~..'~...,*~,, ............................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number oF Stories ................................ 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front .....~......C~.. ............ Rear .......... .-~.~..~? ......... Depth ........ ../....'~..'~...(..). ..... 10. Date of Purchase ................ .'..~./..~i.O.~..'~...Name of Former Owner ..... ~)~'.tr~....~.":;.',..:.r(<,~,~...~ ............. 11. Zone or use district in which premises are situated .............. ~.~..~.'.i.....Z~.'~.~.,..~.r,' ........ .:.,:::...: ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... /...v~....i). ............................... 13. Name of Owner of premises.~.l~;...~.~. £h~.':.~:~ ............... Address ............................................ Phone NO ..................... Nome of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor ........ /J ............. ~...~.-,~ .............. Address ............................................ Phone NO. PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-bock 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 N W-Y.O_,~}rt,,l)l; S S I 5 a COUNTY OF ....'~..¢¢~.~...'¢.."2,, ...... )r ,' , x~J /~' '(~'~" '~ J~(~ r e oe s that he ,s t e l. nt -- -'~' ..... ~ ben du swan d s sand sa ' h app'ca .................................................. /.., ........................................ g Y , P Y (Name of individual signing application) above named. He is the ................................ ~~..'. ................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed t~ said work and to make and file this application; that all statements contained in this application are true to }hr}best of his know¢tpdge and belief; and that the work will be performed in the manner set forth in the applicotio~ fJ~d therewi¢h, j ~, Sworn to before me this ~ ~ _~~~J~. / I~t Il ................ 3 .... ....