HomeMy WebLinkAbout627-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFIGE
$OUTHOLD~ N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at.~f}~.~J),..~l.~ff.~.P..~...~.~.~..~...~.....t~...~...~.~...].~'~'-~e~t
Map No. '.~..~..."~.,..~...~.....~.,.~,..~Jock No. ~**
........................ Lo, No ....... .t~,t ......................................................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.......................... ~Z~,~..~. ............ , 19....~, pursuant to which Building Permit No ...... ~...~.~. ..........
dated ~Z 8 , 19 ~ was,s
............................................................ , ' sued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ..............
.......................................................... ~/~..P~ .. ;~;~..g~.~.~. .....................................
This certificate is issued to ....~...~...~.~.~...~.~ ................................................................
(owner, lessee or tenant)
of the aforesaid building.
FORM NO. 2
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° 627 Z Date .............................&p.ril....8............. 1939....
Permission is hereby granted to:
Y. Poananaki...A/C ....'.roehtig.......................................
w....... Rttituak p...J,...........................................
.................................................................................
to ..snita.Asn•eaat�R ..Q!]aA..as.'.s' n .rw c�ting.........................................................................
......p......................................................\.. ...............` t ........................................................
Z ksrran�}•
at remises located at ...LOL..flf..� .
... .T:.,.. .L .I.niva.................................................................
.........................................................U=010
.................................................................................................................................................................
pursuant to application dated .................................&RT:id....6...............19.✓>.... and approved by the
Building Inspector
Fee $..t�.:_:C..............
................ ....................................I.................... .....
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ........................................ 19 ........ Permit No ...............................
Application No. ~ 2~ -(
Disapproved a/c ..... ./. ......................... ;>,, .~. ................ ,~,, ............ ~ .................
.......... ........ ........................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
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 ~ot and of buildings on premises, relationship to ad}oining premises or public streets
o'r 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 applicqtion 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 a Certificate of Occupancy
shall have been granted 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 alterations, or for removal or demolition, as hereir~ described.
The applicant agrees to comply with oil applicable laws; ordinances and regulations.
.....A.:! ....... .............................................
(Signature of applicant, or name, if a corporation)
............ /.!:!./..'!../..:¢..:...:':..::..:....5:.:, .................................
(Address of applicant)
State whether applicant is owner, !essee, agent, architect, engineer, general contractor, electrician, plumber or builder.
...................................... ...............................................................................................................
Name of owner of premises....~~:-- --(..~. '
I{ applicant is a corporata, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done, Map No: ',,'~..,~.:~,::t.'.'....,!,,,,'!~,,3.',L. ............ Lot No: ....................
Street and Number ..~....:...(~..~.~'.~.',.~.;:.;;~.; ....... ~:(;!;~:.:t:.:~x..~z.;.: ................. ..L_~~ ........ .~...c~.::..~..~. ...............
Municipality
2. State existing use and occupancy of pr~emises and intended use and occupancy of proposed construction:
b. Intended use and occupancy ............................. !.! ......................... ! ........ l.~;.......(~...:'.(~f;.t:;:: .................................
3. Nature of work (check which applicable): New Building .................... Addition ...... ~i.Alteration ..... ~ ......
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost ....... ~....~.?. ........................................... Fee ....~x~.~ ..........................................................................
(to be paid on filing this application)
umts ................................ Number of dwelling units on each floor ............................
5. If dwelling, number of dwelling ' O'~'"~'"'
If ga rag~;"number~ofl~ars .............. , ........................................................................................................ ~...m..~z ..........
6. If business/commercial or mixed occupancy, ~2ecify nq~ure and extent of each type of use ..............................
7. Dimensions of existin~ structures, ff ~ny: Front ......... ~ .............. Rear ......... ' ................... Depth ............................
Height ............................ Number of Stories ,~....~.~ .......................................................................................
Dimensions o~ s~me'str~¢ture with ~tt~ions oF"~dditions~22T ....................... R~r ................................
Depth .............................. H~i~ht .~...[~ ...................... Numar o~ Stories ................................
8. Dimensions of entire new constru~, FrOnt ................ ~ ......... R~ar ............................ Depth ............................
Height ............................ Number of Stories ¢'z-~.~ ~
9. Size of lot: Front ............................ Rear ............................ Depth ............................
10. Date of Purchase ........................................................ Name of lo,mer, Ow~ r'"4 ..................................................
1]. Zone or use district in which premises are situated ......................................................... ~ ................................
12. Does proposed construction vio~te an~ zoning law, ordinance or regulation? ....................................................
13. Name of Owner of premises ........................................ Address ............................................ hone NO .....................
Name of Architect ........................................................ Address ............................................ Phone NO .....................
Name of conwac~or .................................................... ~daress ............................................ Phone NO .....................
PLOT DIAGRAM
Locate clearly and distinctly all 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 OP NEW~J:~P-/~,~,~,,/I ) S S
COUNTY OF ....~...~.j.).: ...... 'Z4 '
.................................................... ; ............................................ be ng duly sworn, deposes and seys that he is the ~pplicent
(Neme of individuQI signing eppliceti
ebove n~med. He is the .............................................................................................................................................................
(ContrQctor, egent, corporate officer, etc.)
of s~id owner or owners, end is duly euthorized to perform or h~ve performed the s~id work end to m~ke ~nd file
this ~pplicetion; thet ~11 stetements contained in this epplic~tion Qre true to the best of his knowledge ond belief;
end that the work will be performed in the m~ner ~l~rth in the epplic~tion filed therewith.
Sworn to b~ore me this
~ 4~ of .
.......................... ~ ............ 'Z ...............