HomeMy WebLinkAbout1282-zFOI~ NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S O~:FICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No ....... ~...3,~"/..3 ........ Date ................... ~L~IU&:I~...~ ............, 19...62. ~-~'
THIS CERTIFIES that the building located at B~y..,~.~tt~i~.~...~C.Qr~.~I,¢~ ...................... Street
Map No ...... ~.~1.~9 ....... Block No..e.~ ..............Lot No ................. 't~O ............................................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
............. D~GI~I}~I~:~..8 ............................. , 19.~.. pursuant to which Building Permit No.~..:L:~.~...
dated D~..I~,..~...~...~. .................... , 19....G...0., was issued, and conforms to all of the requirements
of the applicable provisions of the I.aw. The occupancy for which this certificate is issued is ..........
~{~Z~/A~..O~..~AMI~.,:i~E~Z~ ..................................................................................
This certificate is issued to ........... .~..~..~.~.~.g..~....~.~..~,~...D~.~.:~.c~..~...~t,~l~. .....................................
(owner, lessee or tenant}
of the aforesaid building.
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? 1282 Z
Date ................. Dec,~.~. ..........~-. ......... 19-60.
Permission is hereby granted to:
M&6g.le~..&..~.¢o~....~/O..~.~&ee...Da~&~¢
............. Cn~.hogue,.....~...~. .............................
tc ..... B~lt..~..addi~ion..~..an...ex d~e
at premises located at ..... L~...~..~.O.....~..~r~S ................................................................
............ ~...A~e..~..Lil~e...L~.~ .......... ~o~ue.~....N.:Z. ....................................................
pursuant to application dated ................... ~b~r..---~ .................. 19..~0., and approved by the
Building Inspector
Fee $.....Y.O0 ...........
Building Inspector
I~ORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ..................... 19 ....
Application No .............................
Approved...: ............ !.(..: ................... 19...!.!..Permit No. ~ j ~ ~ ~
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
InspectS:.
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 part of this location.
c. The work coYered 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 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 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.
~a.~.er,.Q! co~tr~ ot.9.V.
~,.,~,,, Baatrice ClarF Dav,~ds '
Name of owner of, .............................................................................................................................................................
If applicant is a corporate, signature of duty authorized officer.
(Name and title of co,orate officer)
1. L~ation of land on which proposed work will be done. Map No: ..... ~.~ ............................. Lot No: ..~.Q ...........
Street and Number ....... ~ ...... .~?..~.~....~...~.~.v~,~ ..................................................................................................
Municipali~
2. S~ate existing use and occu~ncy of pr~mises and inten~e~ use and ~cupancy of proposed construction:
a. ExisJing use and occupancy ...................... ~.~a~ .....................................................................................
b, Intended use and ~cupancy ................... ~.9.~.~.~.~,~ ...................................................................................
3. Nature of work (check which applicable): New Building .................... Addition~ ....... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4.
Estimated
Cost...i~.P....o.
Fee
(to~e 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....~l~,l~ ................. Rear ...... ~1~. ............... Depth ........ .~.~. .............
Height ..~,~!. ................... Number of Stories ........ ~ .................................................................................................
Dimensions of same structure with alterations or additions: Front ..... ~1~.I. .................... Rear ..J ........ .(1~!. .............
Depth .....,~l~!. ................. Height ..~! ..................... Number of Stories ....... jJ .......................
8. Dimensions of entire new construction: Front....~lt. ................. Rear .....~0-J ................ Depth ........ J~l ..............
Height ....~1. ................. Number of Stories ...~, .....................
9. Size of lot: Front ............. ~! ...... Rear .....~,~.1 .............. Depth ......~t ..............
10. Date of Purchase ........................................................ Name of Former Owner ....~tJl'-,..J~ ....................
11. Zone or use district in which premises are situated .......... ~J~..-.llJ~. ....................................................................
12. Does proposed construc~'i0n ¥i01ate any zoning law, ordinance or regulation? ......... ~1~ .....................................
13. Name of Owner of premisesl~e0.~..J~'l~ ............. Address ..0~l,~l~tl~#JJe~r.,, ........ Phone N~...
Name of Architect ........................................................ Address ............................................ Phone NO .....................
Name of Contractorl~F..&..Jjilll~lJ ............. Address (Jl/.~l~li~l~l~...Jj~,~r~ ........ 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 block numbers or description according to deed, and show street names and indicate
wheth~e£ inte,rior or Forner !at.
PL.O't
STATE OF NEW,~OR~/ . ~ ,) S S
........... : ........... i....~.~.~..~. ............... being duly sworn, deposes and says that he is the applicant
' (Name of individual signing application) , ~/
above named. He is fhe,.....C~....~...~'~....~..~.~....Y.....~f...r....~.Z.~' "~l'~/ ~'~" ~ ~"-/~'~ ' / ........................................
~/ (Contractor,(cJger~f/corporate officer, etc.)
of said owner or owners, ancf is duly authorized to perform or Eave'~erformed the said work and to make and file
this application; that all statements contained in_th_~s.api~lication are true to the best of his knowledge and belief;
and that the work will be performed in the..r~artp~_ ~rEin the application filed therewith.
Sworn to before me this ~
x ~ , Residh~E IrJ Suffolk County . , -,
.~....~..~..... da~f ....... ~..~...~..~....~...~...,.~..co~.~...~j~,. s~-,el4~o (Signature or app,ican,,~,