HomeMy WebLinkAbout1155-zTOWN OF SOUTItOLD
BUILDING DF-PARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CgRTIFICAT~ OF OCCUPANCY
No. g$31 Date 0atober 10 19 60
Cresc~mt a Madellne ave
THIS CEI~TIFIES that the building located at ...................................................................... Street
conforms substantially to the Application for Building Pcrmit heretofore filed in this office
~ul~ a7 6o
dated ............................................... 19 ........ pursuaut to which Building Permit No.
dated ................................................. 19. ., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is
Prtvat, one ia~ally dw~tli~g
Be~'t Scaglio~ti (o~er}
This certificale is issued to ........................................................................................................
(owner, lessee or tenant)
of the aforesaid building.
FOR,M NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTM[NT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 1155 Z
Dote ........................... ~TL~.....~.9 ............ 19..(~0.
Permission is hereby granted to:
...:Ber. t..Se~g~o.t t;$ ........................................
........... Na~eti~e..~c.-ez,~e~n¢-.Ave ..............
.............. ~i-s~e~..-~.~ta~d ....................................
to "'Btti'td" 'an "~Oi't ~'on" '0~"' ~" '~'~'~ %'~'ff~' '~'i Z'f fi~- ......................................................
at premises located at ..... t/~l,C]e~.~.~,.~t*x~,~;...,~r,e ................................................................
......................................................................... t~i~l~z. ~..-Z. stand.~....l~w ~ ~. ........................................
pursuant to application dated ............................. ~T:g~i.~r.....~? ................ 19..60., and approved by the
Building Inspector
Fee
Building Inspector
FORM NO. I
TOWN OF SOUTHOLD
'BUILDING DEPARTM[NT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
° ..q.
Examined ............... ~..~/. 19..~..
Approved ........................................ 9 ........ Permit No ...........................
Disapproved
Application No ...... /...L..:....:.. ......
(Building Inspector)
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 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 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 alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable lawn, ordinances and regulations.
(Signature of apphcant, or name, if a corporation)
(Address of applicant) .~'
7
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder·
premises ......................... ,~:~:~ ..............................................................................................................
Name of owner of
If applicant is a corporate, signature of duly authorized officer.
............ (Name onZ'fiiiZ ............
1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: ....................
Street and Number ....~...~.....:~~~d~...~d~..~..~~..~MnJci~alit ( ................
· .p · y
2. State existing use and occupancy of premises and intended use and occupancy o,f proposed construction:
e. Existing use end occuponcy ..... .q. .......................................
b. Intended use and occuponcy ...............................................................................................................................
3. Nature of work (check which applicable): New Building .................... Addition ......~............AIteratJon ....................
Repair .................... Removal .................... Demolition .................... Oth~ Work (Describe) ....................
4. Estimated Cost .......... ~..,.~....O.....~..:..~ ............................. Fee ..................... .~.~..~..~....O. ......................................................
(to be paid on filing this application)
?
dwelling, number of dwelling units..Z...~/~....~....Number of dwelling units on each floor ....... Z .................
5.
If
If garage, number of cars ............................................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each ty.pe of use ..............................
7. Dimensions of existin~ structures, if any: Front ....... '.~....0.....~. Rear ........ ..¢~....,O...~....... Depth ....... ..~:....~....7~.'..
~--"~'-"'/ of Stories
Height ..../.. ...... ...~.Trm.....Number ........... ...............................................................................................
Dimensions of s~'(~e//structure with alterations or additions: Front ....... . .z;~'..~.. ................. Rear ......... ,~,..~. ...............
Depth ...~.~:~. ................... Height ........ ..~...~..'~.. ............. Number of Stories ......... ./. ....................
8. Dimensions of entire new construction: Front ...... Z.,~. ............... Rear ........ /....'.~... .......... Depth ....~...~.. ................
Height ..../..[.). ................. / ,~ ,¢',,'/Numbe'r of Stories ........
9. S,ze of ,at: Front ..... ..... Rear ..... Depth
10. Date of Purchase .../..~....~..'..~.. ....................................... Name of F~rmer. Owner ...... ~..~...~.....~..'.~.,'...~...~.. ....... ..?...~/
L
11. Zone or use district in which premises are situated .......... .~..',~-,~-~.f.~.,.~... .................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ......... :.~'~r.~ ..................................
13. Name of Owner of premises ....... ~ ................... Address ............................................ Phone NO .....................
Name of Architect ........................................................ Address ............................................ Phone NO .....................
Name of 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 block numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
dOT ~/~O
lB'
STATE'. OF NEW YORK, ) S S.
COUNTY OF ............................ )
...................................................... , .......................................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. ,He is the ............................. ~r,~ ..............................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner/or owners and is duly authorized to perform or have pe,rformed the said work and to make and file
this application; that all statements contained in this alsplicatlon are tF~ to the best of his knowledge and belief;
and that the wtrk will be performed in the manner set forth in the applicati~,n flied therewith. ~
Sworn to b~fore\ me this / ~ .~ ~ .~~
....... ~..Z ......... ~; ';~~ ........... ~...,>9~.....:. (Sig;~plicant)
Nota~ ~~~~~ounty