Loading...
HomeMy WebLinkAbout1167-zFOI~M IVO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~/~.....l~t, II..R~e.~ .................................. Street Map No ..... ~ .......... Block No....~ ........... Lot No ...... ~ ....... t~tt~.[..~it[.:[Dll.t...lxl.,.~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................................... A~l!~9tl~.....c} ....... , 19...i~0 pursuant to which Building Permit No dated ..................... ~ll~.llS.t, ....... .c). ........ , 1 9....(~131 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 ........ ............ l~i.V~¢e .. erie ..i?~.t,l¥...d.~e~..li~g ................................................................................... The certificate is issued to ..G.~.t~l~...lfl~.iclf~Oll .............. 0'4,~1~ ........................................................... (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? 1167 z Date ............................ A~]g~S.t,....9 ........ 19,60_ Permission is hereby granted to: Doug Rog e~..z.....A/C.....Ol, au4~...H~.~s~n. ........................ .............. Ea~t'--~io~ ....................................... to .,...B~l.'t ~... ~¢..o~...~:~l ~.y.. 4~ .]A.n~ ................................................................................. at premises located at '"'~'~'~"']~L'~'~"-~(~C[ .......................................................................................... ............................................. ~ ~..~....~r.~.~ ~......R,. Z, ......................................................................... pursuant to application dated ............................ ~ti~Lt~ ........ ¢~ ............ 19.~O.., and approved by the Building Inspector ~ee $t0~ go' ........... FO.F,~I~ NO. 4 TOWI~ OF SOUTHOLD BU~LDII~G DEPARTMENT TOWI~ CLEHiCS OFFICE SOUTHOLD, N. Y. CZHTIFICATE OF OCCUPANCY No. '"ZgO~ .......... Date .......................... :(...:,~ ......... THIS CElaTIFIES that the building located a~ "'S/S' .~i~a..&..~/s-..~m n"'~g ~ap No. ~ ............ Block No...~ ....... Lot No.... ~ .......... ~8~'"~'~ ...... ~¢'~;'?"~ ..... conforms substantially to the Application for Buildh~g Permit heretofore filed .in th~s, of~?e dated A~ ~g ~ , 19 60 pursuant to which Building Permit No. ',.~..~h.~ ..... · ?-" g ..... 7 ................. ~,- %ted ..... .~ .0 .......... 1~...~ was issued and conforms to all of the t'~q~[re~nts a~cah~evv_ ~, provisions of the law. The occupancy for which this certificate is~js~ue~d is of the ............ ~a*~:-o~...~a~5'57"~,~eS['~ng ............................................................................. :¥'"~ ......... This certificale is issued to ...... ~a~e'"H~s~" "~ ' ' ~ ant' of the aforesaid building. ........ ........ FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved Disapproved (Building Inspector) Application No .......... ./..~..¥...~.... ..... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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 tS 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, os herein described. The applicant agrees to comply with a I applicable lows, ordinances and regular ans. ..................... ................................... (Signat~'fe of~fpplic~'f, or name, if a corporation) (Address of applicant) State whether applicant is~owner, lessee, agent, architect, engineer, general contractor, electrician, plumber, or builder. Name of owner of premises ........... ~.~.~,,~z~ .~.z~ .......................................................................................... if applicant is o corporate, signature of duly authorized officer. (Name and title oF corporate, officer) ,¢ j ,~ ~ /q Street and Number ....... .,~,X/~,~.~/~,¥....~,,~./~.,,,..~.......~..~.,.: ............................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............................. .....~.-...~.~:~ ................................................................................................ b. Intended use and occupancy ......... ~..,~......: ...................................................................................... Locate clearly and distinctly all property lines. Give street and block whether interior or corner lot. ~'/~ Addition Alteration ....... 3. Nature of work (check which applicable): New Building ..................................................... Repair ................. .,~ Removal .................... Demolition ................ ~,. Other Work (Describe) .................... 4. Estimated Cost ...... ~..~...~..~ ......................................... Fee .......... ......................................................................... (to be 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 ............................ Rear ............................ Depth ................................ Height ............................ Number of Stories ............................................................................................................. 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....(~.....cr~ ................... Size of lot: Front ......... ~...~... ........... Rear ............................ Depth ............................ , 10. D~ate of Purch. ose ....... ~...../?....~...~. ~. .............. :.... Name ,~,~ ~ormer Owner ............ ~ ...................... 11. zone or use aistrict 'n wmcn premises a e situotea ............... z..: ................................................................................. 12. Does proposed construction vioate any zoning law, ordinance or re,gulation? .......... .?..~.. ....................... 13. Name of Owner of premises........~....~..~.~Address ....~,~,..~....?..L/..~..~...:. Phone NO..i..ii.iiiiiiiiiiiii Name of Architect ............................,/~_/,~'~) .................... Address ..........................................~'~- ./~ ~,~. ~ ~- Phone NO ..................... Name Contractor ....... ~'.~.(z~./~ ........... Address .....4~ .~..~...'d~...~..:.. Phone NO ..................... P.LOT DIAGRAM buildings, whether existing or proposed, and indicate all set-back dimensions from numbers or description according to deed, and show street names and indicate STATE OF NE'v~gR.,K. ~.~ ) S S COUNTY O ..,., ...... ' ' ...................................' ~'~' ~"~.~....~..~..~.~ ............................ being duly sworn, deposes and says that he is the applicant (Name of i~dividdal si~fling apph'ca,~Lq~_) abo e named..e is the .................. ................................................................ : ........................................ (Contractor, agent, corporate officer, etc.) of said owner or owners and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed Jn the manner set forth in the application filed therewith. (Signature of applicant)