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HomeMy WebLinkAbout1176-zTOWN OF SOUTHOLD BUILDING D]~PARTMENT 3.'OWN CLERK'S OFFICE SOUTHOLD, N, Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at l~.t..~....r.~...o.~f. Sound View ~{~e~t ofi li l'a' ........................ Map No ....... ?.?..*.. .......... Block No ......... ;.?~?.......Lot No ........ :.~..~ .................................................... conforms ~ubstantial]y to the Application for Buik~ing Permit heretofore filed in this office dated ................ ~.~.9.~..~.~....~.~ ........... 19...6...0.. pursuant to which Building Permit No.....~....~.~.7...6.. dated .............. ~e~...~.~...~..8. ............ 19....6..0.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate i~ issued is ........................ This certificate is issued to .....R.~..r~..?..~?...~..k.~.~?..k...~...~?.?.~ ................................................... (owner, lessee or tenant) of the afo~'esaid building. FOR,M 1~O. 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? H?§, Z Date ......................... A?J~ .t,l~..~.,....~.~. ......... 19.. ~...0.. Permission is hereby granted to: G ,~, ~mi~..&..~,or~.. A/~....~ug. ene..Edc~ia~ ........... ........... So.~tbol~ ................................................. to .... ~ui&d...an.. addit ion ..on.. en...e~is .%~ n~...~:e...ll.~ ..................................................... at premises located at .%~/.$..P.~...Read...~/~..~e~..¥.~e~..~ve ................................................ .................................................. ~c~u~olcl ~.....~.~. ........................................................................... pursuant to application dated ...................................... A~t;.....]~..19.~O.., ahd approved by the Building Inspector Fee $....~...OO..~..Cheek Building Inspe¢ 'or \ FOR~ NO. 1 TOWN OF SOUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ~/ z~....//'~T'~I 9 ~...~ Permit ......... .................... ..... Disapproved a/c~ ............................ (Building Inspector) ~' ~.~ APPLICATION FOR BUILDING PERMIT Dote....~ ......... .~......~.... ............. 19.,,~.,~ ..... INSTRUCTIONS a. This application must be completely filled Jn 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 permff 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 ©ccupancy 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 laws, ordinances and regulations. (Signature o~...g,c,,}plicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Name of .owner of p m' ....~~......~~.'c:...'zc,,': ..................................................................... If applicant is a corporate,~_signature~ authorized officer. (Name and title of corporate officer) 1. Location of land on which~gz.opose~d work will be done.~//'///~MaP No....~. .......................... Block .................................. Street and Numbe~~.,~-...,..~~..'.~,,~&...~ 2. State existing use and occupancy of premieses and'intended use and occupancy of proposed construction: a. ExisHng use and occupancy.....~~, .................. b. Intended use and occupancy~ ............ ~M.~ ....................................................................................... 3. Nature of work (check which applicable): New Building .................... Addition ....... ~ ...... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ....~.,~'~c~ ..~. ..........'~... ............... Fee ................ .~. ....... ~' (to be paid on filing this application) FEES: 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................................................................ 10. '~ 11. 12. If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................ 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 ....~ .......... Dimensions of entire new construction: Front ............. ~ ......... Rear ..'.~...:c..~... ............... Depth /o Height ......~....~... ............. Number of Stories ...~ ......... Size of lot: Front ....../...~.~..~ ........... Rear ........ ../.....'~...~. ....... Depth ..... ./......~..~...~.. ........ Zone or use district Jn which premises are ua ea ................................ : ............................................................... re ese c0nstr p Does p p d ucticn violate any zoning law, ordinance or ~regulation ..................................................... of o r ' ~----~"~' ' Name Owner f p emlses ........ ~...~ress ..................................... ....... Phone NO ..................... Name of Architect ................................ ~. ................... Address ...... ..~m~...~ .............. Phone NO ..................... Name of Contracto'F~..~:..~.,~Address ...~~..Phone NO, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ell 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. STATE OF NEW )fORK, "// ) S S ............... ~ ......................................... ~ .......................... .~- being du~y sworn, deposes and says that he is the applicant (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 the said work and,,,.t~) make and file this application; that ell statements contained in this application are true to the best,~of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ' '" (bingature of 61:Kp,h'cant) Notary ~:~ ........ .~..,¢~4~<. .......... y