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HomeMy WebLinkAbout1240-z~Ol~iVf ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT '~'OWN CLERIC'S OFFICE SOUTHOLD. N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ~Sia~.~. ~.,...Sc~X~O~,d .............. Street Map No ......... ~ ....... Block No. "~W ..............L~ot l~lo ............... ~ ............................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. 0~;O]~...:L8 ........... 19....60pursuant to which Building Permit No. ~...~..~.Q. .... dated ............ (~o~z....~4] ............19..~0, was issued, and conforms to all of the require- ments o£ the applicable provisions of the law. The occupancy ~or which this certificate is issued is .......................... ]~j~ ~VA~.., Olq]g.. t~i~a~4.~ .~... I~V~ ~T~I:.~ ....................................................... This certificate is issued to ...:k1~...dT,...J~&i~e...~ .......................................................... (owner, lessee or tenant) of the aforesaid building, ' - ~uilding inspector/ FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12~0 Z Date .................... 0c~.tohez'.....~L8 ............ 19_60. Permission is hereby granted to: B~ker & Fick.e. ia~.~en..A~C.....~.~..~....Ir.~'l~ ..................... ............... ~.o.~..o..z.! ~ ......i¢.~.!, ............................. to ...$.~$.%.cl...ao...addit ian.,.om..an..ezci~i£ng.., d.w~J~.%~ ....................................................... at premises lobated et ..~/.8 ........ .~.~ai~..R©~td. ...................................................................................... ....................................... ~ ............. ~..o..~.ko...z.~.,......~....~, ........................................................................ pursuant to application dated ................................. ~.~.~b~.....,~.~....19,50., and approved by the Building inspector Building ~nspector FOP~M NO. ! Approved .................................... , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19....~' C) 19 ........ Permit No ................................. Application No ......(.. ~..~.Z. f~...?.. ......... Disapproved a/c ....... ~~ APPLICATION FOR BUILDING INSTRUCTIONS · a. This application must be completely filled in by typewriter or in ~'k ant] submitted' in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adioining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is [~art 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 ava, liable for inspection throughout tl~e~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 Regu arians for the construction of buildings additions or alterations, or for removal or demolition¢ as herein described. ,.The applicant agrees to comply w th aH 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. ..................... ................................ ; ............................................................................................. Name of owner of premises.../-,,~..::..";J-..~-..~...'~/m~ .~.,'Z~....~L/...~)..../.../~,./.. ............................................................................................ If applicant is a corporate, signature of duly authorized officer. .... (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number ....................................... ~...'~...*..7~.....,~Z.....~....~ ........................................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .~......,~'...,~'-..~..../...L~-..../.....~.~......,~-~....../C~....~.'q.'.....~z..../..~.../....4~...-'(~', .............................. b. Intended use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New Building .................... Addition ...... .L,~.......,..Alteratlor~ .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ............... /?.~....~....~..'~.. ................... Feb ....; ..................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... i./.. ........... 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 ....~...~.J'... ............. Depth .....~.....o. ..................... ' Height ...... /...~. ............... Number of Stories ........... ./.. ............................................................................................ i. Dimensions of same structure with alterations or additions: Front ........ ..':~....~...~ ............. Rear ..... .~.,~..~...~.. ............... Depth ......... ..,~....0...: ............ Height ........ ./~. ................. Number of Stories ...... ~ ....................... 8. Dimensions of eniire new construction: Front ............................Rear ............................ Depth ............................ Height ............................ Number of Stories ................................ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ..... ; .................................................. 1 I. Zone or use district in which premises are s tuated ~....~....~..'../..~...~-,.,49f'...~...~....~.,. ............................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ..~(..~..'. ........................................... 13. Name of Owner of premises. ,.~..~.~.,...~.Z~,, .~...~.('~'.....Address .~.b.~..TTf.--(..4~.l~./D.;.....~....,'~3.-.. Phone NO ..................... Name of Architect .................................................... Address. ......................................... Phone NO ..................... Name of Contractor ~..~..~.¢~../:f~....~..'..~(/..~....~...~.A~cl~dr~e~' ....... ..'--.~...q..2~...'f~..¢:.z.-...~..,..~.,.~..- Phone NO,-5:.~..:~.'..?.~..Z.~. ~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give slreet and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. · STATE OF NEW,ct¢OI~¢,~~~-,,~--/2~ S. -'S /~'~2/~ / '~t ~' ~ ~ '~ ' COUNTY ........ .~..~.~..~c~.....~...../..~/...~..~./~Z..../...~..~./~....~.~..~..5.~..~`...~.. .................. being duly 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, end is d'uly authorized to perform or have performed the said work and' to make and file this application; that all tstatements 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. ]IIDITB T. ........... of ..... ........