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HomeMy WebLinkAbout992-zFOR~ N,O. ~ TOWN OF $OUT~IOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N, Y. CERTIFICATE OF OCCUPANCY n/s Rt. 27 on E. Town Road Street THIS CERTIFIES that the building located al '~i~i~l{6~';'"'~'~"~/~ ..................... M B~ist Churck. proDerty ** - . &** a~'l~o~ ....................... TJlOC~R 2~o ..................... ~o~ i'qo .............................................................................. conforms substantially to th4 Application for Building Permit heretofore filed in this office dated March 14 1960 pursuant to which Building Permit No. Z 992 Marchl4 19._6.0..., was issued, and conforms to all of the requirements dated ................................................ , of the applicable provisions of the law. The occupancy for which this certificate is issued is ' PRIVATE ONE FAMILY DWELLING This certificate is issued to ~.~.~.t...e....~.a.~?..~...?~ ........................................................................ (owner, lessee or tenant) of the aforesaid building. Building I~spector FOI~M 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 AUTHOR!ZED) N? 992 Z Permission is hereby granted to: to ...... B.ulld.. ~..a~c~t.t~m...om ..~: .~l~g.. d~LZ~r~ .............. , .............. at pr~mises located at ...F~s,t...T~.-]BO~ ....... .B&p~'S.t..C. hU~- .eh..~l~ .................................... ............... ~ ................... lt/~.....Rt...2.2A .......... C~tchc~ues.....~*L. ................................................... pursuant-to application dated ........................... ~aZ~J~-.-..~LJ~ ............... 19..~0, and approved by the Building Inspector Fee $..~'~:..O~...~a~:iJ et'leek Building Inspector / ........ FOItM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEP`K'S OFFICE SOUTHOLD, N. Y. Examined ........... ., .................. ,../.. ,--~19..~..O. Approved ..... ./.;.., 19..~.¢...Permit No. ~ /~..~...c>~ Disapproved a/c ................... ;'.LL'~ ~'j'_ ............. .......... .... (Building Inspector) APPLICATION FOP. BUILDING PERMIT Application No ............ ~ .~...~ 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 Iocatlon of lot and of buildings On premises, relationship to adjoining premises or punic 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 inspe.ction 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 B,uilding 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 of applicant, or name, if a corporation) ............................... .............................. State whether applicant is/p~vner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... ~ ........ ~..~...: ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ................................ : .......... at No:...~....~..~ ........ Street and Number .......... ~...~=.!. ... fh .'...; ........... ; .: ............................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ................................................................................................................................ b. Intended use and occupancy ..................... .t..k. ............. .'..~.../......C..¥.~ ............................................................ 3. Nature of work (check which applicable): New Building .................... Addition ...... ~ .......... AIteratior~ .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ..~:~ 4) O Fee (to be paid on filing this application) 5. If dwetling, 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 I ~ Height ............................ Number of Stories .......~ .......... 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... ] 1. Zone or use district in which premises are s~tuated ....................................................................................... 12. Does proposed construction violate on,/ zoning law, ordinance or regulation? ........................................................ 13. Name of Owner of premises ........................................ Address .......................................... Phone NO ..................... Name of Architect .................................................... Address .......................................... Phone bio ..................... blame of Contractor .................................................... Address .......................................... Phone bio ..................... 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. JtlDITF[ T. DO)~E~ ................. f...~., day of ................ ~.~'.'~.ffi')'~:.t~?, t,~/ (Signature of applicant) STATE OF NEW~,,Y~, J/ ) S S COUNTY OF ._'~47'z,,i~.~..~c.....,) ' '_ ........................................ ~ ......... [.~ ........ being duly sworn, deposes and says that he is the applicon, (Nome of individual signing oppiicatioip~ , above named. He is the ..................................... ~..~T...~ ...................................................................... (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 in the manner set forth in the application filed therewith.