HomeMy WebLinkAbout1007-zFi~F.~ N~O. 4
TOWN OF SOUTHOI, D
BUILDING DEPARTMENT
TOWN CLERK'S OFF~CE
$OUTHOLD, N. Y.
OF'OCCUPANCY
THIS CERTIFIES that the building located al ?.~..~.~.]-. ~..~. ............................................. Street
Map No. ~.~. ........... Block No....~. ........ Lot 1N'o. ~.~.X.. ....... ~.~.%.~.~1~..~..,... ~,~i* .......................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .................~/.I.a..~'..C.~......~.l~......., 19..~..0. pursua'nt to which Building Permit No...Z~..~0.0.~. .....
~lated ........... .?./~..h.. .......... ~ ........ 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
.................... ..P..r..,.%.v..~.t 9....o.~e...~Lami~,:z..d.w~/.l~3~g, ....................................................................................
This eertifleale is issued to ..~..~:D~.~.Y.. lq.a,],.gD .............. (....o.~lrl~r.) ....................................................
(owner, lessee or tenant)
of the aforesaid building.
.......... l ' '?~' '~ '~'~' ~ ' "' ' '" ' ' ' ' ' x~ .................. ' 'V
Building Inspector
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)
1007 Z
Dote ......................... l~a~.eh.... ~ ........... ~9.60...
Permission is hereby granted to:
Irwfn..T~tb~Ll,....AZC.....8.~amley......~a]~. ..........
.............. ~.~tituek~.....~:~. ...........................
pursuant to application dated ........... ~ ................ ]~a~h....~ ..............19.~0.., and approved by 'the
Building Inspector . , ,
. Fee $...~,,.00 ............
FORM ~0. I
TOWN OF SOUTHOLD
'. '~ ~ BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined .~7.~,..-~,~,/~..,~19.~.~.(.~.
Approved ~-~./~x'~.(~.....~.~., 1 ~z.~C./... Permit No .......... ~...x~.~J.~?..~
Disapproved a/c ...........; ................. ;:;:: ......... ~. -.~:::.~ ....... :4~LLL[' ................
Application No ........./..~.~..~ ........
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
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 o Certificate of Occupancy
shall have been granted by the Building Inspector. ii .......
APPLICATION IS HEREBY MADE to the Building Department for the issua.nce of a Building Permit pursuant to the
Building Zone Ordinance of the, Town of Southold, Suffolk County, New York, and other applicable Lows, 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)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................... ...................................................................................................................
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: ..... ../~.......~.......7~.. .................. Lot No: ......... ~/ .........
Street and Number ......~....Ch..C~..~..~..~'.....~...~ ............. 2..'~...~~~ ...... ~'...~..: ...............................
~/ Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
b. Intended use and occupancy .......................... L..~. ............... ...~.../....C.-~...~..~....~.......~r......~..~...~..~.?~.~' .....................
Locate clearly and distinctly all
property lines. Give street end bbck
whether interior or corne, r lot.
3. Nature of work (check which applicable): New Building .................... Addition ...... ~ ........ Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe)
4. Estimated Cost ....... ..~....0....O....~._~,.. .................................. Fee ......5~.. ..................................................................................
(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 ........... .f..~. ............. Rear ......J...0. .................. Depth ..,..~... ...................
Height ............................ Number of Stories.......l~...~ .............
9. Size of lot: Front .......... ~,~...,O,..~. ....... Rear ............................ Depth ~/~ 0 ~
10. Date of Purchase ........................... ............................. Name of Former Owner ........................................................
1 I. Zone or use district in which premises are s tuated ...... ,~ ........ ..~..~.?..'. .................................................
12. Does proposed construct on via ate any zon ng law, ordinance or ragu a,tj_on? .................................................... .
13. Name of Owner of remises ..~.:.~.....~.~.'.,~ Address '~'t,~-: Phone
Name of Architect ................................................... Address Phone NO .....................
Name of Contractor .... ..~..t:....--~ .......... Address Phone NO.'
PLOT 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
S,ATE Or
S
S
COUNTY OF ...~,~k~..;:...) ' '
I/lkx~, ..~,~-- ' ^ ^~'--~~ 'ein ' I r 'eose n' sa ,'at' he is the a 'icant
............................... ~..:.....~...)...,~w~... ............................................ o g au y swo n, a p s a a ys 'n ppi
(Name of indivi'd'ual signing appl, J~,ation)~
above named. He is the ............................ ...k~..~...~.,..~..-c~<'m~ ........................................................................................
(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 h, is knowledge and belief;
and that the, work will be performed in the manner set forth in the application filed therewith.
JUDITH T, BOKEN
Swam to before me this
(Signature of applicant)