HomeMy WebLinkAbout1631-zNO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THI~ CERTIFIES that the bu,ldmg located at ..~/~.~...~.~g~/~...Jl,~,.~...J~.t;.~,~.~ ...... Street
Map NoM~tt,,...~a:l:k Block No...?...~.?. ........... Lot No ...... .~...4...~..~.~.,.....O..~..~..~.3. ......................
Pro~er ~tes
conforms substantially to the Apphcat~on for Building Permit heretofore fJled in this office dated
................................... ~..~.~..~ ./I~....I¢...~..I~. .... 19...~.~.. pursuant to which Building Permit No...~...~J~
dated ...................... ,l:l~l::~..&8., 19....~1, was issued, and conforms to ail of the requirements
of the apphcable prowsions of the law. The occupancy for which this certificate is ~ssued ~s ..........
PRi~AT~ ~ F~,Y DW~L?-ING
This certificate is issued to .......... ~..~*.....~...~..O...f~. Z..R~.,....~l/r~.e~. ...........................................
(owner, lessee or tenant)
of the aforesaid building '
Building Inspector
]FO~ NO. ~
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°. 1631, Z
Date ................ l)~c~,~lb6Z'... ~8 ........... 196~k..
Permission is hereby granted to:
I~, l~t t e z~to~.t;h.... ~f. l~..I~o~;.o th~....._~._~:ynor. .............
...... ~.tg~-t~kr... N. ~r. .............................
to. ~I,. ~.. ~d~.t;~ on.. tm...~,...eIlst:~.. ~ll~N~ ......................................................
at premises Iocated at .~;...~,'l~..& .~..].:I.~¥... ~t~l.~,~-t,~l~' ..~t~l~'...~p ............................
....................................... ~/~....8.sg~y...Pu~d.~ ........ ~tt.~uek. ................................................
pursuant to application dated ........................... ,l~el~be~.....],~ ..... 19~]!..., and approved by the
Braiding Inspector
Fee $..~'.,,.0J~l ...........
g In
FOl~[ NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N, Y.
Examined ........... ~ ..C~..... _/.....~...., 19...~../...
Approved ' ~ ~. ~/~; ~ /
........................................ , 19 ...... Permit No ................................
Disapproved o/c ................~........~.........~......_........
.~t r)
Application No..Z .~.....?...../. ............
APPLICATION FOR BUILDING PERMIT
Date ~..C-~r. ...... /(~'~., 19....~...~. .......
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 port of this application.
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 pa rt 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 Lows, 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 oil applicable laws, ordinances and regulations.
....
(Signature of applicant, or name, if ~'~'~i~i .........
...................... ...........
(Address of applicant) .......
State whether/~p~lica_r~_~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ~..r....~:~...*
If applicant is a corporate, signature of duly outhorizelJ officer.
(Name and title of corporate officer)
Loc on of ,and on wh,ch proposed work w one
1. ' ' . ' - ·
Street and Number ..... ~Z=~.."..~~ /~C~, ~~~';' ...........
a ............ I' ~'~'~i~ .................. ........ ~ .........................
2. State existing use and occupancy of pre~i~n~ and~upancy of pr~osed construction:
a. ~isting use and ~cupancy ....._~,/~ .............................................. ~.~...;..~:
b. Intended use and ~cupancy ...........................................................................................
3. Nature of work (check which applicable): New Building .................. Addition ....~.....~-. ...... Alteration ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................
4. Estimated Cost ..... /~', .~......~....~. ................................ Fee ................................................................. ~ .........................
(to be paid on filing this application)
§. 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 natureand 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 ......... /.....2~... .......... Depth .... ./....~. ..................
Height ............................ Number of Stories...~ ..............
9. Size of lot: Front ............ ..~......~... .......... Rear ......... .?......J".. .......... Depth .../....~....?...~. ......................
10. Date of Purchase ............................................. : .......... Name of FoEmer Owner ....... : ................................................
11. Zone or use district in which premises are situated......[~.~.......~ .................. ...~ ............................................
12. Does proposed construction vi~ate ~an~ zonln~ law, ordinance or regulation ........ ~,..-....
13. Name of Owner of premises ..u;~4...,~....~....:~A~"-~ ]/'~ ~(Z~ddress ............................................ Phone No .....................
Name of Architect ................................................. Address ............................................ Phone No .....................
Name of Contractor ~.r...~~. ......... ]:....Address ....,~.~] ...... Phone No .....................
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.
STATE OF NEWr--~OR/K, . ) c c ~ '
COUNTY OF - ' --
........... J.~.:,..~.~ ........ ~~~...~.being duly sworn, deposes and says that he is the applicant
(Na~f individual sig~ng a~n)
above named. He is the ............ .~~.~ ........ ~: .......................................................................................
(C~traCtor, 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 stOtements contained in this application are true to the best of his knowledge and belief;
and that the work will be performed i~ ~ set forth in the application filed ther~Jth.
Sworn to before me this ~ot~ Public, ~te of New York~
-- ~ _ ~ ~o. ~2-0~963, Suffolk ~u~./
................. of ........