Loading...
HomeMy WebLinkAbout1565-zTOWN OF SOUTHOLD BUiLDiNG DEPARTMENT TOWN CLERK'S OFF~CE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...~...},3~7 ........... Date ................~ul~re'"~ ......................... , 19 ....... THIS CERTIFIES that the building located ati~/'.~...~,~lO,~.t~..~d.~...G~ee, nj~Ol~'.~ ........ Street Map No .......... &,, ...... Block No ............. ~,~,... Lot No ..................... 'eiSa' .......... ~i'(~ ......................... conforms substantially to the Application for Building Permit heretofore filed in 'this office dated ................................. 4~tr.~r,¢lZ~'...2~ .... 19..~:L. pursuant to which Building Permit NO ...... dated ......................~e~l~'..,~, 19..6.~., was issued, and conforms toall of the requirements of the applicable provisions of the I~w. The occupancy for which this certificate is issued is .......... .............................. · l?R,~d~,~...Ot~ ·. ~',~v~ ~'.. ~)~.~ZJL~I ............................ . ~,....:,.. i:.... ........................ This certificate is issued to .~:~.~...~';~J~O¢~...O~l~: ..................... . ...... :,.... ............................. (owner lessee or tenant} of the a.foresaid building. Building Ir~spectoj' { TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTFIOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1565 Z Date ......................... ~epT,~t.~o,r.....-~6.. 19_~. ~.. Permission is hereby granted to: Cb.~ ]~¥I.e.....,q/C......Pe~a.~r...~t8~ ~.~ezt ................ ............. ~: ~Lq?,'o:C ~ ............................................. at premises located at ..,.}~r/,~.....N~r¢~a.,Roa~: ..................................................................................... ......................................................... ~ree._q~por~ .................................................................................. pursuant to application dated .............................. S.ep.i;embez,...,,k6...19...6.]:, and approved by the Building Inspector Fee $'"~00 ............ Building Inspector \ TOWN 0[: SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........~..~t .~.... ~. ~...L/.¢..., 19.~..J... Approved .............................. t...~ ........ 19.~.!.....Permit No ............................. Disapproved a/c ............................... ......_~_~r.... ..... App',cot,on No..ZZ .C .......... (Bui Idin~,nspector) APPLICATION FOR BUILDING PERMIT Dote ................. ...... 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 bedrawn on thediagram which is part 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 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. .... ........ .............................. (Sign.ature of applicant, or name, if a corporation) .......... .G, ......................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general cqntractor, 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. Lec~tionoflondonwhichproposedworkwill}~edo~o,p~,N(~: ........... "~"t)~ ............ ~Lot Ne: .~. ................. Street and Number .....~..../S...~~......~.....~...~- ..................... ~ ................................. Municipality 2. State existing use and occupancy o~ntended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~~~ ....................... ~r ...................................... ~ ............................................... b. Intended use and occupancy .................. ~.~. .................. ...J~...M~...~...~ ...................................................... 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) 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. D mensions of ex stin structures f an ' Front ~- 7 Rear ;~'7 De~tb g . Y ..................................................... ~ ,, ..... 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 Height ............................ Number of Stories ......... ~ ....... 9. Size of lot: Front ................................ Rear ............................ Depth ........................................ 10. Date of Purchase ........................................................ Name of Forme~ Owner ........................................................ 11. Zone or use dstrct n whch promses ore stuated .......................... ~ .................................................................. 12. Does proposed construction vi~lote any zoning Iow, ordinance or rggulotian? ........ ~ .................................... 13. Nome of Owner of prem ses ~...~..~.~~ Address ...... Phone No Nome of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...... Q,~,.~....~.'. ............ Address t ~ ............................................ 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. L~ [ , ~C~ L; ~/ k) STATE OF NE~C~Y.O~j~I~,i~ COUNTY OF .q~:z~'.~ ...... ) · · ' ' ............................ .~/..../.~..c~...L....~ .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ........... ...............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 staCements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the ~rT)~rfh in the application filed therewith. Sworn to before me this ~ Nota~ Publ~, State of New York ~/ ..................... .... (S'~n~ture of applicant) .... ...................