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HomeMy WebLinkAbout1332-zTOWN OF SOUTHOLD B'UILDING DEPARTME~IT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z...~.20.~. ............. Date ............. .~r~tt~,~~ ......... .~.~. .......... , 1 ~.~ .... THIS CERTIFIES that the building located at ...~/~.....(]'~a~......A~ ............................ Street Mop No..~.}r~ .............. Block No ...... ~.:~. .......... Lot No. 'X[ ......... JSat¢~ttl.~k'j"-'"~i'~· .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................... ~"¢,~ .......... 2'~: ............. , 19~.... pursuant to which Building Permit No. ~...~.].~.. dated ..................... ~'t.e~ ......... ~.~'......, 19.~.1.., was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .......... ........ p~. ~.v.a.t e...or,~ ..:ga.'~i ~..~.. ~:L~n~ ...................................................................................... This certificate is issued to '"/~"'~'~']'~'~"~"~'~'"~'}?~::;~,'~'~"'i;;~'~'~'~"~;~' ............................... of the aforesaid building. H.D.Aproval 1/i%/62 by MaJkowski 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) N? 1332 z Date ................... H~eh.-...2.~ ................. 1~t .... Permission is hereby granted to: A, Re.~..1.1.y.. &--.~o~ ....................................................... .................. ~attituek.r.....l~..~. ........................ to ...t~ilcL..new.. ~e...~ami.t¥-.dwet.ttm~ ................................................................................... at premises located at .-~/~.....~Z~.../k~ ........................................................................................ ............................................................ ;~a.~;itu~kr.....~,.~,. ............................................................. pursuant to application dated ............................... ~Z'-~]?~....2-~' ........... l g~]~..., and approved by the Building Inspector Fee $.10.~10 ........... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... . .~.c. ~.¥.....~.. ~ 19..~q ./.. Approved ........................................ 19 ........ Permit No. '~'-~ ~' Disapproved a/c ........l.........~-...-..........-.....~x.................~.......-................. ................. ................................. Application No../....~..?...~ ......... APPLICATION FOR BUILDING PERMIT Date ............... ......... ...... 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 coYered 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 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 oil 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. ..4..-. ................... Name of owner of ................ ..~... ................................................................. 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: ....~......~...../~... ........................ Lot No: ./~'~.... ........... Street and Number ......~..'?..~.~......~....~....~...~.~..~ ............ ...~.....'~...~....~.....~.....~ ......... Municipality 2. State existing use and occupancy of pr. emises and intended use and occupancy of proposed construction: a. Ex st ng use and occupancy ....... ~~.....~....~:~.....~ .................................................................. b. Intended use and .............................................................................. I ............................................ 3. Nature of work (check which applicable): New Building....~..~..~(...Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... Cost/.-~ :5'0 ~ ~-~ Fee 0. ~ 4. Estimated .... .~ ...................................................... ~/ ....................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units..4"~..'~... ............... 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 ......... ..,-~..5~(. .......... Rear ....... .~....~.. ............ Depth ..77..,..95.. .................. Height ............................ Number of Stories ...~ .......... 9, Size of lot: Front ...~...O;Zg... ................ Rear ..... ./..~ ............. Depth .......,/..~...O. ........... 10. Date of Purchase ......... Z.~'....~.....O. ............................... Name of Former Owner .....~..~., ......................... 11. Zone or use district in which premises are situated ............ ~:~ ........ .~.....J:~... ............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ,..,~ ....................................... ~ Q'' ~2~- ~ ~ Address ,~...-~ Phone NO 13. Name of Owner of premises..i'..t;..:~l,t) ......................................................................... Name of Architect ............................ ~.! .......................... Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and dlstinctly all buildings, whether existing or proposed, and indicate property lines. Give street and block numbers or description according to deed, and whether int~ r~or or corner lot. all set.back dimensions from ~how street names and indicate STATE OF NEV~L.,YC~K,/ ) S S COUNTY OF ..~'s.'..~.~........)~,/~//~-~g,' ............................... ~, .~....:...~..~..~~ ........ ~ .............. being duly sworn, deposes and says that he is the applicant ..... (Name of individual signing appli~:ation) above named. He is the ................. ~../f'.:~..'z.k..~r.7......~'~'~-"~'""%'.< ........................................................................ (Contractor, agent, corlborote officer, etc.) of said owner or owners, and is du y author zed to perform or hove 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 s know edge and be ef; and 'that the work will be performed in the manner set forth in the app~e~t~pn/r_ /filed tJa~rrew, i, th. Sworn to before me this )UD e=t z~ , ~ r'~,~ ~ r/~t ~o ~ leo~,/r~u~,!,c, st~'t~ of ~w ¥ot~S nature of a licant) . m~. ~ aay o~ ........... , g PP ........ Notary Public,