HomeMy WebLinkAbout1353-z~O]R~ ~0. 4
TOWN OF 5OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD. N. Y.
CERTIFICATE OF OCCUPANCY
No.g. ~ .J. tOiY .......... Date .............................. AllUVia.1;..... 29 .... 19..$;[
THIS CERTIFIES that the building located at Ker~qFRd..&..~eV.,A~r~ ................. Street
.Map No...:~f-~ ............. Block No....~2X~ ............ L, ot lxfo....X~ ....... ~llt~l~,d ..............................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ....................... tgla.~(~h......30..., 19...6]~ pursuant to which Building Permit No ..... ~[.~.~..~...
dated ..................... ~a~all.....~0 ......19.~., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is ,..Pr.i. va%e.-.ene...f, amf~y.-.~l~e.l. Ll. ng ...............................................................................
This certificate is issued to ~.ho!q~,~..t~.O]9]~ ..................Q~,~e~ ..................................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspecto~
FOI~][ NO. 2
TOWH OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, H. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 1353, z
Date ............................ ..~....~..~...~..,....~.0... ....... ] 9..~...~...
Permission is hereby granted to:
~,~,j.,..S..~.~..t..h....~....S.........~..g....T.~.s....p..e..~ ...................
............ B.o~hald ,.....~.,,.'X'., ................................
to ....... ]~uil~L..new...One.. f. aml 1~... ~e.1 liP, g ...............................................................................
at premises Iocoted at ..~er~r...RcL,&..8~tl,~..:~/ie~,~...~~v.e ..............................................................
........................................... ~.o~tP~l.d, .....N...~., .................................................................................
pursuant to application dated ............................... ..~..~.?...~..~......,~..Q ........... 19~...],....., and approved by the
Building Inspector
Fee $....;kg.:..O..O.. ........
Building Inspector
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined......~....c:~...M .~.... ?..¢?. ...... 19..~...(.'..
Approved ........................................ I9 ........ Perm,t No ...............................
Disapproved o/c .....(~~~
........... ..........................................
(BuiJdJng Inlpector)
Application No. / 3--~.~
APPLICATION FOR BUILDING PERMIT
Date ~..../.~...~...~ ~ ."~..Q ..................... 1 9..6. ,~. ......
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and su6mitted in duplicate to the Building
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to ~djoining 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 thr'oughout 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 a Iterations, 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 or o[~p~icor~t"):
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premise~~.'Z.~-.. ...... ~~ ...................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
t. Location of land on which proposed work will be done. ~-~*~5~;~.,i~...i/y~,~,~)...,4./~e;.:.... Lot No: ....................
Street and Number .~....~.../..~/...~.../~...J.....~....Z).......~.~....~..~,..~...../r~./.J....~-(~..c..~)...~..~.~ ........ ~...~.....7~...,~..~...../..J. ...................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
o. Existing use and occupancy.....(-,-~,./.~....~.~..(~.....~.....~...',...~......~....~..../.'~... ..........................................................................
b. Intended use ond occuponcy ........ ./..t..~a.~.......'~. ................................................................................................
3. Nature of work (check which applicable): New Building....../,~.............Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ........ ~....M.....~. ........... Number of dwelling units on each floor ............................
If garage, number of cars ...........................................................................................................
6. If business, commercial ar mixed occupancy, specify nature and extent of each type of use ..............................
7. Dimensions of existing structures, Jf 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 '...-~...~..~ ................. Depth ...'.'~..~ ..................
12. Does proposed construction violate any zoning law, ordinance or regulation? .../~...~ ............................................
Name of Architect ........................................................ Address ............................................ Phone NO .....................
PLOT DIAGRAM
Locate clearly and distinctly oil 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
COUNTY OF
SS.
...... being duly sworn, deposes and says that he is the applicant
(Name of individual sigmng application)
above named. He is the .............................................................................................................................................................
(Contractor, agent, corl~orate officer, etc.)
of sa d 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 J~nowledge end belief;
and that the work will be performed in the rCk~, e~,,L~r~ f~h in the applicat,~_filed t, he~rewit~,~ ~
Sworn to before me this ~id,?ia, st~t~N ~~~
~Y Co~ ffo~ co ~ York · '
..... ~.~ ............ d~y o~ ....~.~..~ ........... ,~..~i~.~6~o0 Unty (Signature of ~pphcent)