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HomeMy WebLinkAbout1642-zFOi~i~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD,. N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .... ~,~z/~.~l.~,~e....~...e..l[t..~...,~.~.~..~...~,~.,~.,,.....~..~..~.~f~ Map No...~.:~lock ~o ...... .~ .........Lot No ............ ;.. ........................................................ conform~ substantiolly to the Application for Building Permit heretofore filed~ in. this office dated ................. ~.~aa~.,[~ ...................... , 19...6~ pursuant to which Building Rermit No ........... ~..[642 dated ...... ~..~a~..~ ..................... , 19....6~ was issued, and conforms to all of the requikements of the applicable~provisions of the law. The occupancy for which this certificate is issued' i~. ....... .......... ~.~...~...~.~.~ ................... ~ ................................................................... The certificate is issued to ............................ ~.~...~ ....................................... (o~er, lessee or tenant) of the aforesa'id'bu[Iding. Building Inspector/ FOi~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 1642, z Date ........................ ~r~l~..... ~,~. ...... ] 9..6~. Permission is hereby granted to: Oz'~.g:Ln~,l..,Homes ....... A,/C.....Al~'r. ed...i~nse, ons ...... ........ ~Lckl le...l;s lan~ t.... N. ~'... ....................... to ...]B'a,t.].d...new.. one.. t'amil.y., d, we.ll&n~ ................................................................................... at premises located at ..~l',.'~..~id.e.....¥1eli~..~',~w..~)~.~,~'s ............................................................. ..................................................... ~t~l~.l;.~; ;Lt~.~:~....J..¥. ..................................................................... pursuant to application dated ........................ ,il:n~'~..~r ....... .~.~'. .......... ]96~...., and approved by the Building Inspector Fee $.~,.~.,.0..0 ........... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE .~.. SOUTHOLD, N. Y. Examined ... ~.~m~....~.O------------------%~....., 19~..*..~. Approved .....~ .......... ~ ................. , 19..~....Permit No..r.~.../...~....4~....~. ...... ........... .................. ................ ,. ............. Disapproved O/C ................................... ....... .......... ...... ..... ............... ...................................... , (Building I~pector) APPLICATION FOR ~UILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and s~ibmitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on p remises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must bedrawn on thediagrom 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 inpd 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to .csm~ly with all applicable laws, ordin~ancps and regulations. (Signature of applicant, or name, if o corporation) Middle Isl~(~ ~,~,, (Address of applicant) 'State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... ..c..0~.t~..~.~..t.o~r. ........................... Name of owner of premises ....,~,~,~..~f~.....~.~.~f)~ ............................................................................................................... ff 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: ..l~.s.~...~ie~. .................... Lot No: .................... Street and Number ...~Z~..g.:l.d.e..!~.e~...V.~.~w..~&~re ............ N-~t,.ti~.~ek .............. ~....~ ................................... Municipality 2. State existing 'use and occupancy of premises and intended use and occupancy oF proposed construction: a. Existing use and occupancy ...... .V.~.~rl.t..].~l'l.d ................................................................................. b. Intended use and occupancy one family, dwelli.~.~ 3. Nature of work (check which opplicaNe): New Building ..~:y~ ........ Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Esti m ate d Cost '.....]'...0. ~...0..0..0.. ......................................... Fee ..... ~..0. ................................................................................ (to be paid an filing this application) 5. If dwelling, number of dwelling units ....D.Q.e ................... 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 .............. .2..~, .............. Rear ........... ~...0./..~..0. ..... Depth ....'...b¢..~. ................. Height ............................ Number of Stories: .......'1 ....................... 9. Size of lot: Front ....~.~'. ...................... Rear ......... ZO.O,2~ ....... Depth ..... .'1.~8/'..2Q.~ .................. 10. Date of Purchase ....... ~.~.~ ....................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .......... !!~,!~. ................................................................................ 12. Does propbsed construction violate any zoning law, ordinance or regulation? .......... kqQ ....................................... 13. Name of Owner of premises ..A...~..~..Z'...e.~...~.~.~.O..o..~.. ....... Address ...22,7..-..~2...~,~¢~c~;,.A~.mhon~le.e~...V.;$.~.~§e Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....0.~.[~..~...~...o..~...e.~ ............... Address ........ jv',~,~,~,...~.~,~ ..... Phone No ............ , ......... PLOT DIAGRA,M 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 NEW YORK, ) COUNTY OF .... ~f~OZk ....... .................................. ~BR.~...~.~.O.~ ..................................... being duly s~orn, deposes and says that he is the applicant (N.cme of individual signing application) bove , med. the ............ .................... ............................... of said owner or owners, and is du~y authorized to perform or have performed t~e s~work and to make and file this application; that all statements contained in this applicatioq ~u~ to h~ be}t/of his knowledge and belief; and that the work will be performed in the ~ ~rth in t~e ~[ic~tion ~il~d t~e~ewith. Sworn to before me this .................. ............................