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HomeMy WebLinkAbout1646-zF~RM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~.l~.~.~...~.~..,...~....e~.....~..~l..~..~.O.~.....~.~...~..~. .... Street Map No .... ~.~.~ ........... Block No....a...et..~.. ............ Lot No ........... .~..e...e. ..................................................... conforms substantially to the Application for Building Permit heretofore filed in this office doted ................... .G'...a.p,~.~.~'~....2..9... ...................... , 19...6...2.. pursuant to which Building Permit No .......... ~...]..646 dated ........ ~.~l~ltt,:k~...;~. ................. , 19 .~2, was ~ssued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ......... lL~ZT~r&%~,..gll~...it'~..~lll~Z,T~3:3t~ ................................................................................... The certificate ,s issued to ...... .C..~.a.~.~.....O..~...O.~.!...~.e.[ ................................................................... (owner, lessee or tenant) of the aforescid budding. ilding In FOR~ NO. 2 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) No. 1646' Z Date ........ ~raum~-"'29 ................ ~62"' Permission is hereby granted to: ~y.....l~a~rd.... ~.. ~.l-ara.. ~y, ............. .......... I¢~t l.tue~ ...................................... to .. l~u&.td., e~.. port-.~m..e~J[~ti.r~..d~ee~.i~n~ ...................................... , ........................... at premises Iocated at ~'1~-'ll~' ~l~,..l~t~ ........................................................ '- .......................... .................................................... · e~..~uff~o]~ ............................................ ~ ............................... pursuant to application dated ........................ 'J~lUt~j~' ......~.~ ........ ]962.., ?'nd approved by the Bu~ldmg inspector Fee $.~(~ ............. t i Building Inspe~ct~( ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19.~.....2~ I( Approved ....~... ............................... , 19.!!.....Permit 'o...~....../....~.....?....~,. ...... Disapproved a/c ....... ~(7.Z~ii~ ..... (Buildi~'g Inspector) Application No ............................. APPLICATION FORBUILDINGPERMIT Date ' c~'~'"'~---~ '~ I ......... ........ ..................................., 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 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 all applicable lows, ordinances and regulations. ........................................ (SiJinature of al~p!icant, or name, if a corporation) (Address of applicant) State whet~e,~ appl.~ic~nt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................................... ......... ....................................................................................... Name of owner of premises ......... i:~J ....... .?~.. ........................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed wo~k will be do, l~. Map No: ..... ..~.......~.. ..............Lot No: .. ~ ..~.... 2.State existing use and occupancy of~remise~nd intended use and occupancy of proposed construction: a Ex st ng use and occupancy ¥~' 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) ~ f 5. If dwelling, number of dwelling units ...... ~ ................. Number o 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 .......... ..~......C:~.. ...... 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 ..Z..~.. ................. Depth ...~ .................. Stories .................................. Height ............................ Number of ~ 9. Size of lot: Front ................................ Rear ............................ Depth ........................................ 10. Date of Purchase ........................................................ Nar~e,,,~f~Former Owner ........................................................ 11. Zone or use district in which premises are situated......~) ....... ~..: .............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ ~ .................................. 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .., ............................ i ..................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly ali 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. IkO p STATE OF NEWt~,~(,~'.~ ) c c couNT OF ...... .... f...~.~ ~c~ ........ be ng du y sworn, deposes and says that he is the applicant ................~'~'~'~ individ'"'~'""~ ~'~i'~) above named. He is the .......................... ~.~ ....... ~ .............................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owneEs,.andi~.~g~y 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 knowledge and belief; and that the work will be ~erformed,i~.~ ~r set forth in the application flied }herewith. Sworn to before me th'i~ ' '~ ff0~ '~.~'~c,'~t'~ o~ ~'~ Yor~ ~ ~ ~ / / ~ · ~ F:c, 52-'~34~963. Suffolk Cou,~I~ ~ ~ ~./ / / ~ ~ _ / J .................Notary Pubhc~'..,~~~...:'~" ' ' ...... '-~..-~p~, ,w ..................... ~-.~.1 x..x..~j.~.~.. ....... . .~~.. . ..{ ....... ..... ..........