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HomeMy WebLinkAbout1654-z]F~)I{3VI NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No .. ~.. ~%~'2cJ. .......... Date ...................... THIS CERTIFIES that the budding located at ..]~...L,~__TLe ................................................. Street M~o..~....a~...~.. ............ Block No .... ~ ........... Lot No..Z~, ....... ~l,~t, zk-.~J;~(3k',..~,Z, .................. conforms substantially to the Applicahon for Building Permit heretofore filed in this office dated ......................... ~Ta~.z~.a~......2~ .............. , 19.62_. pursuant to which Building Permit No. ~_1_~.... dated .......................... ,Fel~tta,t'.~'....~.., 19..62,., was issued, and conforms to all of the requirements of the apphcable prov,s,ons of the law. The occupancy for wh,ch this certificate is issued is ........ ~.S.V.~.%e...o~e...~.~l,l¥...~elltng ............................................................................................... The certificate is issued to .... Jo,h~..~I.,...~=d:[r~e.. ................ ~. ............................................ (owner, lessee or tenant) of the aforesaid building. H,D,approval Nov, 20t 1962 by R,Villa ~ Budding Inspector J FOI~M ~0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT..,. N? Permission is hereby granted to' (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1654' Z Date ............... ~'J!l~¢_~ _~'Jr ..... 27. ........19~... at premises located at .].O~..~...~LI~$ ....... ~}~:~...~'.~.~']1:; ............................................................ pursuant to application dated ................... ~i~tn__~'~.....~,7. ............... 19t~,..., and approved by the Building Inspector Building Inspector / FOI~M NO. 1 TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This epplicetion 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 o 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 hove 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. ...... ....... .................................. (Signature of applicant, or name, if a corporation) .................... (Address of applicant) State whether applicant is lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .....?...O..ff...~..........~..~........~...~..~...D.../...~...K...~.. .......................................................................................... 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 t~i~:~/F ......... ~)..~..~....~. ....... '?~....N....~.. ..... Lot No: ..../~. ............ Street and Number ...~..~....~.....,.~.~/-...~....~.~......../~....~...~.~...~...c...~.~ ....... .~...:.?..:..:. ............................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy J~/.~ H o ~'t E 3. Nature of work (check which applicable): New Building ...~..~'..../~...... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ..... ~./.0.,~..~...O...O..:...o....o. .......................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .O...fl...~. .......... ' ....... 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 ...... ..~...~.....~ .............. Rear ............................ Depth ....~...?.....O. ............. Height ............................ Number of Stories ..................... 9. Size of lot: Front ....... ..~..~..q.~..o...~ ........ Rear ....~..~..?..:..~.~ .......... Depth ..Z.~..~:..~../. ....... ~'..~.:.o..?.. .... 10. Date of Purchase .......~..~...~.:.....~......./.~..~. ...................... Name of FOrmer Owner ..~..~..5..~p..//../~....~/.~..~.~.....D...~..~..~.?...~..A'../... 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .....~/.~ ............................................ remises ~ ~:' ~.o-u~..~lAdd,-~ ./~../~.~:..~..u..~..~.~.....~..:..?.:.... Phone No.~/.~....~..q..~.~.?.? t3. Name of Owner of p .................. : ............................. Name of Architect ..L.~..~/?.........~.........~..E...~.?..!..~..~f~ ........ Address ...~.....~..T..~..t.'2C..~..S..~.,...~.:.?..:.... Phone No..~?..?..-...E'.?...?.?. Name of Contractor lou~ f ~#~ ~-c~-~/ft Address ./~..~....TZC...!.~.?.?...~..~....~.'...~..-..... Phone l'qo/-.~.....:. ........... ................................................ PLOT DIAGRAM Locate clearly and distinctly ail 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 ...~.'..~.~..~..o...~...~,. ....... ) S.S. ................................................................................................. being duly sworn, deposes and (Name of individual signing application) says that he is the applicant above named. He is the ........ .O...q~.....~....~...F~,. ............................................................................................................................. (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 statements contained in this application are true to the best of his knowledge and belief; ~nwdo/nh?ot tbhe~orWeOrmkeV~ihllisbe performe~(~!~.~ut~,~(R3~e~ set forth in the application filed therewith ....... '~...~.. ......... day~z~. · ~~ '~J .l~i;:;, ~ 9 · ~ · ~"- ~~ '~" '.-"'~'--'J~'~ Notary Public, ...~~. County ........................ i'~'i'~'r~'~u;;;';~f";~'ii;;'~:t'i .............................