HomeMy WebLinkAbout1661-zTOWN OF SOUTHOLD
BUILDING DEPARTMENT
'~OWN CLERK'S OFPICE
SOUTHOLD, N. Y.
No. Z1661 ........
CERTIFICATE OF OCCUPANCY
Date ............... Augu. st
.13 ....... 19..62
..... Street
of the aforesaid building.
H.D.approval August lO~ 1962 by Ro Villa
Building Inspector
THIS CERTIFIES that the building located at ..1t]/$. I~O~s.t Lane
Map No...~.. Block No. ;XZX~ ........... Lot IMo ~ ..... ~)~I~o~Ld ..........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ..... lV~a~'fl]l ~..., 19.62. pursuant to which Building Permit No .... Z1661
dated ............ I~]X. ~ , 19....6~ was issued, and conforms to all of the require~
ments of the applicable provisions of the law. The occupancy for which this certificate is
~ssued is . .Pri~ate ..ox~e..zCa~. dw.e!ling .......................................
This certificate is issued to .... ~.eder.~ck_I~nnert~
(owner, lessee or tenant)
FOI~M NO. ~
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? 1661, Z
Date ............................. JJlI~P--JJl.....7. ......... 19..6~.
Permission is hereby granted to:
G.1~..~l.f,h..&..l~on~.. ~....~f~.... F~.ed~:Lcl~ Lennert~
........ S.Qut..h~].d ....................................................
to ..... Jh~tld...n~w.. ~l~..£a~n~:l,~t..dwe~ll'~n~ ................................................................................
at premises located at .....~.S.....Lo~llS.t..~IIII~ .................................................................................
....................................................... Sautho~d .....................................................................................
pursuant to application dated ........................... 14A'1'~11.....7. ................. 19..~l~, and approved by the
Building Inspector
Fee $.3.0..O1~ ..........
Building Inspector
FOI~M NO. I
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
E×om,ned ..... ............ ,
ApproYed ........................ :.:. ............ No. ...........
(Buildi~tor)
APPLICATION FOR BUILDING PERMIT
Date ...... ..~......~....~.. ....... .7. ......................... , 19..~ ......
App,cat,on ............
INSTRUCTIONS
o. 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 port 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 have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 regulotionsj ~
(Si~rr~atur.~ applicant, or nome, if o corporation)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ...~...,,"/,,~z....~..~.....~ ...........................
if appli?g~t~ is a corporate, s~ature of~luly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work ~Ma~ .......... Lot No: ....................
Street and Number .~~ ..................... M'b' 'icipoii .............................................................................
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
o. Existing use and occupancy ....~., .~..~:~.~_~... ~...~ .................... .......
b. Intended use and occupancy ...... ~~ ................. . .....
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ........ , .........
Repair ................. .~n~moval .................... Demolition ................... .,nlDther,~'ork (Describe) ........................
....... 'T~c2/~ ~
4. ~sT~matea ~ost ............................................................ cee ..........................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units .............................. Number of dwelling units on each floor ............................
tf garage, number of cars .............................................................................................................................................
6. If business, com~rcial or mixed occupancy, specify natureand 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 ................................ N~mber of Stories ........................................
8. Dimensions o(~n~irenewconstruction: Front ....... ~....~.." ........... Rear ..~...~..- ............... Depth .~.C." ................
' ' ~ .... to'e~
~eight ............................ Number or ~ n ................. ~ ................
9. Size of lot: Front ....~.~.~."---- ............... Rear ....~.~..~------ ............. Depth ...... ~.~ .......................
]0. Date of Purchase ..... ¢....~ ............................................ iName of Former ~ner ........................................................
11. Zone or use district in which premises are situated .................................................................................................
12.Does proposed constructiCn violate any zoning law, ordinance or regulation~ ............................................ .~.
of Ow,e, of p, m,se, ....................................... ........................................... *ho,e .......
Name of Architect ...................................................... Address ............................................ Phone No .....................
of ......... *dd,e,, * ,hone
PLOT DIAG~M
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from
property lines. Give street and. block numbers or description ac¢ording to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW YORK, )
COUNTy ~ ............
............... ~~.~;7...%.......-:...-~.. ........ ~:.....being du(y sworn, deposes and says that he is the applicant
(Name of individual si~).._~r_~
above named. He is the ........... ~ ......... .~..../ ............................. ._ ....................................................................
(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;
and that the work will be performed in the manner set J~C.h ~i.nCJ~.~apptication filed therewith.
Sworn to before me th~s ,
........... 'r .......... ¢ /"'~'":'~ .... ~'~/_ /j' , 4 ~.~ ,~,~ ........... ,/¢:.L.,~.~;~:',:4;,r.r.C:i........,,::~.~.......-4.::.f:::(:.~ ......................
· --~ .. ~ ,, ~ / . ~ . ~ ,
(S nature of a hcant)
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