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HomeMy WebLinkAbout1677-zFOP~M NO. 4~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ....~...e..n..~...~..a...~....g...~.~.e. .................................... Street ::;~,~7~ ......... B ack No ..... ~ ........ Lot No ~6., ........ ~..~..~.~...~.~...~.~.,...~....~...~ .................. conforms substantially to the Applicahon for Building Permit heretofore filed in this office dated ................................... ~.~!. ....... ~, ...... , IgOr, .... pursuant to which Building Permit No ..Z..~.~..~.~'.... dated ........................... ~'Vl~.C~....~ .... , 19.~.~, .... was issued, and conforms to all of the requirements of the apphcable provisions of the law. The occupancy for which this certificate is issued is ........ ...... I~z':Lva~..ane...famfI~r...d~elling ........................................................................................ The certificate is ~ssued to .Dawl~..lF~;atea..inc~ ............... Q.kr~9~. ................................................... (owner, lessee or tenant) of the aforesaid building. N.D. Approval June 1~, 1962 by Villa & Ma~kowski Building Inspector j FOltM 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 PULL COMPLETION OF THE WORK AUTHORIZED) N.o 1677~ z Permission is hereby granted to: pursuant to apphcatlon dated ................................. ~h"'~.~ ....... 19.~.., and approved by the Bulldin~ [nspector Building Inspector TOWN OF SO~TSOL~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved I[ 1~ , q ~. //~ 7 7 ........................................ 19 ........ Permit No ................................. Disapproved a/c ............................................................................................ Application No.../!..~....~ .~. ........... (Building I nr~bector) APPLICATION FOR BUILDING PERMIT Date ............ .~..C,b_..2~, ....................... , 19...(~, ........ INSTRUCTIONS a. ThLs 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 o detailed description of layout of property must be drown 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 sholt 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 ri' 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 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 regulations. (Signature of applicant, or nome, if o corporation) Jericho Turni~ike, Centereach, N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. O-~¥nez~ Nome of owner of premises D~w~ I~$.t~.~es v ~r~¢ ........................... 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 No: ........ ].6.~.2 ........................... Lot No: ...1].6 .......... Street and Number ...C,f~Jct.t~al..Z~.J.~e,,..Mat.t,i.t.u~k., ....................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy vacant land b. Intended use and occupancy residence ......................................................... 3. Nature of work (check which applicable): New Building ...... X ......... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost $5~000.00 Fee $10.00 (to be paid on filing this application) 5. If dwelling, number of dwelling units ....], ......................... Number of dwelling units on each floor .......... ~: ................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...... m.-..-...-. ................ 7. Dimensions of existing structures, if any: Front......-.rzm.-. ............ Rear ...::..-.z.-r .............. Depth .....m.-:.m..-. ................ Height ............................ Number of Stories ...... :z..~?..-. ............................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front ........ ;].6 .................... Rear ...... ~.6. ................. Depth .......... :~.~ .............. Height ........... .~..0..! ........... Number of Stories ............. ~. ................... 9. Size of lot: Front 90 Rear 90 th 190 10. Date of Purchase ..............1..9..~.6. .................................. Name of Former Owner ........ ~m.J:..t...b: .................................... 11. Zone or use district in which premises are s tuated residence 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ..~.~ ......................................... 13. Name of Owner of prem sesg..~..w..~...~..t..~..$..e..~.,.!.P..q,Addres~.e...~..t...e.?'..e.a..g..~. ...................... Phone No.~.l~.:.8..-T..9..~...5..© Name of Arch tec~..q..b..e..i...~..e..¥.....~.....~..w..~.t. ................... Address ~.f..a.P..e..cl.u..a..~.~::..¥.: ........ Phone N~l..:.~Z.6...O..6...O.. Name of Contract~a..w...i!...~.~a.t...e.....~...1.~..~..s..~..C...o.¥.P..Address .C..9.~...t:..e..z/..e..~.g.l~.~.N..:.~.:. ....... Phone No.~..u..t..8..-...9..g...5..0 PLOT DIAGRAM Locate clearly and distinctly alt 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. L T"' 116 7 J , ~,5 L 0 £o'F 115- STATE OF NEW YOP~ ) COUNTY OF ....... ..~.~9.]¢..[.{....) S.S. ............... ~..~..e..(}..c]g.~..~..~J~,;p.].~.~. ............................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ...... .P...i2.e..~.J,.~.e..i~.,...j).fl.w..p...l~.l~&f~.e.s.,...~,i'L¢. ............................................................................. (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 tk~is application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ....q~..~.......~...Sw°rn to before dc~me ofthis'-7//' ' ~'~ '~? ,~ /]l~/1,] ~/ul~/ /~L,/I//~'~-C/~' ~' ~ ~/'>1 +¢ '~(-~' ,,., :,. .;:f..,..,.~:,~.~¥.:..m<..~....~.¢...Z.l.l'r ........ ..-mz. ................................... Notary Pubhc, .../..~...¢.~,.~...i; ~;¢,f;;..,.:...¢o,urih/'~'~ (Signt~ture of applicant)