HomeMy WebLinkAbout1866-zNO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at ~.~...t:..~..~...~..~..~....~.~..~.c~.~..~.~r*:~a.`r~..C..U`.`t`~`h.~.~..~.~eet
Map NoR'a!SlaatL..P.~,, Block No ....... ff..*. ........... Lot No ........ ,ti, fl ......................................................
conforms substantially to the Application for Building Permit heretofore filed in this office doted
Z 1866
............................ .A..~..~.~..~...~.....~..~. ................. , 19..6..~.... pursuant to waich Bui[ding Permit No .................
dated .................. .A.~.g.'.~...m.~....2..8.. ................ , ] 9......6.~ was issued, and conforms to a[I of the requirements
of the applicable provisions of the low. The occupancy for which this certificate is issued is ........
The certificate is issued to ..~l~'...I~l~)il~.~.~.~....~..~ill~. .................................. ,~, ...............
(owner, lessee or tenant)
of the aforesaid building.
Building 'Inspector ........ ._~
~. TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUT~IOLD, iq. Y.
BUILDING PERMIT
(THIS F~ERMIT MUST I~E KEPT ON THE pREMISES UNTIL, FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 1866 Z
Permission is hereby granted to:
t~.em~7....~u~k~ ........................................ : ...........
........... ~a~'sau"~oint ........................................
...................... Cute'hoErner .....................................
to '"'B'~t~Z~'"~" '~;d'cl ~.'~; ~U~i' "5~'"~" '~'~'~,~L~ "~'[:l~ii~ ...................... : .................. '"'"'~ .....
at premises located '~;Ot,'"~ .... i::;'~'~'~;:~, , ·
Building Ihspecfor
FO~M NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved 1" '' '~- [ ~'-~ ~
19 ........ Permit No.
/
Application No. IPz
A~PLICATION FOR B'U~LDING PERMIT
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 p remises, relationship to adjoining premises or public streets or
areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this applica-
tion.
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 applica.nt. Such
permit shall be kept on the premises available for inspection throughout the progress of the work.
e. No bui]ding 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 M,~DE 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, 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 owner, lessee, agent, architect, engineer, general contractor, electrician, pIumber or builder.
Agent of owner
Name of owner of premises ..~e. nr¥..Ktzakel .....................................................................................................................
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.: ...... ~,~.9,.~..P..0.~.O..~. ..... Lot No.: ....].../....~.., .......
Street and Number ....P..~.q~.....9~,0..~,. f~P.P..~rRd6e....Te.~,e.,...13.u.C.~,lr~o.~.~e .............................................
Municipality
2, State existing use and occupancy of premises and intended use and occupancy o~ proposed construction.
a. Existing use and occupancy ....~1~/.e.],],f~ .........................................................................................................
b. Intended use and occupancy # with an addition
3. Nature of work (check which applicable): New Building .................... Addition ...~ ........ Alteration ..................
Repair .................. Remora! .................. Demolition .................. Other Work (Describe) ..................
4. Estimated Cost ........,],,.0...0~)....~./..~. ................................ Fee .......... ~.. ................ i ..........................................................
(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 a,nd 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 ....~..-.],.0..~ ............ Rear ............ ~..-..~.0.. ........ Depth .....~.._..lf.. .................
Height .............................. Number of Stories ..g~,~. ....................
9. Size of lot: Front .............................. Rear .................................. Depth ..............................
10. Date of Purchase .......................................................... Name of Former Owner ........................................................
11. Zone or use district in which premises are situated...I!~Y...~.:L~.[ ................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ............. ..~'..O. ............................................
13. Name of Owner of premises ...~,~.~.~...[~.'11~_] ..... Address ................................................ Phone No ...................
Name of Architect .................................................... Address ................................................ Phone No ...................
Name of Contractor ...~.~n~.S~..~TD~n.~S .................. Address .......... l~,.t;.~,~.~.14D~ ................ Phone No ..................
P~OT DIAGRAM
Locke cleorly and distinctly oil buildings, whether existing or proposed, and indicote oil set-bock dimensions from
prc~oerty lines. Give street and block numbers or description according ~H~o deed, and show street names and indicate
whether interior or corner lot.
I
STATE OF NEW YORK, )
COUNTY OF ...~£~]J~ ....... ) S.S.
............................... l~.ligal-...1~.o:r.l:,hJ~:g.t,o~ ....................... being duly sworn, deposes qnd soys that he is the applicant
(Name of individual signing application) '
above named. He is the ............... IXg~..l;...Q,,f'...O.t~.e~. .........
(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 ond belief; and
that the work will be performed in the manner set forth in the application,filed therewith.
Sworn to before me this
............... g.8..., d~of .................. Au .S:~% ......... , ~.~a.. ~ // r'-
Notary Publ c ..(~. ~.~'-~'~J~-~ ..," · ~"~".'--g~'"~~ ...........
~""~'"-~-~',%~'a'r'y"fl/l~'~~,' ~ou, n~ty~, ~f- (Signature of appli$~ht) .....
,, 52-0344963, Suno~K gounty~;~,,~.~ ~