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HomeMy WebLinkAbout1867-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ~..:kC~9.~. ............. Date ............................ .O.~.~.g.b.~.T......~l., 19..6..~.F... THIS CERTIFIES that the building located at ..~J.a:S.'6..~J,t ................................................. Street Map No..~,~;Z .............Block No ......~ ......... Lot No..~,....C.u.~c}~g~t...N.,.~4 ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......................................... ~LI~.LtS.t;.....28., 19~... pursuant to which Building Permit No. ~l.i~.~..7...~.. dated ................................ A~a~,~,.....2~, 19.~.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ..... .~. ~v. ~,lm...o~.w...,~:~m~,.~... ~.~.e.~l...t ~, ........................................................................................... The certificate is issued to .~e~...T,O~ ........................... 0~. ............................................. (owner, lessee or tenant) of the aforesaid building. FORM 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) N? 1867 z Permission is hereby granted to: 'Y,,il~"~ ............................................... ........... L~t'"~ ...................................................... ................... Gu:kehoet~v...N,,.¥.,s .......................... to. ~'~d'"~"a'~ fl~ t~'~n'"~" ~n"'~x~fl~'~t~'"d~t~L~ ........................................................ ct premises located at 'I~;"~?e~1~'~l'"~V~ ................................................................................... ............................................................. ~'~'i~'~"'~';"ff; ................................................................ pursuant to application dated ....................... il~l'~1~'t; ....... ~'8 ............... 191~2..., and approved by the Building Inspector Fee $ "~'*vO0 ............ F~M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am,ned ....... Approved ........................................ , 19 ........ Permit No .......... Disapproved a/c ........ ............. ........................... (Building Inspecttr) Application No.../...~****~...~ ......... APPLICATION FOR BUILDING PERMIT Dat ........... ........... , INSTRUCTIONS o. This application must be completely fi~ed 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 applica- tion. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approvat 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 building sha~l 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 MA,DE to the Building Deportment for the issuance of a Building Permit pursuan¢ 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations, .............. ...... ............... (Signature of applicant, or" ~-r~me, if a: corporation) .... ~'Addr~ss of applicant) State whether oppficont is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~.,¢,: ,"~*C~. ' ' * Name of owner of premises .......... ~~.. ................................................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be dofle. Map No.: .... ;~ ................................. Lot .No.: ...................... Street and Number ....... /~~.~..Z.~..~ .~...~. ~.~.-~¢.~..~....~..:..~..''/ ........ .~.~~.., ..~..-. ~..~.,. // ~ ~ .Municipality ~ 2. State existing use and occupancy oF premises and intended use and occupancy of proposed construction. a. Existing use and occupancy .......... .~,,Ac'),/, .~'/.C~..'./~.~'.T~.,...,.~.~,~'.,~.',/.,~.,.~,',,-~.C,.',~.-. ................................................. b. intended use and occupancy ............... ...-~..~.~.~. ............................................................................................. 3. Nature of work (check which applicable): New Building .................... Addition .................. Alteration .................. Repair .................. Remova! ........;~... Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ............ ~, .¢~....%..!! ............................ Fee ...................................................................... (to be paid on filing this application) ,5. If dwelling, number of dwelling units ............ J ... ................. Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupo,ncy, specjf, z,nature .and extent of each type of use .................................... .... I?' / ' ) 7. D.mens,ons of/ex.sting structures, if any: Front ............................ Rear ..~...Z ................. Depth .....~.~..~.. .................. Height .../.~.. ........... Number of Stories / Dimensions~s~me st~cture w th o t~e~at o~'"~"~ ~'~'r~'"'~';~'f ........ '~Y .................. ~;~'; ........ ~'~'~ ............. Depth ...................... Heght /.~.. Number of S~'i'~ ....... 7 ............................................. 8. Dimensionsof~tntrene~';'onstruct~';';~';~' 12~i,~. Rear ...... ?'.",~..'.'.~.'.'.'. ............ Height ...... ~.. .................... Number of Stories ..... / ....................... / 9. Size of lot: Front ....... ~--~ ........... ~ ..... Rear ...... ~ ..................Depth .............................. ~ , 10. Date of Purchase ............/.~..,.~....~m.. .............................. N~q~_~/~'n~ O¢,¢~exr,,'~'~..,..~...~... 1 ~. Zone ar use district in which premises are situated, ,;,.j~~....,.c~'~r¢~'.. ................................................ 12. Does proposed construct on v o ate, any zoning .law, etd nance or renu at nn? ...... ~ ......................................... 13. Name of Owner of prom.sas ..... Address. Phone No..~.~..,..~..-..~.~r/ Name of Architect .......... .~7,;~._-_~. ........................... Address ................................................ Phone No ................... Name of Contractor ....;;,,~¢~...~. .......................... Address :...~-~¢¢~. ............................ Phone No~'~....~...-~-.'~..¢. ~/ PLOT DIAG~,A~M Locate clearly and distinctly ell buildings, whether existing or proposed, a~d indicate ell 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. / 1 / ¢'7': // STATE OF NEW Y.,~P.~/Z~'. ) ,. ,. , couNw OF '/ ........................ ~ .........~?....' ........... being du'y sworn deposes and says that he is the applicant (Name of individual signin/~ pi_ica.fiend) 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 o.nd belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ / ' ........... ~ ..... day pf ....... ~ ............ , 19..~..... Notary Public .,~/~ii~C~a'tt~ ........ ~~'~'~~~ .................