HomeMy WebLinkAbout1890-zTOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. '~-'~'2.~ ............... Date .................... Nevem]~e:v.....~..~. ...... , 1962...
THIS CERTIFIES that the building located at ..... O0~r.;~ood...~.~&~. ................................... Street
M 1~esland
ap i'~o ....................... Block No .....~ ...........Lot No ..... ~,~, .......~.ot~ho.~.tl...N.~.~., ...............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.............................. ~e.~ot~emt~)er.....~.,'3...., 19.62.. pursuant to which Building Permit No.
dated ................................ Se~p'~,'"'"2~, 19..~p., 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 ........
........ p~ Aya.~ .....omc...~.~a~ t.y., ~we l&~.r~ ....................................................................................
The certificate is issued to ..... Henr¥...~..He.ten..Whi.~ .......... {~rae~..: ....... ..-.. ............................
~owner, lessee or tenant)
of the aforesaid building.
Buildirig Inspector
FOEM 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.o 1890 z
Permission is hereby granted to:
Don a ld" F~'~I ~'~ I '61~'"" ~C" '~'fi~"~" g~ l'~'fi' ' ~'J[ te
....... Bi~t~61i~ .....................................................
to "l~u~'~'d'"an" add~tl'on"'D~" ~m'"~l'~ ~ig "~'~ Ilt~ ......................................................
at premises located at "OJ~K~i'6bi~'.']~'6jJ.~' .......... '~J~/~'~.~fi~l')' ............................................................
...................................................... · O~]~l'd ............................................................................... ~ ......
pursuant to application dated ......................... .~.~.~;.....~ ....... t9.~..., and approved by the
Building Inspector
Fee $~00 ..............
Building Inspector '(
FO~M NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined '
Approved ........................... ~..k. ......... , 19...I.:...Permit No...~./.,.~.~...~;..? ......
Disapproved a/c .... ~...~,.~,.~,~._.._... ~_._. _ .. _ ._........., ................
....... ....... ......................
(Building Inspector) [
APPLICATION FOR ;~UILDING PERMIT
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 p remises, 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 part of this applica-
tion.
c. The work covered by this app]icati6n may not be commenced before issuance of Building Permit.
d. Upon opprovat 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 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 Deportment 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, alterations, or for removal or demolition, os herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
D. On~ld t~..e.d eri.ck .....................................................
(Signature of applicant, or name, if a corporation)
............ S.o~thald .................................................................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, p]umber or builder.
................................................. C~n.t~.a~r. ......................................................................................................................
Name of owner of premises .....H~llr..~,.~,...H~.rt...~h.izJ;~ .................................................................................................
If applicant is a corporate, signoi'ure of duly authorized officer.
(Name and title of corporate officer)
1, Location of land on which proposed work will be done. Mop No.: ....I.~.~.~.~P...c! ................... Lot No.: ...... .x..~...~. .........
Street and Number Oakwood Roadt Southold~ N.Y.
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction.
a. Existing use and occupancy ......... c],Yze.].li~ ....................................................................................................
" with an ad ition
b. Intended use and occupancy ..........................................................................................................................
3. Nature of work (check which applicable): New Building .................... Addition .~X~ ......... Alteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..................
4. Estimated Cost ................ .~.Q..O....P.../.'.M.. ............................ Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units ............C~. ............. Number of dwelling units on each floor ............................
If garage, number of cars ............................................................................................................................................
6. If business, commercial or mixed occupa.ncy, 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 ........... ..1..Ii. ..............
Height .............................. Number of Stories ....q~.~ ....................
9. Size of lot: Front .............................. Rear .................................. Depth ..............................
10. Date of Purchase .......................................................... Na,ma of Former Owner ..........
Il. Zone or use district in which premises are situated, u.tu
12. Does proposed construction viol.ate any zoning ]ow, ordinance or regulation? ............ ~,Q .............................................
13. Name of Owner of premises }~.e~XLY....~..~.t..~ ........ Address ................................................ Phone No ...................
Name of Architect .................................................... Address ................................................ Phone No ...................
Name of Contractor ..D.o. rt.,...~'.~.~.flx'.$.~ .............. Address ................................................ Phone No ..................
PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing or proposed, c~nd 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 corr lot.
STATE OF NEW YORK, )
COUNTY OF ...... ~.~.£z~.~11¢.....) S.S.
........................ D.~r~aZ~l Fr..e~e:r.:i.e~: ........... being duly sworn, deposes and says that he is the applicant
(Name of individual signing application) ......... '
above named. Lie is the ............. .~or~ts~ra¢i, oz'
(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 ali 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 forth in the application filed therewith.
Sworn to before me this
.2...2. day of ..S. ep,.t.~mbe.r. ........ , 19 6.~. ~_ ~ ,~ ~ / ~, . ~
.......... ............. . Y...
~ [%ta~y Public, State o! ~ev: ,c,