The URL can be used to link to this page

Home My WebLink About2221-zFOI~M NO. 4 TOWN OF SOUTHO~.D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATe OF OCCUPANCY THIS CERTIFIES that the building located at ...... ~/~.....t~111~:~1,..,~1t.~. ........................... Street Map No .......;~ ........... Block No ........ ~ .......... Lot No..Y,~X~ ............. ~,ll.~):l~ .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................................... )e.t....16 ............. , 196.~... pursuant to which Building Permit No. 22~..~ .... dated .......................... .0.C.~.~.~.f~'.....,~.~..., 19..~.3..., was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ...l~.~.vat~.....tw~..~ant~....c~w~ng ............................................................................................ The certificate is issued to ...~...~1¢~.~1 ............... (}~1~. .............................................................. (owner, lessee or tenant) of the aforesaid building. FOI~M NO. ~ TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMI? (THIS I~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2221, Z Permission is hereby granted to: ~p~ro Zu~I~oh Hummei Ave $outhold .,~z.~.. ~...~.~.t.~,t. ~.L?.~...~..~..x.~s.~.g....~.~5~..t..~.s. ....................................................... at premises located at ...i.~.~I~,..,...~.~.~....,A.,V,..~. ..................................................................................... ~outholcl ~ N, ~f. pursuant to application dated ............................ 0,?~.0.~?..I',...,.,1.~. .......... 19.,6.~..:., and approved 'By the Building Inspector .e $..~.:..0...0. ............ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ................................. Application No ............................. APPLICATION FOR BUILDING 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 premises, relationship to adjoining premises or public s}reets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Up, on approval of this application, the Building Inspector will issue a 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 sha)l 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 ""Bu[idlng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ]~egulations, for the construction of building% additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ali applicable laws, ordinances and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, ~plectrician, plumber or builder. OWl'lel" ame of owner of ........................................................................ ............................................. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) . I. Location of land on which proposed work w~ll be done. Map No ........................... /. .............. Lot No: .................... Street and Number N/,, Hummel Avo~. Sou~hold i \ Municipality , , prqposed construction: 2. State existing use and occupancy of premises and intended use and occupan~zy,'of a. Existing use end anc' dwe ~ ] ~ " W/ Addition /' b. Intended and occupancy 3. Nature of work (check which applicable): New Building .................. Addition ........ ~ Alteration ............. Relb,,bir .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost .~..~00..~/~ .................................... Fee .......... ~ ........................ ~ ................................................ (to be paid on iling this application) 5. If dwelling, number of dwelling units ""~/O ................... Number of dwelling units on each floor ........................ If garage, number of cars ......................................................................................................................................... 6. If l~usiness, commercial or mixed occupancy, 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 ................~1, ....... Depth ...J~ .................. Height ............................Number of Stories ...... '~W(~ .................... 9. Sizelot/at: Front ................................ Rear ............................ Depth ........................................ 10. Dat~ of Purchase ........................................................Name of Former Owner .................................................... 11. Zone or use district in which premises are situated.....~l~l...~.~.l~,l~ ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ................. ~t~. ........................... 13. Name of Owner of premises .l~];~.'t.~..~,~],,~O~.....Address ..... ~l.t~l:t~O~, ................... Phone No ................. Narhe of Architect ............................... '...~. ................... Address ............................................ Phone No ................. Name of Contractor .............................. .~ ................... Address ............................................ Phone No ................. PLOT DIAGRA,M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr~ property lines. Give street and block numbers or description according to deed, and show street names and indic whether interior or corner lot. STATE OF NEW YORK, ) COUNTY OF ..1~1,~',,~.].l~, ........ ) S.S. sworn, deposes and says tt~at he is the appli~ .................. r.... ·. ~.~'~ ~'~. · ,~U(~.]. ~.~. ........................................ being duly (Name of individual signing application) above nam'ed. He is the ............... O14~e~ ..... .~u,'~..~.~.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 f this application; that all statements contained in f~is application ore true to the best of his knowledge and bali and that the work will be performed in the'q~b~rTer~e~[l~forth in the application filed therewith. Sworn to bi~fore me this ,,,, ,,, i,u,lrc, ~;[c~te of New York .................. ~ .y)' ........ ~'". '~u~'~' ................. '' '~D .... ..~'~',,~'~t Nato y b', ,~...h.:.: ............. : .......... ,......-.' .......... .,,~2~,,,,,~ff¢/~//,/~¢ ,,7 ( 'g ~'~f applicant)