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HomeMy WebLinkAbout2249-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. 'Z..'1'8¥0 ............ Date .............................. .~y.....[,~,, ......... , 19~.tt,... THIS CERTIFIES that the building located at ........ ~[.....]~....~l~,e~l, aJ'~..Bl.~'.(] Street Map No ...... ~ ......... Block No .......... ~ ...... Lot No...~ ............ S~'O..'~,~O,.~d.t...~[,.~., ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................... ~Jo.~.el~be~'. ....... ~ 19.~,.~.. pursuant to which Building Permit No ..... -,02.~ doted ............................ ~'B%-.....~.9. ........ , 19..1~.~., was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ .... P~.i~a~e.. one...t'am.i ~.i~'...(one.. k.i- ~:-e hell.).... ¢1 we .'t .1. f~§ ........................................................ The certificate is issued to ...~.~.~.~.al~..~'~/&~l. ............. iowl~ne~r,~i~¥~.¥..~.~¥i .............................. of the aforesaid building. FOl~I NO. ~ ?OWN O~ $OUT~OL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BJ~ K~PT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N. 2249 z Permission is hereby granted to: P~It al~.. Iioae~.... ~/i~.. tA t.t t~--ll~ ............... ........... !~t;.....~ ..................................................... ........... 15.a//~t.~,~..lJl~ ............................. , ......... to ... t~all~l., aa.. ad~ ti. aa.. eri.. ea.-.e~ ~.t,i ~t~" ~e3~ .14=r~ .................................... i ................. at premises located at ..... RJ.t!L...lfi~el3~ll~..ltlL'~'~..~..Ope4Bhee..Av.r..,.-!Je~A~3~t~ ............ : ..... pursuant to application dated ........................... J~OVeal1:~.....[~ ..... 19~,~/.., and approved by the Building Inspector NOT]~i~ This addlt;lon is not i;o have a seeon~l ki~i3hert in t, he ~welling Fee $...5. ................ .......................... aaiiaiaa"ia; aax;" f ...... ' ............ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. Approved ........................................ , 19 ........ Permit No ............ ~ .................... Disapproved a/c ..... ~~ APPLICATION FOR BUiLDiNG PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink anti,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 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 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 shall 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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. ' (~ignoture of applicant, or nome, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ........ ....................................................................................................................... Name of owner of premises ...~..L~/,..~..~Z... ....... ..~..~..q..t~...~ ..................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number .~./ff/ Municipality ' ' ................... 2. State existing use and occupancy of premises and intencled use and occupancy of proposed construction: a. Existing use and occupancy / ~.~.f~Y ~61~f . b. Intended use and occupancy .................................................... ~i. ...................................................................... 3. Nature of work (check which applicable): New Building .................. Addition ...../~. ........ Alteration ........... RePair ..... ~ ........... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ...J.~.~...~..~..o.....T ................................... Fee ..................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... I .................... Number of dwelling units on each floor ..... /. ................. If garage, number of cars .L../~JT.~.]..s. zl..~...~.....TW...L....~,...~ ........ :.,.~..~.~.~.. ....... .~ .................................... 6. if business, commercial or mixed occupancy/, speci fy nature and extent of each type of use ...:'. ....................... 7. D~mens~ons of ex~shng structures, ~f an~'/Frbnt.....~J-~t ................. Rear ...'c/r..~. ................. Depth ...~./.. ................ · T . /1. ' t gh ......~..¢~.......~. ...... Number of Stones ..../~....././.T~ ............................................................... ,~dh,~a ............... He t Dimensions of same structure with alterations or additions: Front ...:......7....~...~..O...~./. ...... Rear ?'.~. 1' Depth ...~......-. ............... Height ..~¢....O.......~...~..'. .......... Number of Stories ....l...~...~:'.. .......................... - .,, ,, . .... ..... 8. Dimensions of entire new construction: Front....~...i...~..~. .............. Rear ......................... Depth Height ....Z..'~.....~....T-.'. ....... Number of Stories ........ J. ........................ 9. Size of lot: Front ..j..~...c~...¢..~. ............. Rear .'..--~'.. ....... L~..O..,..~.-~'... Depth ....'~....../.~..I. ...................... 10. Date of Purchase .t~.~.~.. ...... /..O..~..../..~....~....*~.. ............. Name of Former Owner ~.~.q..~.~.~..?...S. ...... ./~..~..o...?....6'~...~.. 11. Zone or use district in which premises are situated ............................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulationP ............................ 13. Name of Owner of premises ~!.~Z//:~.....~..9...~..~..~.......Address/.~..~.'./..~.....j/.(z.~.~.~.,...~.~..~..~../lP~one No.~...~..~.m~ Name of Architect~.~../~....~......~..:.C¢)..~...~..~. ............. Address ...~./~.,D/..~.....'.~..I...~.~....~'.L.~.,. Phone No. Name of Contractor .~./J-Z..~..~..Z.'~..~ .~e......./....44.~.....Address ../~..//~Z.~Cf..~.L.v~..~..,./~..L~..:... Phone No.~..~.~..'.~.oz PLOT DIAGRAM Locate clearly and distinctly alt buildings, whether existing or proposed, and indicate all set-back dimensions fi 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 y,f~YRl(~ /~ ) ~ ~ COUNTY.OF .~.) ~'3' ................. i,:.(~.~..~:: ...... '.:.:......:..'..../.:'being dul~ sworn, depose~ and says that he is the opplic, (bAFbme of individual signi_ ng. appli_~a!~,~o)/~. ,'--/-- ,~- I above nar~ed. He is the .......... ~..~... ~,..,...-..... ........................................................................ J .... (~/ // (Contractor, agent, corporate officer, etc.) J of said owner or owners, and is duly authorized to perform or have pi~rformed the said work and to make and ~ile this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in th~tJ~bZ~/.rl~,'.e~.~ffo, rth in the .application~ filed therewith. J Sworn to before e th s ,, , ............. .,.? ..... ........ Notary Public, ~~~,.. ,,~?u,~t~'. ~//- (Signature of applicant')' ........................ 1 ....