HomeMy WebLinkAbout2258-zFOB2~ NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. 'Z"'2'~G2 ............ Date .......... Febvua.~Z/'. ......... 2 ............... , 19~5...
THIS CERTIFIES that the building located ats~lltlttl~...j)~.~e.i...M~.~.~J~ ................ Street
M ,Calif, I~;[dd Block No. Lot No ...... ~D ..........................................................
ap mo. j~}jj~.~,~l~ ....................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
............. J~O~'~lll~e~"~ .......................... , 10.~.~.. pursuant to which Building Permit No..:~..~
dated ...~O.~elt~C..~.~...[~l~,~ ........... , 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 ........
...................................... ..............................................................................
The certificate is issued to .......... ~'.~...J-[~*'~l~'~ .....................................................................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector[
TOWN OF $OUTHOLD
BUILDING ,DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 2258 Z Date ......................... J~.tgmJ:Hg~...,.~. ...... , 19.....~
Permission is hereby granted to:
Thomas ~.:L~he~.....~,f.~....~,l~ou~ .............................
............ ~t~ .............................................
to .. ~ ..~..ad~on..~..~...e~ ~t~..~wel~.~ .......................................................
at premises located at ....~..~...C..~..$~,). ......... ~..~..~e~ .................................
.................. ~ ..................... ~..~ ........ ~¢~ ............................................................
pursuant to.application dated ....... ~ ..................... ~0~....2~ .............. , 19..~., and approved by the
Building Inspector
Fee $...~..(X) ............
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTIvt ENT
TOWN CLERK'S OFFICE
.SOUTHOLD, N. Y.
proved ........................................ , ]9 ........ Permit No .....
Disapproved a/c ~/~ ~T~~
(Buildin~spector)
APPLICATION FOR BUILDING PERMIT
Date ................................ November..~ 19...6~ ........
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 Iot'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 application.
c. The work covered by this applicatibn 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 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 or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
....... Thomas..l~lsher. ..........................................................
(Signature of applicant, or name, if a corporation)
.............. ~a.ttltuck .............................................................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Contractor
Name of owner of premises .......... ~.....~'~a,011~. .....................................................................................................................
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: ..... (~a.l~t..~iclcl,...l~.t ....... Lot No: ..... ~.9 ...........
Street and Number ..~um~i.t..])r,'~It'e.! ...........ls~,tZStl,lcl~; ..........................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy oF proposed construction:
a. Existing use and occupancy ...... ]DW~I.,~,iI:t,~ .........................................................................................
b. Intended use and occupancy ............ !! .............~.i.ttl,..all..~dd:Ltio1% ...............................................................
3. Nature of work (check which applicable): New Building .................. Addition.............~ ..... Alteration
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................
4. Estimated Cost ............................................................ tee
(to be paid on filing this application)
one
5. If dwelling, number of dwelling units .............................. r~umt~er or dwelling units on each floor
If garage, number of cars
6. If business, 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 some structure with alterations ar additions: Front ................................ Rear
Depth ............................ Height ................................ Number of Stories ........................................
8. D mens OhS of ent re new construction' Front ~1' Rear
Height ............................ Number of Stories ..................................
9. Si~e Of lot: Front ................................ Rear ............................ Depth ........................................
10. Date of Pgrchase ........................................................ Name of Former Owner
11. Zone or use district in which premises are situated
.12. Dads proposed construction violate any zoning law, ordinance or regulation? no
13. Name of Owner of premises ....... ..~......~..?...l~....~. ............. Address ............................................ Phone No.
Name of Architect ...................................................... Address ............................................ Phone No.
Name of Contractor ...~...{.~...~.~..?..~.-- -' -- ............................ Address l~ttttUok Phone No.
PLOT DIAGRAM
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 NE~.¥~J~,. )
COUNTY' OF .~..~.~..'F.Y.~.~.. ......... ) S.S.
................................................................................................. being duly sworn, deposes and says that he is the
(Name of individual signing application)
aontraot
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
t contame ~Hf~,sB I,caton are true to the best of hs knowled e
tbs ~ licaton' that al statemens ' ~ ' ~D' ' ' a and bel
and that the work wH be performed ~n t~ ~ ~e}~ ~.r~n the apphcat~on filed therewith.
Sworn to elate me ,.,~ ~G;0,~e'r ' ,~
Notary ................ Pdblic, .' ........ :;~:.~ ~(~<~.....:~.r~:~:C'.<'~.~" ......... ~;~:"'"'L]". ................ ~'" ~ ........ ' ~~ .................................... :gnat' ......... :f bl,cant) ~