HomeMy WebLinkAbout2040-zFOR~I NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No...Z~16.~/.~. .............. Date ......................... ~.,U~.U,~.~....22 ....... , 19...6~
THIS CERTIFIES that the building located at .N/(~.....~.,th...~Oac] .................................Street
Map No. ~ .............. Block No .......~ ........ Lot No. ~ .............. (j~ee~t~o~'.t ........................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
................................... ~*~.t3~ ......... ~0...., 19.~.. pursuant to which Building Permit No.
dated ............................ ~T~'.:L.I.....~.2......, 19L~..., 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 ........
........... ~.ri~at~...oz~e.. t~amil~....d~e.l,li~ .....................................................................................
The certificate is issued to ...JGJi~..~ee-~; .............. ; ............ ; ........... ~q~¢~. ...............................
~owner, lessee or reno,hr)
of the aforesaid building.
H.D. approval Aug,
21, '63
By P. Fmjkowski
................ ........ ...................
Building Inspector l'
FO]~ NO, ~
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)
2040 Z
Permission is hereby granted to:
O .I/. 8mi .th.. ~.. B. on L...A~..C...~ohn. SehLacht ..........
................. ~.o. utho~d ............................................
to ..]tulld..new..~na..z~amil~...ctwelll~ ............................................ ~ .......................................
at premises located at ....~.S.....J~O~'.t,~,~OIJ~ .................. ~ ..................................................................
............................................... ',~enpo~.t ...........................................................................................
pursuant to application dated ..................... ,lJ~ 1 ....... ~.0 ................... 19.(~.., and approved by the
Building Inspector
Fee $.. ],O~.l~. .........
TOWN OF SOUTHOLD
'BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
..............
.................
Application No.....~.~(.~.~ ....
APPLICATION FOR BUILDING PERMIT
Date
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 premises, 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 port of this applica-
tion.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon a,pprovol 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 part for any purpose whatever until a Certificate of Occupancy
shall hove been granted by the Building Inspector.
APPLICATION IS HEREBY MA~DE to the Building Deportment for the'is~i~nce of o Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk CounL~; New York, and other applicable Laws, Ordinances or
Regulations for the construction oS buildings, additions, o~terati6ns, or for removal or demolition, as herein described.
The applicant agrees to comply with oll applicable lows, ordinances o~d regulations.
· (Signature of applicant, or name/ it a corporation)
State wh~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.... ....... ........................................................ ...............................................................
If applicant is o corporate, signature ~f duly outh, prized 9,fficer.
(Name and title of corporate officer)
Location of land on which proposed work will be done. Mop.No.: ........ ~'. .................... Lot No.: ...~ .........
Street and Number .......................................... ~ ....~.~. ...........................
,~unicipality
State existing use and occupancy of pre~d intended use and occupancy of proposed construction.
b Intended use and occupancy ........ ~~...<7¢f~....c~- .~r~.... ............................................
3. Nature of work (check which applicable): New Building ..... ~..,......~Addition ................. ~A, Jterotio, p ..................
Repair .................. Re~.ova!,,~ ~ ,---'- .................. ~D~emolition .................. Other Work (Describe)
Cost.:.,Z .................... Fee , ..........................................................
4.
Est
mated
(to be paid on filin,a this application)
5. If dwelling, number of dwelling units .......... /., ................... Number of dwelling units on each floor ............................
If garage, number of cars ......... ~M..c.~..../. ......................
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 same structure with alterations or additions: Front ................................ Rear ................................
Depth ................................ Height ................................ Number of Stories ................................
8. Dimensions of entire new construction: Front ....... ...~...~...L.R.~. ..... Rear ........ ..'~'....G~.....~..~.. ..... Depth ...... ..-~....~..~...~.~: .......
Height ....... ,g...~.. ............... Number of Stories ........ ~...'..: ...............
9. Size of lot: Front .../....~...~.../, ............... Rear ...../....~......':~....~. ............ Depth .~..,./...~'......~.......c~..,~
10, Date of Purchase ,~C~?,~..~,,~. ..... .~,.,~,,~. ....... Na,m~ of Former Owner~ ....... ,,~.,~,,,,~,, ........ ~,,,~,,,,~,,,,,~,, ......
] 1. Zone or use district in which premises ore situated ........ ~,~,,~,,,> ...............................................................................
12. Does proposed construction violate any_ zen ng law etd nonce or reau ationP /"V ~
13. Name of Owner of premises'~.~../X/.Z~......'~..~..~...~'....~'..c...~/~. Addres~.~'...~....~..~..~.~ .~ ~'./'~i,7.~.~/~iSh'~l~o
Name of Architect ~ ~ Address ................................................ Phone No.
Name of Controctor~..9..,.~Lr~....'~...../~..'./..~...~..?..~...~.../~...~Address ................................................ Phone No.J'...e....~_.%.~..~'.~-~'
PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from
whetherPr°perty interiorlines' GiVeor cornerStreet lot.and block nu,mbers or descripyano~/z/~/acc°J;d~f~g'-t~-- deed, and show street names and indicate
Ioo
STATE OF NEW '~OR, K,, ~ ,~ ) ~ ~
COUNTY OF .~..~....) 3.5.. ,
(Name of individual signing application)
~bove named. He s the .......... ~~z~
................. .............................
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 and belief; and
that the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this ~ - , ~ ~ ~
.............. ................ ........... ,
~otory Public ..~..~O~~~nty~'"~ .................. ~'i~;'~[;';~";?' .............................