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HomeMy WebLinkAbout2505-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the bu~ldmg located at ..~6/~...~a~:~&o~..P, Oa~ ....................... Street ~a~l:, wooer Es~ ~ , ap i~o ...................... OiOCK NO ...................... tot' NO. "6'~, ........ conforms substantially to the Application for Buildmg Permit heretofore filed ~n thru office dated .................................... A1/~.US.~....22. , 19.(:~i.... pursuant to which Building Permit No .... 2.~:(~:..Z dated ................................ A~ ........ 2,~.., 19.~+ , was issued, and conforms to all of the requirements of the applicable prowszons of the law. The occupancy for which this certificate is issued is ........ . Px:.t.v.~.te.. oD, e ...f. amil.y.., d.~ll ~ng .......................................................................................... The certificate is ,ssued to ..]lt. ai,.l~¥...F'/.ie.~hma~ ....................... 6)wz~ ...................................... (owner, lessee or tenant) of the aforesaid building. H.D.Approval Jan. I~, 1965 by R.Villa TO~,VFI OF SOUTHOLD BUILDIFIG DEPARTMENT TOWFI CLERK'S OFFICE SOUTHOLD, FI. Y. BUILDING PERMIT (THIS PERMIT MUST BE K~PT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) :/22Z121:;':i' ....... ~'"~ .......... '~~'"~ ............................................. ~ '-'7~ ....... .~ .............. "a'"~'~ ................... ~ ..... ~.:__o. ............................. ........................................ ~..~..~....'h....LL~ ........................... '---'"-~ L........~'-~~ ............. Building Inspector Fee $.L..~..;.~ and approved by the s-9 SUFFOLK COUNTY DEPARTMENT OF HEALTH Building Permit TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at - ~GiVe deed on) ' have been inspected by this Department and found to be satisfactory. District Engineer FORM NO.: TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................... ................................. APPLICATION FOR BUILDING PERMIT Da,e ................... , ..... 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 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 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 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, ordinonce~s-qnd regulations. ~ ~ (Signa, b~,re of appli,cant, or nome, if a corporation) State whether applicant is owner, lessee, agent, arc. bitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................................................................................. :. ................ 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 ......... Lot No: ..~ ............... Street and Number ..~~..../~J~c~.....'~.. .................................................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exist ng use and occupanc'y ~ ~ b. Intended use and occupanc~ ....... .//_~...~.....(~ ............... ~..~ ........................................ 3. Nature of work (check which applicable): New Building ..... ~ ......... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ............. ~.....~,/.~..~-~.. ...................... Fee ............ ./..~1.....~.....~... ............................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ~ ....... Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify natureand 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 ...~....~'.. .................. Height ....... ~'~..0..[ ........... Number of Stories ........ ~ ........... 9. Size of lot: Front ....... ~.~.~ ............... Rear ..... J.,,~.~. ............. Depth .../....~..~ ......................... 10. Date of Purchase ..... '..~...~,,..~ ......................... Name of Former Owner ~(.~..~).~.~....~. ............. Il I -- r~,, ~ ,,,~ ""-/h- ~ 0 1 1. Zone or use district Tff which premises are situated.....lfJ/~~ ......................................................... ... 12. Does proposed construct on voate any zonng aw, ordnance or reguatJon? ..... ...~._...-. ...................................... 13. Name of Owner of premises .. dress ...I..)?...". ., ..... Phone No ..................... Name of Architect .................................................... Address ............................................ Phone No ..................... Name of Contractor ~~[ ........... Address ...~~....~..:.~...:. Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and 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 corner lot. STATE OF NEW YORK, ) c COUNTY/~/'~ I~T /(,) [~) _ l ........... ~....(..~.~d[,.~,, ............................ being duly sworn, deposes and says that he is the applicant (Name of indivTdual signing application) .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 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 pe~l~lH~e mg~ner set forth in the application filed therewith. Sworn to before me thi~0T~R¥ pUBLiC, State .......... Notary b 'c~~. Count~ ...... '~'r~'~'~i'6';;' '; ~' ' ~l~'i;~'~'~ ~')' .............................