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Home My WebLink About2554-zFOP~M NO. 4 TOWN OF SOUTHOI..D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ........ D~E[ass..Ro~([ ............................. Street Map No, --::~E ............. Block No ......~ ........ Lot No .... ~ ..........~[e~t~¥"-JJ~.~, ................... conforms substantially to the Application for Buildmg Permit heretofore filed in this office dated ....................................... ~*~:~e~ ...,~ 19..t~. pursuant to which Building Perrmt No. ~..~"'t~...~. dated ............................. Q~,~.Qb.e,l~...,.[L.~., 19,~.., was ~ssued, and conforrns to all of the requ~rernents of the applicable provisions of the Iow The occupancy for which this cerhficate m issued is ........ ... P,r.l.v.a.te..~z~e.. family.., d,welli, ng ............................................................................................ The certific(~te is issued to .~[Wa~....~Jl~,~.H ......... O~3P.~. ....................................................... (owner, lessee or tenant) of the aforesaid building H.D. Approval April by R. Villa Building Inspector FO~I~ NO. 2 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) N,O 2554 z Date ......................... jJ~t.t, ohez,..... ].l} ........ , 19...(:t~f Permission is hereby granted to: Ton~...Nc~.~....A/C....X~w....l~osh~.~ek ..... ..................... ~rien~ ............................................ to ........ ~i.l~.-:mew..emro.. family.- ~ett..Lu~ .............................................................................. at premises located at ..... ~)~1~. '~-~S-.~ ................................................................................... ...................................................... ~te~t ........................................................................................... pursuant to application dated ......................... ~.~ ....... '~!- ................ 19.~.., and approved by the Building Inspector Fee $..~O,00 .......... SUFFOLK COUNTY DEPARTMENT OF HEALTH mdg. Pe~it No. The sewage disposal facilities for a structure located at . _ ~ed-loca%ion) have been inspected by this Department and found to be satisfactory. District Engineer FORM NO. 1 · Examined .......~..~..~ .......... , 1 ~...~..~ Approved ....................... ~l~TlO~ ~OR 8~l~l~ ~[RMIT I NSTRUC'I'[ONS a. This apphcat~on must be completely filled in by typewnter or in ink and submitted in duplicate to the Buildin Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detai~ed description of layout of propertymust be drawn on the diagram which is part of this applicotio, c. The work covered by th~s application may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Suc 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 Occupan; shaJl have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to tF Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe~ The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signotu~ of opplicant, or name, if a corporation) ....................... ........................ (Address of applicarrft) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde If applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of Jand on which p. roposed work will be done. Map No: ............................................ Lot No: .................. Street and Number ..................... /. ............................. c~ Municipality C/ 2 State ex~stmg use and occupancy of premises and ~ntended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................. b Intended use and occupancy ~:?~-'/'~'J-- ' 3. Nature of work (check which applicable) New Building .................. Add~hon ................. Alteration ................. Repair .................... Removal .................... Demohtion .................... Other Work (Describe) ..................................... 4. Estimated Cost ...LQ.,...~....~....O. ..................................... Fee ......................................................................................... (to be prod on filing th~s application) 5. If dwelling, number of dwelling units ..... ../. .................... Number of dwelling umts 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. D~mens~ons of ex~sting structures, ~f any. Front .......................... Rear .......................... Depth ........................... Height ............................ Number of Stories .............................................................................................................. D~mens~ons of same structure w~th alterations or additions: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of ent,re new construction: Front ..... .~../ ................ Rear .... ~../ .................. Depth ........................... Height ...... /.~..! ............. Number of Stories ...... Z. ................... 9. S,ze of lot' Front ...... ./...b....O...L ......... Rear ...J..~.?....(. ............. Depth ..../'..Z~..~ ................. 10. Date of ........................................................ milt_re ...... ..~ Purchase Name f Former Owner ,.....~... /_) ... 11. Zone or use district ~n which premises are s~tuated ..... ~..: .......................................................................... 12.Does proposed construction violate any zoning law, ordinance or regulation;~ .... ~.~..O7.~ .................................... Name of Owner of prem,ses ...............................___...^ddress .. Phone No ................... Name of Arch,tect .......................... ;..____.....~.....____....Address¢~, ~/~ ~::~7,- - ............................................ Phone No ................... Name of Contractor ....."~..~....Address .................... Phone lx~o ................. ~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions flor property hnes. Give street and block numbers or description according to deed, and show street names and ~ndicat whether interior or corner lot. STATE OF NEW YORK COUNTY OF ...2~8'~/..8?.. ......... S S. ............. ~...d)./~...~. ...... ~..../~./~.,~.~..~. ...................................... being duly sworn, deposes and says that he is the applica, (Name of indmdual sigmng application) above named He is the ............................... .~..~./~,.~',~...A:.,~..,7...,~,,,.~,,. .................................................................................... (Contractor, agent, corporate officer, etc ) of smd owner or owners, and is duly authorized to perform or have performed the said work and to make and th~s application; that all statements contained in this application are true to the best of his knowledge and belie and that the work wdl be performed in the manner set forth in the apphcation filed therewith. Sworn to before me this ........ ........... ...................... , ~_~_..~ ~ / ~,,,~ .............. :_...~.....-~...~.......~x....~~ ~ .................. Notary Pubhc, .f~_-,~f...~.;.~-f~/:~a,...y~-~,~.~.. County ~Signature of applicant)