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HomeMy WebLinkAbout2555-zNO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ................. ,~..,?,~,40 Date ......................... ~J.]...~.2. ........... , 19...IS5 THIS CERTIFIES that the building located at~O~l~O~..~,~..gJll...JliE.~l,~'&~,~..~z, Oi~[. Street Map No~a.~.?~jO~t.?.. Block No ..... ~Jl:J~(~l~' Lot No ....... .~ ................................................ conforms substanhalJy to the Apphcahon for Building Permit heretofore filed in this office dated ...................................... O~.,O~l~...],5...., 19.~.4.. pursuant to which Buzlding Permmt No..,~5,~.~... dated ............................ ~1~.~Q]3.~3~...~.~...., 19...~.~., was msued, and conforms to all of the requmrements of the apphcable provisions of the law. The occupancy for which th~s cerhf~cate is issued ~s ........ ............................ D~e.. ~.~m~Z~.. c~elltncJ ................................................................................... The certi~icote ~s issued to ....... ~l'~..,~.~t~ ................................................................................ (owner, lessee or tenoot) of the aforesaid building FOR~ NO. 2 TOWN OF $OUTHOLD 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 2555 Z Date ................................ I~tClb~lL...~l,~., 19..~.~.. Permission is hereby gronted tot .......... I~o.~tho~ .................................................. to llu~ld,..new...ome, l~.amX..~..~wett..~. ...................................................................................... at premises located at ..S/.~t~..R~j;~II,~ .Le~e ....................................................................... ......................................... ..... g..L ..................................................................................... pursuant to application doted ........................ l)e.t01:~.....1.~ ..........19~,.., and approved by the Budding Inspector Fee $..~.,0..?., ..0~.. ........... SUFFOLK COUNTY DEPARTMENT OF HEALTH Date TO WHOM IT MAY CONCERN: Building Permit No. The sewage disposal facilities for a structure located at ' / (Give 'deed location) - ' ~/--o /~-' / ~.. , ...... have been inspected by this Department and found to be satisfactory. District Engineer 150¢~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ ~.,.(...~.. ........ , 19.~....~. Approved ~ I9 ........ Perm,t No ~'~ ~"~"'~'~-' ................. ...... ...................... (Building Inspector)( Application No. APPLICATION FOR BUILDING PERMIT~ INSTRUCTIONS a. This application must be completely filled in by typewriter 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 g~vmg a detoded description of layout of property must be drawn on the diagram which is part of this applicc tion. c. The work covered by th~s appl~cohon n-~ay 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. Suc permit shall be kept on the premises available for inspechon throughout the progress of the work. e No butldtng shall be occupied or used in whole or ~n port for any purpose whatever until a Certificate of Occupon[ shall hove been granted by the. Building Inspector APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances , Regulahons for the construchon of buddings, addmons, alterations, or for removal or demolition, os herein describe[ The apphcant agrees to comply with all apphcable laws, ordinances and regulations. ...... (S~gnature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Name of owner of premises ...... ~"'~'~l ...... "¢~"~/~'/'~" ............................................................................................. If applicant ~s a corporate, signature of duly authorized officer. ..... ...... .................. (Nome and title of corporate officer) 1. Location of land on which proposed work w. II be done Map No.:~..~.~.C.~..~.../..~.......~......~..~. t~//~Lot No.: Street and Number .... /~.,~...~?.....,,~.J~.~. ..... ~......~...~.../ N.,,~'.~ ..... .~.l~r)l.~... ...... ~-- ..... ..~.~J.l,(.t~...~t~.~ .............. Mumcipahty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Ex,sting use and occupancy ............................................................................................................................ b Intended use and occupancy ...... ~J~/~'-~.~... ........................................................................................ 3 Nature of work (check which applicable). New Building ........ /~........ Addition ............... Alteration ................. P, epa~r ................ Remova! ............... Demoht~on ............. Other Work (Describe) .................. 4. Estimated Cost .... ..'~.~...~..¢:~i~.o....~... ............................ Fee .... ..~.. ~.O o...~.. .............................................................. (to be pa~d on fihng th~s apphcation) 5 If dwelhng, number of dwelling umts ........ /. ............... Number of dwelhng umts on each floor .... .~. ................ If garage, number of cars ...~-~. ~ ........... ~,f/~.~---~ ........ ~.~.~ ................................................................ 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use .................................. 7 Dimensions of existing structures, ~f any Front ................... Rear .......................... Depth ............................. Height ............................ Number of Stones ............................................................................................................ D~mens~ons of same structure w~th alterations or additions Front ............................ Rear ............................... Depth ............................... Height ....................... Number of Stones ................................ 8 Dimensions of entire new construction: Front ........ ~.~. ............... Rear..... ...... ~. .................. ~ Depth ...... '~.. ................. Height ........~.. ................ Number of Stor~es ....... j.... 9. S~ze of lot: Front ....... ~.~..~. ............. Rear ..... ~.~.~./ .............. Depth ~f:~.~=-L~........~.O 10 Date of Purchase ........................................................ Name of Former Owner .... ~.~.'...~X,~/;? .............................. 11. Zone or use d~strict m which premises are situated .... ~.~..~-'~./1~'/'~ ................................................................ 12. Does proposed construction wol.ate any z, onmg law, ordinance or regulat~on~ ...... ~.O.....-~.. ........................................... 13. Name of Owner of premises ..t-/..,.~.t'/cJ.l.~"L ............ Address ...~..~"'.~¢r/~L~....~ ................... Phone No~...~...~..7.~.~., Name of Architect .................................................. Address ................................................ Phone No ................. Name of Contractor ~,o~/~.l'~....~...~/..~¢~r., Address ~..~.~O.~ ...... .t.l~l:.¥. ......... Phone No~..~.~.-~...-..z...¥ ? PLOT DIAGRAM Locate clearly and d~stmctly ali buddings, whether ex~stmg or proposed, and ~nd~cate all set-back d~mensions fror property hnes G~ve street and block numbers or description according to deed, and show street names and ind~cat whether interior or corner lot STATE OF NEW YORK, ) COUNTY OF ........................... ) S.S. ..... ~.~ .~..~..~'~) ....... ~.~::~4,~,~,~,/f//'~. .................. being duly sworn, deposes and says that he ~s the applicon (Name of ind~wdua[ s~gning apphcat~on) above named He ,s the ....... ~.~~ ....................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and file th~ apphcahon, that all statements contained in th~s apphcat~on are true to the best of his knowledge and belief; an. that the work wdl be performed in the manner set forth in the apphcation filed therewith. Sworn to before me this ..... ~ ......... do~ of ...... - _ ..... ......... ........... ....... , ..... ....