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HomeMy WebLinkAbout2313-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~t~l~.t,..~,..&..~1.s.t~er...A~ ............. Street Ma~ ...V.~.?..~.....~..a...~..~Block No ........ ~ ....... Lot No..33, ....... ~O.~g~.~,.......~,,~, ................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................... l~.aTI ....... ].6 .........., 10...6..~. pursuant to which Building Permit No. ~.~.~....~... dated ........................ .I~'.~ ....... ~9 ....... , 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 ........ ..... Pm£v.s~te...ol~e..f. amil~...dw~.!ltl~ ........................................................................................... The certificate is issued to .l'Iel:ll~'~...IC~.lll~J~k~..~...~,,t~® .................... (~.e.?...~. ................................. (owner, lessee or tenont) of the aforesaid building. H.D. Approval ~une 30, 196~ by Villa FOE~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TowN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDiN(~ PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AuTtLIoRIZED) 2313 Z Permission is hereby granted to: ............... .~e~o~..~ ................... i..,., .............. to ..... ~a:L~ ..ae~..o~e..,~a~:t~..~e~.3,~ ...................................... . .......................... ......; .......... et premises located at ..... ~,.~..~...33.a...~.~$.~'~"~..~.~~'~ ................................................................ ...... ..................................... ~..e.~..e.,~.~ ..;~.~.~..,~ .~e.~.e~... A.v~ ~ ~...i,.~o.~I~:~ ........ i ............................... pursuant to application dated .......... ,....,, ........ ~G~....~O: .............. i9.~.~.;., and approved' by the Building Inspector Fee $... ~..,..Q.Q. ........ · Building Inspector SUFFOLK COUNTY DEPARTP~t~ OF HEALTH TO ~HOM IT M&Y CONCERN: Date 6/30/64 Building Permit No. 2313Z The sewage disposal facilities for a structure located at ~/~ B.nnett Lane. Southold (Kruoski~ ,,, ' (Give de~d ioca~ion) have been inspected by this Department and found to be satisfactory, District Engineer FO~I NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. Approved ........................................ , 19 ........ Permit 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 Building Inspector. b. PIot plan showing location of lot and of buildings on premises, relationship to adioining premises or public streets or areas, and giving a detailed description of layout of property must be drown 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 part 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. (Sign.ature of applicant, or nome, if o corporation) ............................. State whether applicant is owner, lessee, o9ent, architect, engineer, 9eno, rd contractor, electrician, plumber or builder. . Nome of owner of premises ....~. ........................................................................................ If opplicont is o corporote, signature of duly outhorlzed officer. (Name and title of corporate officer) 1. Location of lend on which proposed work will be done. Map No: ....................................... Lot No: ..~..~. ........... Street and ~NumB~r ............. ::~.: ............ ............................................. ::";; ................. /,.M..~. .{ ............................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exstnguseandoccupancy . f~ ~ ~ 3. Nature of work (check which applicable): New Building ..,~/~ .......... Addition .................. Alteration .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estirpated Cost ...... ............................................. Fee .......... /...~....L.~..X. ......................................................... ~ (to be paid on filing this application) 5. if dwelling, number of dwelling units ............. ~ ................ Number of dwelling units on each floor ......................... If gdrage, 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 .......................................................................................................... Dimgnsions of same structure with alterations or additions: Front ................................ Rear ............................. Dep{h ............................ Height ................................ Number of Stories ........................................ , ! 8. Dimensions of entire new construction: Front ............ ~..~ ............. Rear ...... .~,..~ .............. Depth ....~:.....~... ............ i .Z~ · Height ...... .~...,§...!. ........... Number of Star es..../......~...~... 9. Size of lot: Front ...... /...~...~ ................ Rear ...... ./..,3...$~.. ........... Depth ....... /...(~....6. ...................... ' 10. Date of Purchase ....... /...~....~...,,~ ................................ Name of Former Owner ,~...Crm~....~......~ ......... 11. Zon~ or use district in which premises are situated.....J~,,~,~ ~ ~ .............................. Z\'D oei ........ proposed construction ~,io ate any zoning law, ordinance or regulation? .......~3~.,....~ ..................................... 13. Na~e of Owner of premises .J~..J..~.~..:....,Address ...~...~f./../.....~...:.~..! ...... Phone No .................. Nome of Architect ......... ~ ....................................... Address ............................................ Phone No .................. Name of Contractor ...~_~,~...~..w.: ............... Address ..~.~...~,l...~l.:y.... Phone PLOT DIAGRAM Locate clearly and distinctly ell buildings, whether existing or proposed, and indicate all set-back dimensions fro properly lin~es. Give street and block numbers or description according to deed, and show street names and indic¢ whether interior or corner lot. I 3¥/ ST, \T~: OF iNEW~Y .~,I~//, ,, z~ 'S S COLJNT¥ OF ...~~ ' ' duly sworn, deposes and says that he is the opplicol (Nome of individual signing application) [~ ,,~,._ above named. He is the .................................................. ~.: ................................................................................. (Contractor, agent, corporate officer, etc.) of said owrier or owners, and is duly authorized to perform or have performed the said work and to make and fi th s app cdtion that a statemed~l~b~r~t,~¥g~<~! ia th s app cation are true to the best of his knowledge and beli~ and that th'e work will be perform~cl~:~i~ set forth in the application filed therewith Swom to.b~fo~ me thrs c~m..ss~onA,x;~s March ~0, Notary P u b ' ' c~~Z:~'.~~~ :i'~';;;';';; ' ;:::;:;: ..........................