HomeMy WebLinkAbout2324-zFORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificate Of Occupancy
No. Z~?.~.6 ...... Date .......... J.a~ ..... 17 ....... , 19.7.~.
THIS CERTIFIES that the building located at .. C-indy. La ................ Street
Map No. Deer. P~rk. Block No ........... Lot No..~,~.~. ~,ttituck .N..X, .........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .......... ~ia.r .. 2~ ..., 19.6~ pursuant to which Building Pemit No.. 232t~Z.
dated ........... 1.~x'.. 2~..., 19..61,, was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is P~iva.te. ona. family, dwelLtng..& aeeeaoox'2..bl.d.g .................
The certificate is issued to .... Josaph. & .l?.atr. icia I)eerko~ki ....... .O~erj. .....
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . J. an...1 l...t97~...by. B~.Villa...
UNDERWRITERS CERTIFICATE No...pe~i.~-,~g ..................................
HOUSE NUMBER ..... 38.~. ..... Street .. Cindy. La ..............................
.... ...........
~ Building Inspecto~
FORM NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEpT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 2324 z
Date ...................... J~l~OJt ....... .~ ............. , 19(~1~...
Permission is hereby granted to:
,T.
...Ma~t$.tuek .......................................................
to ..... ~lJ~.(~. ~e.t~.. ~11~.. ~11~ 1~... ~1,~ s,1.1~ ............................................................................. , .....
at premises located at -..Le~,g..~.-..-DeeF-.-pt,~le ........................................... : ..................................
......................................... C~nd~r...Larm ~ .....Ilar ~t t,,mk ...................................................................
pursuant to application dated ................ ; ................ ~J~L~IJ~....~. ..... 19(~,..., and approved by the
Building Inspector
Fee $,~Oe ~t ...........
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Applicohon No .................. ..~.. ......
Approved ................ ~ .................... , 19 ........ Permit No.
Disapproved a/c .......... O~ ~ ~ (. ~
APPLICATION FOR BUILDING PERMIT
Date ........~...~......~...~ ................ , 19.~...~....
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 propertymust 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 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 o Building Permit pursuant to the
Building Zone Ordihance 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, a~ herein described.
The applicant agrees to comply with all applic?ble laws, ordinances, b~il.~ng c.ode a~gd re~l~io, n~
· .........
' ' ...... iX ~ r ~.~' ' ~'"'~l~ii~ ~ ~ ~'i' .......................
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
......................... ..........................................................
................. ................................................... .......
Name of owner of premises ~ ~
If applicant is a corporate, signature of duly authorized officer.
(Nome and title of corporate officer) c~-~-'~'~/~--)
}. Location of land on which proposed work will be done. Map No: ............................................ Lot No: ....................
Street and Number ....~../,~.,~?...~.......~..~....~...~....~....~.........~...~...%~....~..../~./....7~..~..~.....~....~"..~.~"~` ..................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..~.../~.....~:..../~..../~'......'~.. ...'~....~......./~.. ....................................
b. Intended use ond occupancy ...........................................................................
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .............
Repair ............... ~ Removal ....................Demolition .................... Other Work (Describe) ..................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ............... ../(. .......... Number of dwelling units on each floo~ ........................
If g~rage, 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 ...........................................................................................................
Dimensions of same structure with alterations or additions: Front ................................ Rear ............................
Depth .............................. Height ............................... Number of Stories .............. Z ........................
8. Dimensions of entire new construction: Front ........ ~.~. ............. Rea~...~.Z~.....:....?. Depth ..~..~ .~
9. Size:of lot: Front ....... Z~ .............. Rear ..... Z~.( .......... Depth ................ ~.d~.~..~,~
11. Zone or use district in which premises are situated ....... ~fi~~ ................................................... .]..
12. Does proposed construct .... on voate any zon ng aw, ord nonce or reflu orion? ....... ~' ~ ......................
Na~e of Architect ...................................................... Address ...~.~.~.....~.~.. Phone No .................
Na~e of Contractor ~..~.~g~.~......Address ...... ~.~.~.. Phone No.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
property lines. Give street and block numbers or description according to deed, and show street names and indic,
whether in~erior or corner lot. ~ ~
STATE OF NEW YORK,
(Name of individual signing application)
of sold owner or owners, and is duly authorized to perform orI' hove performed the said work and to make and
this a~licbtion; thor all stotements contained in this application are true to the best of his knowledge and beli
and that the work will be performed in the manner set forth i~n th~ application filed therewith._ , '
Notar~,,~ I , Count~ ( gnature of apphcant)