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HomeMy WebLinkAbout2442-zFOH~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY,,' Z 20)+7 November, No. Date ' ' !9 ........ ]~ -[HIS CER~rLFlES, that. Jhe.,bgilding located at ~/~ ~ ~ ~O~O~O .......................................................... Street Map No. Block No. ~ Lot No. conforms substantially to the Application for Building Permit heretofore filed lin this o~f)ce dated .................................................................. , 19 ........ pursuont to which Building ~ermit ~o .................. dated .................................... ~.~ ........ , .........was issued, and conforms fda[J of the requirements of the applicable provisions of~e Jaw. The occupancy for which this certificate is issued Js ........ ~tvate one family dwelling The cerfific~fe ~s ~ssGed fo Willi~ Wells (ow~e~, ~essee of the aforesaid building. Building Insp~tctbr k, FORM 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? 2442 z Permission is hereby granted to: ..... ~lll~..W.~l~ ........................................... ............ .~.a.~..!f.a.~.e.~ ............ , ................................ ................. .~.~.~.~ho.l~ ........................................... to .. ~ Let.. new.. ~ne.. ~a~il~.. ~w~ Ll~n~ .................................................................................... at premises located at ....~..~......~J~...~lkY. f~..~3,~l.l......~.~'...~.l...~Ir~{~.1~..e.~ ............................ ........................................................... ~outhol~t..N.Z. ...................................................................... pursuant to application dated ........................... ~...1~. .......... ~. ............. 19.~'..., and approved by the Building Inspector Fee $1~0~ ........... Building Inspector ~UILDING DEPARTMENT TOWN CLERK'S OFFIGE Approved ........................................ , Ig...~.....Permit No .............................. Disapproved a/c ~ ...................................................... ........ .....i'i....................... ....... A_PPLJ~ATION FOR ~UILDING PERMIT Application No....~....~......~/.~..~ INSTRUCTIONS o. 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 o detailed description of layout of property must be drawn on the diagram which is port of this opplico- tion. c. The work covered by this application TOy not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o 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 po rt for any purpose whatever until o Certificate of Occupancy shall hove 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. .................. .............................. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ',irilliam ,,ells 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.: ..~...y....!;...~..v..e...n. ................ Lot No.: al Street and Number ....... .~.c~...~.~,~..e..~.....~..&.':~.~?:.~...~..°...°:~..°..1.~ ............................... ~.... ..................... ~ ............................ Municipality 2. State existing use and occupancy of premises and intended-use on~ occupancy Of proposed construction. Existing use and occupancy ................................................................................................................................ Intended use and occupancy priw~e dt;elling 3. Nature of work (check which applicable): New Building ......... .~ ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ..... ................................. Fee $10,00 (to be paid on filing this application) 5. If dwelling, number of dwelling units ..............5. ................. Number of dwelling units on each floor ............................ If garage, number of cars 1 car 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 ................................ 8. Dimensions of entire new construction: Front ........ ?..0. ................. Rear ?0 Depth ~G Height ]LB~ Number of Stories ..............~ ............... 9. Size of lot: Front ...... .]:.~..5. ................. Rear 1~5 Depth '125 10. Date of Purchase .......................................................... No,me of Former Owner ........................................................ 11. Zone or use district in which premises are situated; ~esidential 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ 3!.©. ................................................. ~ ~ ~!illia~ Wells ~ay Haven i~3.' Name of Owner o. ~, ......... .............. :' ....................... Address ................................................ Phone No. R05-27'~9 Name of Architect .................................................... Address ................................................ Phone No ................... Nome of Contractor .................................................. Address ................................................ Phone No .................. PLOT DIAGRAM Locate clearly and distinctly ali 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 Y.D~RK,,, ) William ~.~].'15 > beiog d~ly sw~rn~ d~poses and says that he is the applicant (Name of individual signing application) above named. He is *h~ Owner - b~ilde~ ' (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 ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application-filed therewith. Sworn to before me this 7th da,~' J~l~.~ 19...~.~. ~~ ~~ Nota~ Public ....~'...EP.)j,..~..~D~ ............. County (Signature-- of appl~.nt)~~ ..... s-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Building Permit TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at / '-(Give deed ~Cation) 55, .v/~ / ~t~ ....... .... ,,,'~:,'/!~,~ W~.//.~ ,, have been inspected by this Department and fo~d to be satisfacto~. District Engineer