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HomeMy WebLinkAbout2458-zFOII~I NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ~/~......V~.~..~...e..~...~.~.e..W.....D..~..~..~?. ...................... Street Map No ...... ~ ......... Block No ......... ~ ...... Lot No ..... ~..~... ......... .8...O.~.~..O...]:.~...~.....~.:...~.?. ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................................... ~'.t~r. ......... ~...., 19..6.~.. pursuant to which Building Permit No.. ...... 2bc~8.........Z dated .......................... ~'~. ],y. ........... 2]~..., 19..~., was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .. p~..i.v.~.te...orie..I;amily...d.v~elllllg ............................................................................................... The certificate is issued to .~.O~....(:.^...l~.;~.~..~.~fl.O..~.. ................... .O.~.e:~. .............................................. (owner, lessee or teno~t) of the aforesaid building. H.D. Approval Sept 9~ 196~ by R~ Villa ..... ?;'.'.::. :: ........................... Building Inspector 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) N0. 2~58 Z Date ................................ j'~,~.....~ ......... , 19.~. Permission is hereby granted to: ,'r, Ze.l~r. ~,.....AZ..CL ...~o~r...(~.,...~ ~,a~n ......... ................. ~at~.l~ ........................................... to .. ~1~1~...~..o~e...~..~.ly-. ~9/e~..] · .~ .................................................................................... ct premises located at ....~J/~l....~.t,l~.~r~I/...][~.~,~'~ ......................................................................... ................................................................ ~t~._.l.~ ............................................................................... pursuant to application dated ................................. ~i~r......~. ........19..~-, and approved by the Building Inspector Fee $,. ]LD.O~ ......... 1: ....... ........... Building Inspector s-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date~f Bldg. Permit No,......__......_ TO WHOM 1T MAY CONCEPt: The sewage disposal facilities for a structure located at · (Give deed location) ~ - ....... have been in~ected by this Department a~d found to be satisf tory. FOEM NO. I TOWN OF SOUTHOLD BUILDING DEPART,~tENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19...'.!...Permit No. ~...~,. ................. " Disapproved ~~- .......................... ................................. APPLICATION FOR BUILDING PER.MIT Date ~-,.~..,~ .................................,19 ...~....~... INSTRUCTIONS a. This application must be completely fiHed 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 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 shah have been granted by the Building Inspector. ~--~ APPLICATION IS HEREBY MADE to the Building Departmeb;~ for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Count~/; New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, es herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code and regulations. ~ (Signa~~,~or name,, if a corporation) ......... .......................... State whether appJicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~,..~'~ ....... C, ........... 0.~.]".~'""'~~'~ ........................................................ If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number .,~,~,,,~.~'~/),.,,~,,,,(,~JJ~..~(~-~".,~, ,.,,~...,~g~ ................................................... // Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use ond occupancy ..............~, ,,_ __ __ ...~.....0-..~...... ,~....~.'/ /g // ....... ~._~.~;~.~] ..................................... 3. Nature of work (check which applicable): New Building ..... L,,~........... Addition .................. Alteration .................. Repa r .,, Remova Demolition .......... Other Work (Describe) /;/,,, .. .................................... 4. Estimated Cost ...... I.~1:,~,~1,~.,.~,,...-. ........................ Fee .'.!.~[.~.,.,~ ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dweIling units 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. 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 ........................................ / D mens ons of ent re new construction' Front (~ Rear ..DJ:.. I~ De t 8. , ...... ~ ....................................... p h ....~..../....~.. Height ............................ Number of Stories ..... ~ ............ 9.Size of lot: Front ..~),,.';~.....~. ............. Rear .J.~.~. .............. Depth .............. 10.Date of Purchase,,.,)Jr:wr~/,~.....i..--j.{~./r-f:~, .................... Name_ . , .,, ,,., -, . ,at For.rner Ow~ner ;....',.tff.l..Lg.&.....:,,~....'~.~)&.0.,~..U,/.. Zone or use district n wh'~ ch prem ses are situated......~'.~...~..~ ............................. 11. 12. Does proposed construction~ A~- ,~ ..~-~nvi°late any zoning law, ordinance or reauJ, atioo? ................. J'~J,,~t .......................... '1:~. Name of Owner of premises(~.~...~-.~l~...~.Address,,~.~../~.:.~., ....... Phone No ..................... Name of Architect ~ ' " '; ~* " ...................................................... Address ............................ ....... I. ....... Phone No ..................... Nome of Contractor ' ~ '~ ° ' ' ' .................................................... Address I, ..................................... · '. ..... Phone No ..................... . ./'~'~. PLOT DIAGRAM Locat~ c~J~orly and dis~ly all buildings, whether existing or proposed, and indicate oil set-back dimens ons from property linC. Give street and'l~ff~k numbers or description according to deed, and show street names and indicate ~etk, er ,nyrior or corner lot. ~ * ~) ? ?.~ X~, STATE OF NEW YORK, / S.S. COUNTY OF ................................ ................................................................................................. being duly sworn, .deposes and says that he the applicant (Name of individual signing application) above named. He is the ......................................................................................................................................................... (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 Qpplication; that all statements contained in this application are 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 ¢ ~ , ........... .~..~.. ........ day of .....~+/_.. .......................... , 19 ........ ~ ~, · J,,, L~ L J , , I~ ..................