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HomeMy WebLinkAbout2484-zTOWN OF SOUTHOLD BUlL. DING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .t~/~.....~.e~rt~..Rea(~ ................................. Street Ma~pei~.O..O...~. ........... Block No ........ X,X .......... Lot No .... ~ .............. ~O~t~,,~jXl,...]~,.~t, ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................................... .~_.~.~.....,~..O.. .......... , 19....~.... pursuant to which Building Permit No. 2.~.8~..Z.. dated ............................. .~-~..~.......]:..]'.. .......... , t 9....~...~., 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 ........ .... l~.~i~a~e...one'....£amil~....d~.e.~ Zilog ............................................................................................ The certificate is issued to ...~A*..e~..L~o~e.~..~..W~E~. ................................. .0wztel~.s ........................ (owner, lessee or tenant) of the aforesaid building. H.g. Approval Sept 22, 196~ FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BF-. KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TIlE WORK AUTHORIZED). tO Permission is hereby granted to: ~ A .................. , ................. :......~ ........ ~ .......... ~ O .................................... ~.....~ ............... Building Inspector Fee $/.~ ..~ s-9 SC~D SUFFOLK COUNTY DE?AHTMENT OF HEALTH Date~~~_~ Bldgo Permit No, TO WHOM 1T MAY CONCERN: The sewage disposal facilities for a structure located at ~ G~v~e deed location) ' ,4:-~ ~ ,,, have been inspected by this Department and found to he satisfactory. District Engineer FOI~I NO. ~t TOWN OF SOGTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om,ned ....... ........ ., Approved ........................................ , 19 ........ Permit No ............................. Disopproved o/c ................................ (Building I~spector) APPLICATION FOR BUILDING PERMIT Dote ............................... : ............................ ,19..CV..... 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 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. . . (Signature of oppJicant, or name, if a corporation) (Address of apphcant) 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. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ........ ~.,/.,E.~, ........................ Lot No: ...... ~..;.~, ....... Street and Number J~EolHE~/5 /~0 Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~/~ P/IT- .................. b. intended use and occupancy 3. Nature of work (check which applicable): New Building..............~/ .... Addition .................. Alteration ................. Repair .................. .~emoval .................... Demolition .................... Other Work (Describe) ...................................... 4. Est mated Cost ........... ¢ ............................................... Fee .................................................................. (to be paid on filing this application) I 5. If dwelling, number of dwelling units ............................ Number of dwelling 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 ;-,/'o .......................... Rear .......................... Depth ............................ N~inhf,?e~l~or, zc~ · 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 ....... ~..~ ............ Rear .......................... Depth Height ~p~o~. /~ ~. Number of Stories 9. Size of lot: Front ~' I ............................ Rear .......... Z~.~ ........ Depth .......... ~.~..~. ......... 10. Date of Purchase .~.~....~.~.....~. .............. Name of Former 11. Zone or use district in which premises are snua.e .................................................................................................. 12. Does proposed construction violate any zaning law, ordinance or regulation? .......... ~ ...................................... 13. Nome of Owner of p m sas ........................................ Address .~ ....................................... ~,hone No. Name of Architect ............................... :~ ........................................................ .I .............. Phone No?~.~; .............. Loc,to cleorlv ond distinctly all buildinos, whother existin~ or proposed, ond}i~cotololl set-b~ck dimensions from ~roperty lines. Giro streot ~nd block /~hethe[ ?torior or cornor lot. numbors or description ~ccord,n0 to deod, ~sho~. street homes ~nd indicoto STATE OF NEW YORK, ~ S.S, COUNTY OF ................................ ............................................................................................. ~ duly sworn, deposes and says that he is the applicant (Nome of individual signing application) above n~med, He is the 0 ~ ~'/[ [~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dMy 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 b.e~fore me this /..~. _ .'~.-.. - ~ day of .... , Notary Public, /'~,,-~:'~ ............. I;!.~.~:~.N....~, ...... ........................... .... [" i~ot~lry ub c, State of New York ~ 24-60727~5 Qualified in Kings County