HomeMy WebLinkAbout2801-zFO~ NO, 4
TOWN OF SOUTHOI. D
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. ,~...2,27.~J ............. Date ............................... .0.c.t,.,...16 ........ , 19..65..
THIS CERTIFIES that the building located at ..S~.~.....~o~rtd...A.~.e .................................. Street
Map No ..... ..~. ~. .......... Block No ......~ ......... Lot No. ~r,~ ......... .~[f~.~;..~..~:q~.~. ...........................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
..................................... *,T.'g~ty~ ........ ;~.~. ....... , 19.~.~.... pursuant to which Building Permit No. ~..~..0.~...~.
dated .............................. .~'_.l~t~.e. ....... .;~.~....., 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 ........
...~.e..~.~...~.t.~.~.t.~ .......................................................................................................................
The certificate is issued to .,~;[.]~C.C~....A~.~/~ ........................ .0.~.[',,~. ...............................................
(owner, lessee or tena,nt)
of the aforesaid building.
FORI~I 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? 2801 Z Date .............................. ~ ...... Sa ........ , 19..6~.
Permission is hereby granted to:
........ liat.ti.tuak~ .....~. ~.~ .................................
to...tO. ~u~ko ..a~.t~,~t iene ..at, d? .b~: t6 .. at~ .. ~td~t. ~on ..orr .t~u~z_,re s~ ..bui.td~ ....
at premises located at ....~.~.....~Ol~I4t..~VO .......................................................................................
..................................................... lla~.ti.tuek~.....l~.Y.. ......................................................................
pursuant to application dated ................................. ~.ttl~....28 ........196~..., and approved by the
Building Inspector
Fee $...~..OO ............
FOI~M NO, I
TOWN OF SOUTHOI. D
BUII'DING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ........... _. ....... , 19 ........
^pproved ........................................ , Permit
Disapproved a/c
.................... ................................
' (Building InspectorI
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. Plot plan showing location of lot and of buildings on premises, relationship to ad oining premises or public streets or
areas, and giving a deta led description of layout of property must be drawn on the diagram which is part of this application.
c. The work covered by this application may not be commenced before issua.nce 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 lhe
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, building code and regulations.
(Signature of applicant, or name, if a corporation)
(^ddress of applicant)
State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder.
Name of owner of premises TJ.~.e.O ~ ~.gz¢~;y: .......................... ....
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; ........... ~ ...................Lot No.: ~ ..............
Street and Number S'/.S Sotmd aye [via%tire,ak
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .,.b~J.~.$.s...bLL:L~L.c].iD, gs .....................................................................................
b. Intended use and occupancy ...... 8.f~.~..,.¥/~.t..h....{~k.t..c,.....a...t.,~...o..zg.s..a.,.n..d..8~.d...d..i...t..i..o,..~. .........................................
3. Natt~re of work (check which applicable): New Building .................. Addition ~ ........... Alteration ..;x:~ .....
Rep6. ir .................. Removal ..................Demolition.....~!fz'~L~r~..... Other Work (Describe)
4. Estirhoted Cost ......'L.'t.~.O~O ........................................ Fee .....~.
(to be paid on filing this application)
5. If d~,elling, number of dwelling units ............................ Number of dwelling units on each floor
If g~rage, number of cars
6~ If b,'usiness,~ commercial or mixed occupancy, specify nature and extent of each type of use
7. Dim~.nsionsJ of existing structures, if any: Front ....~. .................... Rear .......... .~+. ................. Depth ........ 6.C) .......
Hei~lht ........................ Number of Stories ...(~P~. ..................
DJmi~nsions of same structure with alterations or additions: Front .................................... Rear
Dep!h ................................ Height ............................ Number of Stories ................................
8. Dimbnsions of entire new construction: Front ..... ,~.Lk ......................... Rear ...... ~..bc. ................. Depth ...... ~:f ..........
Height .................... Number of Stories ....... ~.D.G ........................
9. SJzejof lot: Front ............................ Rear .................................... Depth ................................
10. Dot~ of Purchase ........................................................ Name of Former Owner
11. Zonb or use district in which premises ore situated ............ ;Ls.t; ....................
12. Does proposed construction violate any zoning Iow, ordinance or regulation? ............
13. Nam]e of Owner of premises T..;L]pa~..TL~.~.~..~.~o..Address .............. ~a,t;¢.J,t,~, ........Phone No.
Nar~e of Architect ...................................................... Address ............................................ Phone No.
Nar~e of Contractor .....~a.~.~ ...................................... Address ............................................ Phone No.
PLOT DIAGRAM
Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions
property lines. Give street and block number or description according to deed, and show street names and
whether i.nterior or corner lot.
STATE OF NEW YORK, ~.S.S.
.......................... Zc~.e~..~J_,.f.~.a~ta~ .................................... being duly sworn, deposes an~J says that he is the
(Nome of individual signing application)
(Contractor,
agent,
corporate
officer,
etc.)
of said ortner or owners, and is duly authorized to perform or have performed the said work and to make and
this opplidation; that all statements contained in this application are true to the best of his knowledge and belief;
that the wgrk will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
Notary