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HomeMy WebLinkAbout2842-zFOP~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building Iocoted atW/~.....O~L3.]~e~,.~,.e..D~t ................................. Street Map j~l'ion l~atrlor Block No ..... ~ ............. Lot No. 2~.~ ~.~; ~t~.$.Ct~a.....~..,.~,. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................................ ~.tl~t~......~...., 19.6.~.. pursuant to which Building Permit No. 2~.)rf2..~.. dated ............................ AH~[~.~.....~.~...., 19.~.~'...., Was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ · .Pr. iv.a.t~..cn~..~'amily...d.~elling ............................................................................................... The certificate is 'issued to .~rckb~..C,~zl.p.be~L~L ...................................................... O.W,l~.~. ................... (owner, lessee or ten.a:nt) of the aforesaid building. H.D.Approval Oct. 19, 196% by R, Villa ........ .................. Building Inspector (/ FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 2842 Z Date .................................. ~l~q~,ti.....J6., 19.~. Permission is hereby granted to: ,1', D ~ .. · .A~.¢ · · ~Telm · .~,a~p1~],l.. ....................... .......... ~aempo~.t~ ............................................... tO ..... ~l,~l,~..new..ene..$em~t¥...d,~el.t~ .................................................................................. at premises located at .....~.ot~....~.....~ll~O~..)&~ ~.4~ ....................................................................... ................................................ Gg, l,l~tt, e..D~ ......... ~...Nm, ion. t......~.~¥~ .................................. pursuant to application dated ................................. A~,'ase-.-..~ ...... 19..6~., and approved by the Building Inspector Fee $..10~OO ......... S-R SCHD sUFFOLK COUNTT DEPARTMENT OF HEALTH Date ]~ldg, Permit No. TO WHOM IT MAY CONCE~: The sewage dispcsal facilities for a structure located at loca~i on) haveO~een inspected by this Department and found to ~e sat factorY. DistriCt Engineer FOF~ NO. 1 TOWN OF $O~TSOL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19.....~. Approved ........................................ , 19 ........ Permit No ................................. Disapproved' a/c ............................ · ...........,.' ...... ........... .......................... ............................ Application No .................... 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 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 pa rt 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, as herein described. The applicant agrees to, comply with all applicable laws, ordinances, building, code~, and regulations, ./// (Signature of opp~J'cant, or ngf'ne, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~.o.~.r/...~..,...~.~..~ ............................................................................................................... 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: .2, g,~.~. .................................. Lot No: ...~. ............. Street and Number ....... gJ_l~e.~.t,.e..Dz'J~s.....~t,..~...~'~gP~. ....................................................................................... 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 and occupancy . ,!~.e,TJ~C).~ .................................................... 3. NatUre of work (check which applicable): New Building ...,~ ............ Addition .................. Alteration ............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................. 4. Esti~nated Cost ..~2A?.~..~.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~brage, number of cars ....~i'~ .............................................................................................................................. 6, If ~usiness, 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 ............................................................................................................ Dimpnsions of same structure with alterations or additions: Front ................................ Rear ............................. Depih .............................. Height .............................. Number of Stories ........................................ 8. D m/ene.ons of entire new construction: Front ...... 6'~./~. ............... Rear ~ ....... $...~ ............. Depth ...... ~..¥. ........... Hei~lht ..... .-~...~ ................ Number of Stories ..... /...~. ............... 9. Sizelof lot: Front 'IOQ.~ ..................... Rear ..~0.0,.~ .................. Depth ~,~0..~ ......................... ]0. Dat9 of Purchase ........................................................ Name of Former Owner _,,,PP.,,t,,e.,,z',.,,B,Z,.~,,r~,, ......................... 1 l. Zone or use district in which premises are situated ............................................................................................. 12. Doc proposed construction vi9 ate any zon ng law, ordnance or regulation? ..~Jp ......................................... premises ~.,,~.~,r/~' '~'~'~/'~' '~' ................ Phone No. '" / Nar ~e of Architect ......... ,,~ ........................................... Address ............................................ Phone No. Nar ,e of Contractor ..... .~..,~,~. ......... Address ....'.~..~....~?.¥,~.~.,..~../,.~..¥..~,¢~, Phone No. T DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fn property lines G ve street and block numbers or description according to deed, and show street names and indic whether interior or corner lot STATE OF I: NEW)~'OP~ ~ . ~ 1 S S COUNTY ~DF ~.~ ' ' being du y sworn, deposes ond saye that he is the ................ (?'~m~' of individual signing_application) above named. He is the ............... .~.~.q..~.....~. ~te~../J-......V~.,..a:~. ............................................................................................... Il... ! (Contractor, agent, corporate officer, etc.) of said ow,her or owners, and is duly authorized to perform or have performed the said work and to make and t this application; that all statemenetS conttained in this application are true to the best of his knowledge and bell and that tthe work will be perform d in he manner set forth in the application filed therewith Sworn to b~fo~e this ~ ~ , ............... i ' r7 . '/ .~--~/.~'7. // ............... ~..c~...~;~......~.....././..,.....~r~...~<(....~..,.~ ,otory P4,c, / 77:' "gi'gnature of opp ' T ' .... : ~' '"~'~'~', Ydo~ c~_.,:~, ,~ ~_.~_,/',~..~ c/ ~ .................