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HomeMy WebLinkAbout2643-z]~O,l%lVi NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...~..~,15~.'.~ .......... Date ............................ ~ ......... 3 ........ , 19..6~.. THIS CERTIFIES that the building located at .~/~[ ..... JJ~W..~t~.,~Q~T,..A,~.e .................... Street Map No .SC:I~ .............Block No. ~m'~; .............. Lot No ...~:X .......... JJ~%l'..~'~.~'O~[ ................... conforms substantially to the Applicahon for Building Permit heretofore filed in th~s office dated ............................... ~]:~.a~'.~' ....... ~..., 19..~)~. pursuant to which Building Perm,t No. dated .......................... ~.~.~..~.J~......?-,~, 19....~.~, was ,ssued, and conforms to all of the requ,rements of the apphcable provisions of the law The occupancy for wh,ch this certificate is issued is ........ ...Pr&.~.a..one...f~m~ly...d~ellin~ ............................................................................................. The certificate is issued to ...-D~v~..&..He~m[ae ........ H~)~,l~o~ ................................................... (owneF, lessee or tencmt) of the aforesaid building '' Building I nspe~tor FORIV~ 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? 2643 z Permission is hereby granted to: ~.~.~ tL ~r..t,.~a ..~.. ~x~. ..................................... ............. :ll~.. S~.~llc ....................................... to. ~¢~,~1...~x~.. aO,~L ~;ton.. on.. an.. ~cL~.t~rg.. ~l.~el 1.trg ......................................................... ct premises located at ...~....~..~',X~.O.~..AV~ ...................................................................... ......................................................... l~..,~tfnZlc~ ..... IE,.g4 ............................................................. pursuant to application dated ........................... ~11~ .............. ~ ....... 19.~t[~.., and approved by the Building Inspector Building Inspector FOI~ NO. 1 TO~N O~ $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Approved ........................................ , ]0 ........ Permit No ................................. Disap~ roved a/c ....~~ .......... ............ i ........... ................................. Application No,..~....~..,~..~.?. ......... APPLICATION FOR BUILDING PERMIT Date ......................... Z.e.~..u~..P,~'~....,.~3 ...... , 19.~.~ ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin: Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets c areas, and gwing a detailed description of layout of propertymust be drawn on the diagram which is part of this applicatio, 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. Suc 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 Occupanc 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 tk Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances , Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable laws, ordfnances, building code and regulations. (Signature of applicant, or name, if a corporation) .... .......... ................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde ..................................... ........ QYm. . ..................................................................................................................... Name of owner of premises .... D~..~ld..~c..1-Iez'mine...Hp~..Jio~ ........................................................................................ If applicant ~s a corporate, signature of duly authorized officer. (N~me and title of corporate officer) I. Location of land on which proposed work will be done. Map No' . ...... ~ ........................... Lot No: ...;~¢~...~. .... Street and Number .... ~.Z~. ..... ~D.W...~I~.~'.Q~,~..~Vf~ ............... ,1~.~.~/...~1~.~'.9.~.~t ...... ~].,.~.'. ...................................... Municipality 2. State ex~sting use and occupancy of premises and ~ntended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~we,].Z,J.n~. .................................................................................................. b. Intended use and occupancy ............... .s.~..~.e. .......... ~./.~,.~..~...~.....~..~.....~.,d.~..~...~..~..o...~. .................................................... property lines. Give street and block numbers or descriphon according to deed, and shin whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................. Addmon ..... ~..~... ..... Alteration ................ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4. Est, mated Cost ......t4:..~.~.O...Q ..... ~/..~. ............................... Fee ....~.:. ................................................................................ (to be paid on filing this application) 5. If dwelhng, number of dwelling units ..... .O. TL~ ................ Number of dwelling units on each floor .......................... If garage, number of cars ........... D. aD.e .................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................. 7 D~mensions of existing structures, if any: Front ......... 2~ ............ Rear .......... 2,8 ........... Depth ......... -2.LI- ........... Height ............................ Number of Stories ..... ID.O.e ................................................................................................ Dimensions of same structure with alterations or addihons: Front ................................ Rear ............................. Depth .............................. Height .............................. Number of Stories ........................................ 8. D~mensions of entire new construction: Front ..... ~.Lk ................. Rear ....... 2~ ................ Depth .......... ].6. .......... Height ............................ Number of Stones ...... one ............... 9 S~ze of lot: Front ...:1.~0 .................. Rear .... .c).~.,.~.~. ............ Depth ......... ;~.~'],.~.'Z.~ ......... 10. Date of Purchase ........................................................ Name of Former Owner ........... [ug~e...]{~.to~ .......... 11. Zone or use district ,n which premises are situated ...... !!A.!! ....... ~l. is.~, ................................................................ 12 Does proposed construction violate any Tatung law, ordinance or regulation? ...... nO ........................................ 13. Name of Owner of premises .... ,~.~.~il~...~c~::cJ~o~ ...... Address ......... ~.e,w...8]~.f.o.l~ ........ Phone No .................. Name of Architect ...................................................... Address ............................................ Phone No .................. Name of Contractor ..............~..9~....e ............................. Address ............................................ Phone No .................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro street names and indic- ......................... ..~.8.'?'.~I.~..~,O.~.~.C)~ .......................................... being duly sworn, deposes and says that he ,s the applio (Name of individual signing application) above named. He is the .............. Q~e~'. .......................................................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and th~s application, that all statements contained in this application are true to the best of his knowledge and bel and that the work wdl be performed m the manner set forth m the ~hcation filed therewith.. Sworn to before me thl~ L~ C ~Pr,~9 . ,. /~ ~ /~// / .................... ~'. ~y~.n...;..,u.1,;;~..Cvm~P~,, 19..U.).. Z/_ , // ~///. , /_ - _ ,,· ..... ......... ..............