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HomeMy WebLinkAbout3216-zTOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD, N. Y. OERTIFIOATE nF O00UPANOY THIS CERTIFIES that the building located at . .~;J.~. ~O&Cl ................. Street Map No.....~.. ...... Block No.. ~ ...... Lot No...X~X ........ CtlF.~g~tle. ...... conforms substantially to the Applicati, on for Building Permit heretofore filed in this office dated ..... ~:~..[~ ........ 1961~ pursuant to which Building Permit No. 32J.6 ~-. dated .... ~{l~t;~l~..~.;~ ..... , 19.66., was issued, and conforms to all of the require- merits ,of the applicable provisions of the la~v. The occupancy for which this certificate is issued is ....... .a..ew....~.~..m. ~.V;t;tdir~g ............................................ The certificate is issued t,o . ~rlltl:te..l~&~J, tl[l~ .................................... (owner, lessee or tenant) of the afore.said building. Suffolk County Department of Health Approval ................................... FORP~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? 32i6 z Permission is hereby granted fo: to .... ~!_ld..~w..£~a..~t~a. lile...b,,~l~ .............................................................................. at premises located at ...~]~....)[~t~..~:~e.([ ...................................................................................... ................................... ¢~t,~et~tel .... )~.¥, .............................................................................. pursuant to application dated ...................' ..... ~ ......... ~ ..............19.~., and approved by the Budding Inspector Fee $'"J.O~vO0 .......... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , I (2 ........ Permit No ................................. D, isapp roved a/c ................ ~ ..... :...~. (Building nspecto/ A~PI. IC.~TION FOR BUILDING ~ERMIT INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the B~idin~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o 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 opphcation may not be commenced before ~ssuance 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 Jn part for any purpose whatever until a Certificate of Occupanc' shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of o Building Permit pursuant to th. Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply with all apphcable laws, ordinances, building code and regulations. ........ ...... .......... (Signature of apphcant, or name, if a corporation) ............. .............................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde~ Name of owner of premises ........ ~'.~ ....... .~.~ .............................................................................. 1 Location of land on which proposed work will be done. Map No' . ........................................... Lot No: ................. Street and Number ....~ ...... ~.. ............. ~~,c~,~ ...... ~...~.... ....................................................... Mu[~trcipahty 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 ...... .~...~7~ :......]'.~ ~..~. ........................................................................ 3 Nature of work (check which applicable): New Building ..... L.. Addition .................. Alteration ................. Repair .................. ..~emoval .................... Demolition .................... Other Work (Describe) ..................................... 4. Estimated Cost .... ..~...~....~....~....~.. .................................. Fee ......................................................................................... (to be paid on filing this apphcation) 5. If dwelhng, number of dwelling units ............................ Number of dwelling units on each floor .......................... If garage, number of cars ............................................................................................................................... .~ ~_~ ........ 6 If bus,ness, commercial or mixed occupancy, specify nature and extent of each type of use "'~'"~/~'~t~ 7. D~mensions of existing structures, if any: Front .......................... Rear .......................... Depth .......................... Height ............................ Number of Stories ............................................................................................................. - ~- Rear ..~ ................... Dimensions of same structure with alterations or additions: Front .......... z. .................... Depth .....~ ............ Height ......~ ........... Number of Stories .........'.~.,. .......................... 8. Dimensions of enhre new construction: Front ...... ..~.,..~.. ............. Rear .......~,....~.. ............. Depth ...~__o..~...../. .......... (7r / Height .....~, ................... Number of Stories ............................ 9. Size of lot: Front . .~..~...O..'. ................ Rear ...P..~4~.~..'. .............. Depth 10. Date of Purchase ........................................................ Name of Former Owner ...................................................... 11. Zone or use district in which premises are situated ............................................................................................... 12. Does proposed construction vLolate any. zoning law, ordinance or regulation? .................................................... Name of Owner of premises,,~ ;o ,~- ~~R.,.,~....~f~'''Address ...."~ff'~.../~...~~"~' ' ~ Phone No.f~..~.;..~....~..] 13. Name of Architect ................................................... ~ ...Address ............................................ Phone No ................... Name of Contractor .~?F~f...~.., ........ ~tr~....Address~.~...~ ..... Phone No.~...,~.:.~.~/ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-bock dimensions froi property lines. Gwe street and block numbers or description according to deed, and show street names and indica whether interior or corner lot. STATE OF NEW YORK, ~. ~ q COU N~(, OF ................................ ~ .... ~...~......~ .............................................. being duly sworn, deposes and says that he is the applicc · (N~/me of individual signing app~c~ati.9~? ~_ above named. He is the ........................... ~~ ................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and f th~s application; that all statements contained m this application ore true to the best of his knowledge and bell and that the work w~ll be performed in the manner set forth in the application filed therewith. Sworn to before me th,s '~~"~' i~;i'~ .......................... doyof ............................................ , 1~;~;;:. ~ hcant) Notory Pubhc, . ........................................................... ' ' ' .... : .................................