HomeMy WebLinkAbout3223-zFORI~[ NO. 4
TOWN OF SOUTHOLD
BUILDING D~-PARTMENT
TOWN CL1~RK'S OFFICE
SOUTHOLD. N. Y.
OERTIFIOATE OF OOOUPANOY
No. Z. ,26;L0 .... Date .......... .~.~,~.e.~]p.e.~* .... ~..0. .... 19~6..
THIS CERTIFIES that the building located at S//[..Ta:epon. D~, ............ Street
Sour old Shores .
Map No ............. iSlocl( No ............. Lot No...36,...~re.~pnrt, .lt~.~ .......
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ......... Sepil ..... '~.{~ .... 1966. pursuant to which Building Permit No...322]. Z
dated ........... Sepi;-..16 .... 19~6., was issued, and conforms to all of the require-
ments ,of the .applicable provisions of the law. The occupancy for which this certificate is
issued is .. Private' 'ac~esl~ory bLlild.i_ng ( storage .eS) .......................
The certificate is issued t.o . Geal~ge .Il,..Jul~geas ......... Ownol, ....................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ...... ~.. t1~ ............................
- Building Inspector
FOI~I~ NO. ~
TOWN OF SOUTHOL. D
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOL~D, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 3223 Z Date ........................... J]J~llp.t.,~Jab~l~....3-~,., 19..~
Permission is hereby granted to:
............ Geo~tje.. ~...J~,~i~e~s ..........................
.................... Tttc~e~'s...I. ....................................
.............................. 8~h~l~ ...............................
to l~t~.. ~a~.. ~t~l ~..t~ ..~-to wg~..& ..Imam, .heu~ .................................................................
at premises located at ....... ]~'"3J~¥ ..... B~IiL~'I~,"~I]J~,~I~$ .............................................................
...................................... ~Jj~ ..... Te~..I~r~.d "Green~ort',"'lt','t['~' ......................................
pursuant to application dated ............................. J~pt~.....l& .......... 19~.., and approved by the
Building Inspector
Fee $.~,,O(~ .............
Building Inspector
FOI~ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Apphcation No.
D~sapp roved o/c .................... -
................................. i' '6'ii ...............................
APPLICATION FOR BUILDING PERMIT
.......... ...... ............... ,
Date
INSTRUCTIONS
a. Th~s apphcahon must be completely filled in by typewriter or in ink and submitted m duplicate to the Buildin.
Inspector.
b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
areas, and gwmg a detailed description of layout of propertymust be drawn on the diagram which is part of th~s apphcatmor
c The work covered by this application may not be commenced before mssuance of Building Permit.
d. Upon approval of this application, the Building Inspector will ~ssue a Building Permit to the applicant. Suc
permit shall be kept on the premises available for mnspection throughout the progress of the work.
e No building shall be occupied or used in whole or m pa rt 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 ~ssuonce of a Building Permit pursuant to th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe;
The apphcant agrees to comply with oil apphcable Jaws, ordlnagces,_building/~_/~ /~ . . ^ ..c°de and regulations.
.~..~ ..... .~..?...:...~ ........................
(Sigr~ture of applic~f~t, or nJi~e, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde
Name of owner of premises ........ ~ ..... ~...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 ..,~ ........................................ Lot No: ..................
Street and Number ...... ~...~..~/~..~ ........ Mun,clpohty~ ..... ~'~"~"~'"~"~'~ .........................
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 . ..~ ........ ~ ..... ,~l~s,~....~~ ..... ./~.f....t.~_,-,(,t.;,
3 Nature of work (check which applicable): New Budding .................. Add~hon .................. Alteration ..................
Repair .................... Re, moral .................... Demohtion .................... Other Work (Describe) .....................................
4. Estimated Cost ........... .~.[...~.. ........ ~. ............................ Fee .........................................................................................
(to be pa~d on filing th~s apphcation)
5. If dwelhng, number of dwelling umts ............................ 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 Dm~ens~ons of existing structures, if any: Front .......................... Rear .......................... Depth ...........................
Height ........................... Number of Stories ..............................................................................................................
D~mens~ons of same structure w~th alterahons or additions: Front ................................ Rear ...............................
Depth .............................. Height .............................. Number of Stories ........................................
8 Dimensions of entire new construct,on: Front../.../~....~...O~....../.~.. ~... Rear ............................ Depth ...........................
Height ......?.....r....~...~.~ ....... Number of Stories .......
9. S,ze of lot' Front ..... ./. .~. ~.. .. .r. .. .; ..... Rear ..... ~..~...~....r. .......... Depth .../...°....~......5.~.../..,(..~.../
10. Date of Purchase ...f~.~....~..~../(.~....C¢. ............................. Name of Former Owner ...~..,....~,..~...~.......~..~....~..~....~..~...~. ....
11. Zone or use d~stnct m whmh--premises are s~tuoted.......~- ........................................................................................
12 Does proposed construction violate any~g low, ordmance~or regulation~ .... ..~.O. .......... , ..............................
13 Name of Owner of prem,ses .~..¢.~.~..~..~..~].~4~r.~.~45....Address
¢ v ............................. Phone No .................
Name of Architect ..................................................... Address ............................................ Phone No ....................
Name of Contractor ...~ ......................................... Address ............................................ Phone No ...................
PLOT DIAGRAM
Locate clearly and distinctly all buddings, whether existing or proposed, and ~ndlcate all set-back dimensions fron
property hnes. G~ve street and block numbers or descnphon according to deed, and show street names and ind~cat
whether interior or corner lot.
STATE OF NEW ¥OR~/} ~ '~ c c
COUNTY OF ..~¢rh~7'~..t
~...../..~...-...~,,-¢~.~ .......... being duly deposes and says that he is the applica,
................ wo n,
above named. He is the ......... ~ ..................................................................................................................
(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 apphcation; that all statements contained m this application are true to the best of h~s knowledge and behe
and that the work w~ll be performed in the manner set forth in the application filed therewith.
Sworn to before me thru
............. .....
S ~ Co~ '~ ....................