HomeMy WebLinkAbout3108-zFOI~M ~o. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLEI~K'S OFFICE
SOUTHOLD, N. Y.
OEI~TIFIOATE OF OCGUPANO¥
THIS CERTIFIES that the building located at I~,~O~,~,. ~q/. Qr.¢,~e, rfl .o.'.t ..... Street
Beixedon Estates '
Map No ............. Block No ............. Lot No...l..~.,...,.~.o?:t.h.o.~..~.,' ..~:.~?..: .......
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ........... ,.d,~ ....3~..., 19~.6.. pursuant to which Building Permit No..~.108 .Z.
dated ~tay ..~l 19.6.6. was issued, and conforms to all of the require-
ments ,of the .applicable provisions of the law. The occupancy for ~vhich this certificate is
issued is .P;12iva.~e. o~..fa~,q.3,.~..(l~lel],~,ng ...........................................
The certificate is issued go . D~e..Chs:~2].c~s ~o~2~ig .... 0;l~:ll~l~ ........................
(owner, lessee or tenant)
of the aforesaid building.
.Suffolk County Department of Health Appr, oval ........ !~,~ ............................
Building Inspector/
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 3108 z
Permission is hereby granted to:
A.....R~i.tl.~ ..& · .Ser~¢.. · ~qe..... A./g..... Dz~.. ~ Seelig
............. l~a.tt It u~ .............................................
to ...~uild...an..~.diti~..on..a~n..~is ~.~g..*d ~e3.1 ~ ...................................... .................
~t premises located at ..... ~.~.**.[~ .......~e~t~o~**.E~.t~.t~$ ............................................................
........................ T~/...R, eger ~...R~*.&..S./*. Orcha~d"~d. .................................................... ~ ................
...................................... 7.:.qo.~.thold~.....~!o~,.. .................... ~...; .......................................... ~..: ..........
pursuant to application doted ............................. ~¢~¥ .......... .~ .......... 19~.,, and approved bythe
Building Inspector
Fee $,~..,~,.0..0., .............
........ [,,~.~ .~.~.,~..,~ ..................
Building Inspector [
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined '" '?~r ~. ~' 19.~..¢
...... ....... y....¢/......,
Approved ........................ '..! ............. , 19......~.. Permit No....~....../..~.~..~...~
Disapproved a/c ..~ ....... ~..~ .......... 7'7 ..................................
............................. ...................................
(Building Inspecl~r)
Application No....~..../...g.....~... ......
APPLICATION FOR BUILDING PERMIT
Date ................................. ~ ....... 31 ......... I966 .......
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 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 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.
.~.13.~.. J~.. f~ons...Inc .................................................
(Signature of oppJicont, or name, if o corporation)
(Address of applicant)
Stote whether applicant is owner, Jessee, agent, architect, engi'neer, general contractor, electrician, pJumber or buiJder.
.............................................. ¢~t.r. ae.~ ..........................................................................................................................
Nome of owner of premises ..I~:~..~]~.]'e~"~'~'~' ......................................................................................................
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.: .....~J~O~ .................. Lot No.: ...ti,], ................
Street and Number .~S./.~..[..~,~.h~d..&..~i/..~O~l~S...l~d ..................................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
o. Existing use and occupancy ............... d,w~11~l,n~ ................................................................................................
b. Intended use and occupancy ...... ~tl~..~,,~...~.t.t~¢~l ........................................................................
Nat ~re of work (check which applicable): New Buildihg .................. Addition .... ~ ...... Alteration
Rc dr .................. Removal .................. Demolition .................. Other Work (Describe)
Estir ~oted Cost ...... .~iClOQ....I~./.M ............................. Fee ..
[ (to be paid on filing this application)
If dCvelling, number of dwelling units ........... ~ltJt ......... Number of dwelling units on each floor
If g~rage, number of cars
If I:jusiness, commercial or mixed occupancy, specify nature and extent of each type of use
Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth
.h
Hei~lht ........................ Number of Stories
D m,ens~ons oF same structure with alterations or additions: Front .................................... Rear
Depth ................................ Height ............................ Number of Stories ................................
Height .................... Number of Stories ....... .O111~
Sizej of lot: Front ............................ Rear .................................... Depth
DatA of Purchase ........................................................ Name of Former Owner
Zonj~ or use district in which premises are situated ....... .",A..~ .......... ~.S,t, .....
Doe~ proposed construction violate any zoning Iow, ordinance or regulation? ...... ~f~. ....
Nar ~e of Architect ...................................................... Address ............................................ Phone No.
PLOT DIAGRAM
clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr
~es. Give street and block number or description according to deed, and show street names and: indic
10.
11.
13.
L.ocat(
property ti
whether in~
erJor or corner Jot,
STATE OFf NEW~.g~.,~,.
COUN'rY ,OF ....R,,,~,.~.~..,'~,. ...........
............................. &~...~.~..~..~.~.~...~g. .................. being duly sworn, deposes and says that he is the
Name of individual signing application)
above nan ed. He is the ...............
(Contractor, agent, corporate officer, etc.)
oF said owaer or owners, and is duly authorized to perform or have performed the said work and to make and
this application; that all statements contained in this application are true to the best of his knowledge and belief;
that the w,~rk will be performed in the manner set forth in the application filed therewith.
Sworn to b ~fore me this
~Z dayof
............ : ....... ' ':"'"'; .......
Notary Public, ..,;~l~i}~.~t,a~....~ ...... J:;~/~J.~J{~;~'County~'~J ~) .......... ~'~'~"~plicont)
OTARY '~iU~'~ Sta~e