HomeMy WebLinkAbout3167-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No..Z.~.~.~.9 ..... Date ............... May....]~e..., 19,
THIS CERTIFIES that the building located at~.nCh.o.~, 6. ~$~.~m9~ .La,. Street
Map No. ~Larbo~ .Lig~k No ........... Lot No.. 1 ] ...... 8.~Utho~.. ~[~ ~ .......
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............ July...]& 196~. pursuant to which Building Permit No...
dated ......... Ju~y ..... 21.., 19 66., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . .Private, one. ~mily..dwe~.ling ......................................
The certificate is issued to . .Paul..&. J,"y'ano~... Pla~ ....... QkCV~ ...............
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval A~g.. 3.. J~.¢7.. ~]k~.!t... .'~$~.~d~ .....
TOWN OF SOUTHOLD
BUILDING D[PARTMENT
TOWN CLI~RK'S OFFIC[
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 3i67 z . Uote ............................ z~.,y ....... .~ .......... , ,9.66_
Permission is hereby granted to:
Pa~.-.:~i-~...P.~a.~- ~.. ~i.~e ................................
..:LOg.. ~*..10.... ~u~o~..~:Lv~L'.....~.. ..................
.... ;~.~,e~ ~..]~t&.~.l.~ ~.-.~.r~:.o ..............................
to ...... ~.J-.ld...Ile~.. ~r~e .- .~.a~:~ .t.y.- el~e.~ .~.~ng .................................................................................
et premises located at ..,.]bO~0...~l:.f ....... ']{~iP~l?"~'~h~'""~'~'"~ ..................................................
....................... At~c~zo~...ig~nt~..&. '~f~ntt ~ ~ze r"'I~' ....... f{.o.~.~ho.l~.~......~b~., ..............................
pursuant to application dated ................................ ~..21~~.....,~J~ ......... 19..~., and approved by the
Building Inspector
Fee $'""~)',{<)0 ........
Building Inspector
S-9
SCHD
SUFFOLK COUNTY DEPARTMENT
Date
Bldg.
OF HEALTH
Permit No.
1967
TO WHOM IT MAY CONCERN:
at
The sewage disposal facilities for a structure located
,~ ~ (Give deed~ lo'cation)'z -
have been inspected by this department and found to be satisfactory.
District Engineem
District Engineer
FO~M NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUYHOLD, N. Y.
Examined ...~.... ....................... 19 ........
Approved ........................................ , 19 ........ Permit No .............................
?
Application No...~.(. ......................
Disapproved oZ~....'~. ..................... ~:z::.g .................. ~ ...................................
.............. :.::Z ....... ........
................................. ..............................
APPLICATION FOR BUILDING PERMIT
Date ........... ~'.~..(.. ~.~......~..41~ ......................... , 19....~...~....
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 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 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 Deportment 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 o~
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 applicant, or name, if a corporation)
(Address of applicant) //~ '~o~ '~. c/.,
State whether applicant is owner, lessee, agent, architect, engi,neer, general contractor, electrician, plumber or builder.
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 ,'..-~.~
.................................................. (~' ................................. '~v~ ~ ~ i ~'i'l~'~'l'i~ y' ......................................
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..... ..~. _..C~....c:..~.....~..~. .............................................................................
..
b. Intended use and occupancy .............................
4.
5.
6.
10.
11.
12.
13,
Locat
property Ii
whether in
NatOre of work (check which applicable): New Building .................. Addition .................. Alteration ..............
Repc~ir .................. Removal .................. Demolition .................. Other Work (Describe) ....................................
(to be paid on filing this application)
If d,lwelling, number of dwelling units ............................ Number of dwelling units on each floor ........................
If g6rage, number of cars ............ ~.. .......................................................................................................................
If b. usiness, commercial or mixed occupancy, specify nature and extent of each type of use ........................
Dim;ensions of existing structures, if any: Front ............................ Rear ................................ Depth ...................
Hei4ht .f~.,.~ ............ Number of Stories ..... .,.-~-~..:. .................................................................................................
Dim~ensions of some structure with alterations or additions: Front .................................... Rear ........................
Depth ................................ Height ............................ Number of Stories ................................
Dm~ens~ons of entire new construction: Front Z:~/ '6" ~' .... '
Dat~ of Purchase ..... ..'f';?~ ~.
[
Zon~e or use district in which premises are situated ......... ~ ....... ,~...~...~.:~ ...............................................................
Doe~ proposed construction violate any zoning law, ordinance or regulation?
Na~e of Architect ...................................................... Address ............................................ Phone No.
Nar ~e of Contractor ........~ .......................................... Address ............................................ Phone No.
PLOT DIAGRAM
~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr,
nes. Give street and block number or description according to deed, and show street names and
erior or corner Jot.
STATE OF NEW YORK .... ] e e
COUNTY IOF ''''
................. j,.~.g....l~.......~.'~..../Cf/..~ ............................ being duly sworn, deposes and says that he is the applic,
i(Name of individual signing application)
above ne~ed. He is the ..........................................
(Contractor, agent, corporate officer, etc.)
of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make and
this opplkatJon; 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 t?. ~ .~fore me this
~ ~. day of,.
............... ~%"" '-~ n .......... 7"F".' ~"'; .................... / ~- ~ //' .~
--~.~~'~ ~~ .............................. ::. ....................... : ......
Notary ~c, =~lt.zj~.~m~.~, County (Signature of applicant)