HomeMy WebLinkAbout3872-zTOWN OF SOUTHOLD
BUILDING D~EPARTMEN'I~
TOWN CLERK'S OFFICE
SOUTHOLD, Iq. Y.
CERTIFICATE OF OCCUPANCY
N o. ~.....3..2...9..2. ............... Date ........... ~.$,ap~-.etal~er~ .... ~ D, .......... , 19.68_
THIS CERTIFIES that the building located at .C~te~:..~.0n~..Lal:te ............................... Street
Map No ....................... Block No ....................... Lot No. O~c. ieat.,...l~el~...Ylotl:k ...............................
conform~ substantially to the Application for Building Permit heretofore filed in this office dated
............................ .M...a.~.....?..t ....................... 19...6..8... pursuant to ~hich Building Permit No.
dated ................. ..M~..~.....?.~. .................... , 19.~...8...., was issued, ahd conforms to all oF the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ........
................................... ...........................................................
The certificate is issued to ..... .~..~..~..~...~.~.....N.o.~..~.~I~ ................... ...........................................................
(owner, lessee or tenant)
of the aforesaid building.
Health Dept. Approval, July 23, 1968, Robert Villa
....... !~. .~.(..:j.~..'; ...................... ;:J ............... ~ ...............
Building Inspector \
FORM NO. 2
TOWH OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISE
COMPLETION OF THE WORK AUTHORIZED)
UNTIL FULL
N? 3872 Z
Permission is hereby granted to:
~ie~t
pursuon¢ to opplicotion doted ......... ; .................. ~ ....... 4~. ......... ~,.,,,, 19. t..]~ and opprov~ by the
Building Inspector.
S-9
SCHD
SUFFOLK COUNTY DEPARTMENT OF HEALTH
Date,
Bldg.
Permit No. .~15~72 ~
TO WHOM IT MAY CONCERN:
at
The
sewage disposal facilitie~ for a
(Give deed l°ca~ion~ :
structure
located
.//.9, o 7
have been inspected by this department and found to be satisfactory.
O~ner- Curtis Norklun
Bui].der- Tony Norklun
Di~tr~ot Engineer
DiStrict Engineer
BUILDING DEPARTMENT/
TOWN CLERK'S OFFICE -
Examined .............. ~ ................... , .......
Approved ........................................ , 19 ........ Permit No .........................
SOUTHOLD, N. Y. ·
APPlication No. ~-~
Disapproved o/c .............................
APPLICATION FOR BUILDING PERMIT
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 o detailed description of layout of property must be drawn on the diagram which is port 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 oft'ne work.
e. No building shall be occupied or used in whole or in part for am/purpose whatever until a Certificate of Occupancy
shell have been granted by the Building Inspector. ~
APPLICATION IS HEREBY MADE to the Building Department for the issuon'ce of o Building Permit I~ursuant 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 ~-egulations..
(Address of applicant)~'
State whether applicant i{ owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ....... ~ ...... ~.~ ..................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
I. Location of land on which proposed work will__be done. Map No.: ................. ~ ...................... Lot No.: ........................
Municipality
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 ..... *~-~..:. ..........................................................................................................
3. Nature of work (check which apPlicable): New BUildi~ ;[;......LT~...i ..... Addition .................. Alteration ..................
Repair .................. R,,~noval .................. Demolition.: ................ Other Work (Describe) ........................................
4. Estimated Cost ...... ..~/.../...,~.~..O.....~...~.. ......... ~.~....~ ......... Fee . .
(to be paid on filing this application)
5. If dwelling, number of dwelling units ..... ../. .................... 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. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ....................
Height ........................ Number of Stories .................................................................................................................
Dimensions of same structure with alterations or additions: Front .................................... Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front ........ ..O.~..~...~ .................. Rear .....~'...~.. ................. Depth ....~....O.f. .............
Height ..../...~..~ ....... Number of Stories ........ /. .......................
9. Size of lot: Front ..../...~....?..~ .......... Rear ..../...~..~...~. .................. Depth ..... ./...~...~..f. ...............
10. Date of Purchase ........................................................ Name of Farmer Owner ..'~...~ ~..~
11. Zone or use district in which premises are situated ....~..e... . ............
12. Does proposed construction vio~ zoni~g~ I~_ 2rdinance or regulation~ ...~ ............................................
13. Name of Owner of premises .....................~..~Address ........ ...~...~ ............. Phone No.~...~.~...~.~....~'....~...O
NameName afar ContractorArchitect ......................... - -~---~ ~..~~'~'"'"'-~'~ ..........AddressAddress iiiiiiiii~~iiiiiiiiiii Phone No .....................
'"--'-"'/;~'" ....... Phone No .....
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block number or des~:ription according to deed, and show street names and indicate
whether interior or corner lot.
.t
STATE OF NEW YORK, ~ S S
COUNTY OF ....~.~'..~.dJ./~.. )' · ·
......................... .7~...~../~..~........~.~..~..~.,~.~../~.. .................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is the ....................... C~7/~,.~.~..7'.~ .~. ......
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to rr~ke and file
this application; that all statements contained in this application are true to the best of his knowledge and belief; and
that the work will be performed in the manner set forth in the application, filed therewith.
Sworn to before me this
..... ............................
~To. 52-7267800 Suffolk County ~]~erm Exp/re~ l~arch 30, 1