HomeMy WebLinkAbout3958-zTOWN OF SOtJ-I-~-/OLD
BUILDING DEPARTMENT
TOWN CLERlr's OFFICE
SOtrI-~OLD, N. Y.
CE:~TIF'I(::ATE: OF' O~.CUPAN(::Y
THIS CERTIFIES that the building located at .1[~1~..~.~.4 .................. Street
Map No ............. Block No ............. Lot No .... ..m~..t.t~$.t.~....l~m...~9.X~.. .......
conforms substantially ~o the Application for Building Permit heretofore filed in this office
dated ..... .ff.U..ly....1.~.~ ........ , 19..~.. pursu'ant to which Building Permit No..~.9..~.8..~..
dated ..... .~.~.l.~r....1.~.,. ......... 19...~., was issued, and conforms to all of the require-
ments ,of the applicable provisions of the law. The ~ccupancy for which this certificate is
issued is ...]~.~.~.~..~.~.~. · ~ .~g..~.~J.~.. ( .~..~. · .~.~.9.~Y. · .]~-~[. -~.g} ..............................
The certificate is issued to ....Iq.:.~.:..~.~..~.~..~...ff.~... ...................................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .........................................
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Disapproved a/c ....................
APPLICATION FOR EUILDING PER. MIT
Bt, .................................. ,
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 port of this application.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon apprOVal of thi~ 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, housing code, and regulations.
(Signature of aj~licant, or name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder.
............................. ..........................................................................................................................................
Nome of owner of premises .............. · .~..:..,~.:.....~./~./..~..~...~..........~..~.: .................................................................................
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 "~i~:'il~'l'i~ .............................
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..~...d.11.~.u~..-~......~......~...~..O...IC...~..~....-~.. ............................................................................
b. Intended use and occupancy ....~.~..Y..4~..~.....-j.......~...~..~...~...~.~..~.. ...........................................................................
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................
4. Estimated Cost ..... ..~./.~. ............................................... o-e. ~ d . Fee ..........................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ..... ~ ................. Number of dwelling units on eac~ floor ..:.,...,?
If
6. If 'business, commercial or mixed occupancy, specify nature and extent of each type of use ............................
7. Dimensions of existing structures, if any: Front ....~.....T~....~. ............. Rear ./..~.....Z~? ................ Depth . .~<.."J .............
Height ....... /.~.~.../. ........ Number of Stories ....... /. ........................................................................................................
Dimensions of same structure with alterations or additions: Front ....... ~....2: ..................... Rear 2. 2. /
8. Dimensions of entire new construction: Front ....,Z.~ .......................... Rear ..../...~.. .................. Depth .~...~.. ...............
Height ...... ~ ........... Number of Stories ....... /'. ............................................................................................................
9. Size of lot: Front ............................ Rear .................................... Depth ................................
10. Date of Purchase ........................................................ Nome of Former Owner ........................................................
11. Zone or use district in which premises are situated .....................................................................................................
t2. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................
Name of Architect ...................................................... Address ............................................ Phone No .....................
PLOT DIAGRAM
Locote cleorly ond distinctly all buildings, whether 'existing or proposed, ond indicate oll set-b~ck dimensions from
property lines. Give street ond block number or description according to deed, ond show street names ond indicate
whether interior or corner lot.
I 1''/
STATE OF NEW t¥'ORl~/. 6 ~ t S S
COUNTY OF ...~.~.~ ' ' ~.~
........................................~ ~.~ ...... being duly sworn, deposes and says that he is the applicant
(Name of individual signing appr'meecion) ~~.._ - ,~
above named. He is the ............................................ ..~.....'~.....T..~..~g~....~e:3.~..~W~T... ..............................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make 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·
Swam to before me this ,,~ /& , ~' ~
.............................
· .~..~-~-~,~-,~.--~ ~_~//~ 'g ~.,6f applicar
· ~,omm~ssion Expires March 30, 19.~,
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? 3958 Z
Permission is hereby granted to:
. ..i L... .~ ~,.,~.~.~.. . . ..L, Xo. . ..~ ~..~ . . .z. .~ ..............
Matti~uek
Build s~ ad,litlo~ on an existing:
at premises located at ...~./.~......}."..~.~...~.~.~.~. ........................................................................................
............................................... .1'.~..~ :,,.~,;,.~ k.., ...... ~..,1~.,, .......................................................................
pursucm* to application doted ................................. ~.~. ....... .~.~....., 19...(~, and approved by the
Building Inspector.
~ee ,.~.:~. .............
..
................... ~'~lii~Ji~Jg' i~l~ec~'~"" '-'---"--'---~ ....