HomeMy WebLinkAbout3851-zFORM NO. '~
TOWN OF SOUTHOLD
BUILDING DI~PARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE DF OCCUPANCY
No.. ~.. 3065.. · Date ......... 1~¥..3 .............. 19 6.8..
THIS CERTIFIES that the building located at ]Eat~tl: .l~al~e .............. Street
Map No .......... Block No ............. Lot No. Igamt: J~t~;[~l~, .L...~[, ,. l~e~. ~Q~k
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ..... Ap~t% .22 ...... , 19.68. pursuant to which Building Permit No.3581. ~ .
dated ...... ~pzi).. 22 ........ , 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 . . p~.~,v.a.~.e..Q~le..E.~t~;[%l~., d.w.e~,$ii~lg. .............. - ........................
The certi[icate is issued to ..... l~,..lYla~ea~co .......................................
(owner, lessee m' tenant)
of the aforesaid building. ~
Suffolk County Department of Health Approval ..... /..~. f..l~.~. ....................
...... /~W]-c~l~ilding inspector / '
FO~ NO. ~
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? 3851 Z
Permission is hereby granted to:
..~el~.. lte~s,,e....!~.. ~s..~.~.. ............
... ~, .*..~.. ....................... ~
pursuant to application dated ... ......................... ~ .,~...~. ...................... , ...... and
Building Inspector,
FO~ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Application No.
Approved ........................................ , 19 ........ Permit No .............................
Disapproved a/c ~-~2. . ~.~ ~,,.~ .~ ......
"'"" ................. '{'~'~(Idi~"i;~;~" ...............................
/
APPLICATION POR gUILDING PEi~IT
A~r 22 19 68
Date .................. ? ......................................... , ............
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 pr,~mi~es 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 Buildin~ Permit.
d. Upon appFoval 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, housing code, and regulations.
John H~pon:~ ~
(Signature of applicant, or name, if a corporation)
~outl~oZd
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Oontraeto~
~ Massa~o
Nome of owner of premises ....................................................................................................................................................
If applicant is a corporate, signature of duly authorized officer.
..... ~ ............. L...~ ......................................... ~.,..,;..,..~ .................
(Name and title of corporate officer)
1. Location of rand on which proposed work will be done. Map No.: .......... ~ ......................... Lot No.: ...... ~ .............
Street and Number ...~..~.~...b..~...t¢....L....a~...~ ....... ~..~.....~..a.~..~..o...~.. ..........................................................................................
Municipali~
2. State existing use'an~ occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ........ ~.~.~ ........................................................................................................
same with ~ addition
b. Intended use and occupancy .................................................... .................................... . ........................................
3. Nature of work (check which applicable): New Building .................. Addition ~J~
....~;;r;.: ....... Alteration ..... ~ ......
Repair .................. Removal ..................Demolition .................. Other Work (Describe) ...~ ....................................
4. Estimated Cost ..... ~.~.~..0..0. ........................................... Fee ...... ~..~.0...0. ...................................... ' ....................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ..... .O...~.~. ........ ....... 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 us,e ............................
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...................~................. Rear ........... .1.~ ............ ;. Depth ........ '~.~. ...........
Height .................... Number of Stories ...... 0~i~. ...................................................
9. Size of lot: Front ...~ ......................... Rear .................................... Depth .................................
10. Dote of Purchase ........................................................ Name of Former Owner ................... ; ....................................
] ]. Zone or use district in which premises ore situated ........................ ~1..~, ......................................................................
]2. Does proposed con§truc'tion violate any zoning Iow, ordinance or regulation? ....... .~..~. ................................................
13. Name of Owner of premises .~.~..,.~..~..~.~.¢). .............. Address .......~..t..,~..~,~.~.O..~.. ................ 'Phone No .....................
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ...... ~.~...~.~.~..O_~...~.~ ...................... Address .....~..O...~..~.~,O.~.~. ..................... Phone No .....................
PLOT DIAGRAM
/_ocote clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW~.'~]~I~,, t ¢ c
COUNTY OF ..?...~.~..~.?...'~.. ............. ?"~'
..................................... ~.~..~ ............................... being duly sworn, deposes and says that he is the applicant
(Name of ihdividua[ signing app/icotion) ~
above named. He is the ......................... ~.~ .......................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized t~ 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 wiJl be performed in the manner set forth in the application filed therewith.
Sworn to before me this
N0 5~-~618100 Suffolk 'Coun~