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HomeMy WebLinkAbout4371-zFOB~ NO. ~ TOWN OF SOU'mOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .... llij~'""~6Y~ll~"A~fl~ ................................ Street Map No ......... ;j~ .......... Bloc~ No. '":~1[ .............. Lot No. '~11~ .............. l~[~'~J.l~tt .......~'~' ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................ ~T~'"'T ................. , 19...69 pursuant to which Building Permit No. dated ........................... ~TI~' ....... ~ ......... , 19 ...... ~)vas issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ............ · al~.~u~ t~'/'"('~o~i~ )" ~d'~n~ .......................................................................... The certificate is issued to ....~l~l~g.~'~..~'~e~..J,l~ ............ ~ .................................................. (owner, lessee or tenant) of the aforesaid building. House f 71~ Building Inspector FOR~ 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) 4371 Permission is hereby granted to: ............. ~a~cL.~e~l~ea .................................. .................. · 3~..fi..JL~ ....................................... .................. I~.t, tJJlJ~ ....................................... to ............. ~t~.,z~e~...£~,a~..l~,--~, ~,B~:~e.. ~d~l,~ ............. ,, ................................. at premises located at .................... ~4~......~.g~..~r~ ....................................................... ..................................................... Mat~t~;....~.~. ........................................................................ pursuan~ to application dated ................................ Z~. ....... 1 ......... , 19.6~.., and approved by the Building Inspector. Fee $..1~1 .......... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ....... ~ (Building InSpector) Application No..,,,~,..~.Z~. ........... ~ APPLICATION FOR BUILDING PERMIT Rte ........................ .//.. ......................... , INSTRUCTIONS a. This application mU~¥ be completely filled in by typewriter or in ink and submitted~n duplicate to the Building Inspector. of lot and of build ngs on premises, relationship to adjoining premises or public st.reets or b. Plot plan showin.~ ocat on areas, and giving a detailed description of layout of property must be drawn on the diagram wh ch s port of th s app ~cation. 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 Bud ng Department for the issuance of a Building Permit pursuant to the Bu ding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other gpplicabte 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. ....... .......... (Address of applicant) 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.: ............. u. ......... ,~.....;_.....'l'ot NO.: ........................ Street and Number ....... ..~...~./~...-,[../~..l~'.......c~?.~/45tf.~....~,~...l .... { · 2. State existing use and occupancy of premises and intended use and occupancy of proposed cons~'ruction: a. Existing use and occupancy .............. ~-~41~.~..~...~-..~.~........ ................................................. .. ,, ,,,, ...!. b. nrenaeo use aha occupancy ................ n4..~.~r~ ~.~.~, ,...~ ................ /-. ...... / 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Re[novel .................. Demolition .................. Other Work (Describe) ........................................ ~r ,,~ , 0o 4. Estimated Cost ................~...a,~...~...a. ................................ 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 ............................................................................................................................................. 11. 12. 13. property lines. Give street and block number or description according to deed, and show street names and wh~ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .......'~T... .................. 7. Dimensions of existing structures, if any: Front ...... ~ .......... Rear ........... ~ .......... Depth ...~ ..... Dimensions'~'~--ot some structure with alterations or additions: Front ................................ :... Rear ............................ Depth ..'/~i~l~. ....... Height ......................... ~nN~.~ber of Stories .............. i ................. Dimensions of entire new construction: Front .....~lli~,,... Rear ..... .~....~..q. ........... Depth Date of Purchase .............................. ~ ......................... Name of Former Owner ........................................................ Zone or use district in which premises are situated ...... ~f~/.~.~..~.~.&~. ............................................. ..................... · Does proposed construction Violate any zoning law, ordinance or regulation? ....... ~//.,) ............................................... Name of Owner of premises ...~....~..~..~. ............. Address ............................................ Phone No ..................... Nome of Architect .............~ ............................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from indicate nterior or corner lot. STATE OF N ~b'~.~_ tee COUNTY OF~;~../~..l.'...~.....~~'~''~/'~/~] ~ .( /'~..~., J/' / ', (Name of individual signing apph'c.g.t.!bn) . ' above named He is the . ' , ', (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized ~o p~erform o~):~e"l~erformed the said work and to make and file this application; that all statements contained dn,'this appl~,cat~rue to the best of his knowledge and belief; and that the work will be performe~e manner {~} f~rth-in the~llLl~q~ filed therewith. ' Sworn to befo, m me this ~, ~ /7 1~2~ ~l..~.:,~: ~~' ..................