HomeMy WebLinkAbout4432-zFOR~ NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificnte Of Occupnncy
No.Z..37~ ..... Date ............ Apl'L].... 2 .... , 19.
THIS CERTIFIES that the building located at .... C®ntl'a'~ .Dl, ............ Street
Map No. C&pt. IL~dd. Block No..xx ...... Lot No..$~6 .... l~at~;$tuek.. H,~, .......
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............ &t~ .2~. , 19.{~9 pursuant to which Building Permit No..
dated ........... A~I~...2~. , 19.09, was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is ..... l~rl.vate· Garage .-(~eee~o~ .B~- -ld~m$) ........................
The certificate is issued to . .VLad:l]~.~o. & ~e~bi&. Z~$tt~ak ..... 0~r~el, II ..........
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval · · N.,.R, .............................
House
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 432 Z
Permission is hereby granted to:
at premises located at ................ ,~t...~l~....~jl~t,.Jr~..~Jm~ .............................................
......................................................... C~et~..~,$ve ......... I~t,I,.'~ek.....J'.,,'J... .........................
pursuant to application doted .......................... J~j....~9~ ................. , 19:.~1~, and approved by the
Building Inspector.
Fee $.~ .............
IN~Mf NO. I
'TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOIJTHOLD, No ¥o
Examined .................................. , 19 ........
Approved ........................................ , 19 ........ Permit No .............................
AppIicot'ion No.......,. ....................
Disapproved o/c ..... ~ ............ ~
tOuilalng InSpecTor) /
APPLICATION FOR~'~UiLDING PERMII'
INSTRuCTIoNS ,~,,
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building ~
InSpector. ~i,
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or J~
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 this application, the Building Inspector will issue a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspectio0 thrqu, ghout 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 remova or demolition, as herein described.
The applicant ~grees to comply with all applicable laws, ordinances, building code, housing code, and regulations.
( 'g ureo applicant, or name, if a corporation)~
......
(Address of applicant)
State whether applicant is owner, leSsee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................... i ......... .............................................................................. : ................................................................
Name of owner of premises .~...~...~.....~../....~../...~..0 ~). ,...~. 2,,~/VI),/~/,/~ Z/~"
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 artd ~ tl~be.r .........:, .......................... ? ....... L~ ......................................... !..~..~.. ............ ,,.,~,~,,Z~.,;~,,,,..r./. ....... .~.
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ........ ~,~,,~,,,,,,~..,,~,,..~,./,~,,,~,,,.,,,~'d~/~.~,,~m~. ......................................................
n,ended u. and occupa.. ... .....
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ....~.~.../~..,%P/~....~....~.. ............
4. Estimated Cost ........" ---" --~.....~...'/...~.....~?... .......................... 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 .............. ..O./~..~........~..../~....~.. ...................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................
7. Dimensions of existing structures, Jf 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 ....... /..~.....~. ........... Depth
Height .................... Number of Stories
9. Size of lot: Front ........../..O...~..[. ......... Rear .............. ?.~.~.../. ............ Depth ............. ./.Z..O.~ .........
10. Date of Purchase ..... ..-~....6f./,..~....~.r./...~.~..~.. ............... Name of Former Owner
11. Zone or use district in which p~'emises are situated '~:~"
12. Does proposed construction violate any zoning law, ordinance or regulation? ...... .A(...~. .............................. ~'~'~':: ........
13. Name of Owner of premises ....~,~./-~.~:.~'J...~.. ...... Address
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor .................................................... Address ............................................ Phone No .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back .imensions from
property lines. Give street and block number or description according to deed, and q.nd indicate
whether i~terior or corner lot. ~a~(o
STATE OF NEW YORK,~
COUNTY' OF .............. .~.....~... ....... ,( '"'""'
. ~.Z.../~. / ..,~./..~..~......~. i....~....~...~....~..~:..~....J~.. ................. ?. .................. being 'e" -I
duty sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is the ...... .~....~/.....~....~...~<. · ...............................................................................................................................
(Cont_ra_ctor, 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.
Sworn to before me this __ ,./Votary ~OH,~.~. //
~o. O.~.O,.-ubt~e '-eS ~ . .
................... ./... day,of ................
Notary
Public,