HomeMy WebLinkAbout4165-zTOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
~.ERTIFII]ATE DF DI3~.UPANOY
No. ~t .3.1~4 .... Date ..................
THIS CERTIFIES that the building located at~,~..COl; .Ia~130 ................ Street
Map No..:ll~ ........ Block No ..... II ..... Lot No. Ill ... ~tlt;e~losue...li,~e ........
conforms substantially to the Applicati. on for Building Permit heretofore filed in this office
dated ............ ~al~...tO..., 19~. pursuant to which Building Permit No..~.t6~.
dated .......... ~'a~l ....~(~ .... , 149.., 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 ..... Pt';I. vate. accessory..Bu~ld.~ug..(~.ter~e..Bld~) ....................
The certificate is issued t,o . .Le&l~del'. ~eVeF. ............ O~llel' ....................
(owner, lessee or tenant)
of the aforesaid building.
.Suffolk County Department of Health Approval .... N.*.~..· ................................
Building Inspec~r
FO~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTNOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 4165
Permission is hereby granted to:
e y e ~ ~' otc ~.*..~ ..... .{.o; s,~ ~'t:: ~'ro~ ~.~ ...............
to ............... ; .............. ~.. ....... ~ ........ :. .... ; .................. : ..............................................
at premises located at ............................................................................................................................
~'~ and approved by the
pursuant to application dated ............................................................ , 19 ........ ,
Building Inspector.
Fee $ ........ : ...............
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Disapproved a/c ......................... .~.Z .' ......................................
Application No...~.../...~..~.....-~.. ............
(Building Inspector)
APPLICATION FOR BUILDING PERMIT '
Date
......... ~'"""~ .............. E7 .............. ' ............
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 p6blic streets or
areas, and giving a detailed description of layout of property must be drawn on the diagram which is pert bf 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 of the work.
e. No building shall be occupied or used in whole or in part for any purpose whatev6r 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 Southeld Suffolk County, New York, and other applicable Laws, Ordinances or
Regulat ons, for the construction of buildings, additions or a terations, or for remova or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations.
....... ~u~t~'~ ~'? ~'~/~r n ' '
.... .............. '"'r .........
(~ ~/~ L II,~4/ L--' ( ~ ~-C H ~ r-u~
(Address of appficant)
State whether applicant is owner, lessee, agent, architect, engi.neer, 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)
1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................
' Street and Number .....................................................................................................................................................
~unlciPallty
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 Building ....... /........... Addition .................. Alteration ..................
Repair .................. Removal .................. Demoliti~ .................. Other Work (Describe) ........................................
4. Estimated Cost ................................ "*C. ........................... 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 ..~Z.%~..~..~. .......
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 ............ ./..~?..~. ....... Depth ..;...~......./. ...........
Height ...... /...Z...~.~.. 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 .............. ../~..4.~.?...~.~.?..~./..~../...~.....z~.. ...............................................
12. Does proposed construction violate pny zoning law, oj'dinance or regulation? ............ ...'~..?. ........................................
13. r~ame at uwner or premises ...................................... :.Address ............................................ Phone No.
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor .................................................... Address .................................................................
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 description according to deed, and show street names and indicate
whether interior or comer lot.
STATE OF NEW YORK, ! e e
COUNTY OF ................................ ~' ~'~'
................................................................................................. being duly sworn, deposes and says that he is the applicon!
(Name of individual signing al~olication)
above named. He is the .................... ..~.~.~.~.!.~...~.../~ .................................................................................................................
(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
Notary Public, ............................................................ County ' (Signa~re ~¥'~l~ii'~'~ .............................