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HomeMy WebLinkAbout4238-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z...g~..1 ....... Date ................ .0.~.1~....~.6.., 10.~.']. THIS CERTIFIES that the building located at . .0~p.~.e.y..~.e.~ .~. ~t.~. ......... Street Map No. ~.~.e.~t¥.e.s..P..~ Block No....~ ....... Lot No..~.~) ..... G~'~I~Pg.~.~....N.,.~. ~. ....... conforms substantially to the Application for Building Permit heretofore filed in this office 1967 339 dated ... 'Ap~'' '10 .... 1969" 19 .... pursuant to which Building Permit No. dated . I~R. ~ . ~6.~ .&- ~p~. ~96~ -, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P~%7~, ,q~, ~%~.% ,4W~.%%i~g ..................................... The certificate is issued to .~illia~ .~. ~ol~ ....... ~a~. .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ·. p~diD~ ......................... ' Building Inspector FORM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4238 Z Permission is hereby granted to: to at ,premises Iocoted at . Lp.t ~. ~;~ Cl®a~*eB '?O!:nt t~a ;J .... ............................ ~.~LS~, ....(3~pr.~y~¢ &t,.. 2~>&~ .............. ~.e.a~.~ ......................................... pursuan¢ to application dated ............................... ~p~.~ ........ 1.O....., 19...$.~, and approved by the Building Inspector. Disapp~v~ a/c ................ ,,, ....... · ~PLICA~ ~R B~LDING ~RM~ Date /~ l 19 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 Iot and of bqildings o n premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of lay out of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not b e commenced before issuance of Building Permit. d. Upon approval of this application, the Building In spector will issue a Building Permit to the applicant. Such permit shall be kept ~m the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole o~ in part for any purpose whatever until a Certificate .of Occupancy shall have been granted by the Building Inspector. APPLICATION IS I-lk~-~Y 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 build ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply,~/th all applica~]t~ laws, ordinances, building code, (Signature of applicant, or name if a corporation) ..... (Address of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................................................................................................... Name of owner of premise~ ........... ~. ( -~-.~f/. ......[ ./~* .~... */~" · ~.~ '~P' ~ ......................... H a~lie~t is a oo~rate, signature of duly authorize d ~icer. (Name ~d title of co--ate officer) 1. ~ation of l~d ~ which pr~ work will b e done. Map No .... ~t N0.. ~_ ........ ' ....... : ........ ................. Y .................... .......... Municip~i~ 2. S~te exist~g use and ~cup~cy of p~mi~s ~ d intended ~e ~d oc~ of ~ ~ction. a. ~isting use and oceup~cy .................................................................... b. Int~ded ~ .~d ~cup~cy ................................................................... 3. Nature of work (check which applicable): New Building ........ Addition ........ .alteration ...... .. Repair ......... Removal ........ Demolition ........ Other~ oW~?rk (Describe) ...................... 4. Estimated Cost ................................ Fee .... .~ ...................................... (to be paid on filing this application) 5. If dweiling, number of dwelling units .......... Number of dwelling units on each floor .............. If ~arage, number of ears .......................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each t~e of use ........... 7. Dimensions of existing structures, if any'. Front . . . ~...-7.. .......~. Rear . ...~'.7.........~- Depth . .~-. ?... .... __ Height ...... ~ ..~ .... Number of Stories .......... /. .................... ^ ................ ~ ..... Dimensions of sa e structure with alterations or additions nt ~ ~/~- R~-~ ~ ~-~-~- L~3 : ~ ........... .~ ................... Depth ...... ~.. ?.: .~...~ Height .. .... ~P~ ~ ..... Number of Stories ...... (...7..-~. ........ 8. Dimensions of entire .~w construction: Fro.t ..... 3..7. ....... Rear .... ~.? ..... Depth .... ~.~?.. .~ /' Height ............ Number of Stories ............................................................. 9. Size of k~t: Front ....... ~ ..... Rear ..... ./?...~. .... Depth . ./.~..~..~.../..~..~ 10. Date of Purchase .............. /.~..~..~.. ....... Name of Former Owner 11. Zone ar use district in which premises are situated ......... ~....o. .... . .~.~.,~. ................. 12. Does proposed construction violate any 2~ning law, ordinance or regulation? ..... ~ ............... 13. Name of Ownerof premises /~ /~/c Dt-'~ T/-Address /~ L~? ~t~ .~.o. ~ ~']'Phone No?~'~ 33 $ (~ ...................... ~)~--~"r '~ ~: ' 'ii~ o ........... Name of Architect ............................. -~ddress .i..~...i......fillI Phone No ............ Name of ContracWr ............................ Address~~'i Phone No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give s .treet and block number ar description according to deed, and show street names and indicate whether interior o~ ~ lat. [.~ ,-[ ~4~ STA~ OF ~ YO~, )S.S. CO~TY OF .............. ) .................................................... em~ duly swo~, 4e~ and ~s (Name of ~dividual signing applicat~n) c~t a~ve n~ed. He is the ............................................................................ (~a~r, a~ ~r~ate ~icer, etc.) of ~id own~ ~ owne~, ~d ~ duly auth~z~ W p~om or have pe~ ~e ~d ~k ~d ~ m~e ~d file th~ application; ~at ~1 stateme~ ~nta~ in ~is applicon ~ ~e to ~e best of h~ ~owl~ge ~d belief; and that ~e ~k will be p~ ~ ~e mann er set f~ ~ the application filed ~e~wi~. Sworn W befo~ me ~is ......... ..... u ........ .................................................... N~ARY PUBLIC, State of New y~ ~- 52-8125850, Suffo k ~U~ ~m ~p res March ~, Z~ / CLI.:-:;v,_"£: .,' , :.., '-: ",/F"¢F©