HomeMy WebLinkAbout3440-zF~P~M NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
C:ERTIFlC:ATE OF OC:CUPANCY
THIS CERTIFIES that the building located at ,l~/'~.....~4f~.~.~.i~.%t....J~ ......................... Street
Map No....~ ............. Block No ..... ~ ............ Lot No. ~ ......... ~.(~.~.~.~.O.~[.~....,.~.~.~..~. ...................
conform~ substantially to the Application for Building Permit heretofore filed in this office dated
...................................... ~]~,;[~ ....... :J.~...., i9..~., pursuant to which Building Permit No, ..~.~..~1~..~;
doted ................. ~t~, .......... .~.~. ......... , ]?..~., was issued, and conforms fo oil of the requirements
of the applicoble provisions of the Jaw. ~F~e occuponcy for which this certificate is issued is ........
... I~.~'.'l.~t,~...o~e...£~.~Y...O.~.(a .!li~;, ..........................................................................................
The certificat~ is issued to ...~gl~ltt~l...];:~i2Ll~,~rl~JD.P~ ............ QC~'D.¢~3¢. ..................................................
(owner, lessee or tenant)
of the aforesaid building. ,
H,D, ~pproval ;rUlY 1% ~968 by H. Villa
Building Inspector
FORNI NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, lq. Y.
BUILDllqG PERMIT
(THIS PERMIT Must BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? z
PermiSsion is hereby granted t', '' ~' ' : , .
at premises located at .,~..,~-..~.,...~.~.~...:,,*::,.,...~ ..............
.... i~L~ ......... ~, ......... , ...... ,.:.,...L...~...i;.,.,,.~....:.~ ........ :...,: ........ :.........,..:. ......
......... ; .................................... , .......... ~...,~,.... ......................... -.~..~.....! ..... ~..*.~ · ...............,,-~ ......... t*.-..-~-~.
pursuan¢ to application dated ........
Building inspector. ~ : ~' :." ' ' : ": ' '-~
S-9
SCHD
SUFFOLK COUNTY DEPARTMENT OF HEALTH
Bldg. Permit No. ~/~/~>
TO WHOM IT MAY CONCERN:
at
The sewage disposal facilities for a structure located
(Give deed loc~tion)-
have been inspected by this department and found to be satisfactory.
....... t
District Engineer
NO. I
Approved ........................................ ,
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
APPLICATION FOR BUILDING PERMIT
Date
1
INSTRUCTIONS
o. 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 public streets or
areas, and giving a detailed description of layout of propertymust 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 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 Building Department for the issuance of o 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 and regulations.
(Si§nature of applicant, or nome, if o corporation)
..........
(Address of applicant) /
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premise .................................................................................
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 ......... ~ ..............................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction;
o. Existing use and occupancy ...................................................................................................................................
b. Intended use and occupancy .................................................................................................................................
3. Nature of work (check which applicable): New Building ....... ~. ....... Addition .................. Alteration ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ......................................
4, Estimated Cost ............ .~.,~..~.,?,~...c.?..?...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 ................................
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 ............................ Number of Stories .........../ ...............
9. Size of lot: Front .../..~...~:.L./.. ....... Rear ...... ./~. ................. Depth ..........................
10. Date of Purchase ....'.//../..~/...~. ..................................... Name of Former Owner ...~.~.Z'.~,~'..~.x~..~..~..'¢~.~./. ...............
11. Zone or use district in which premises are situated ......... ~.Z~.~...u..I.~...~.. ...............................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ............... ,~...o. ................................
13. Name of Owner of premises ~c~mx'..~./...~fJ.l.'./'.~.~.~lAddress .~,,~..~..-J...q~u..~..~...~..~...CJJct.~.e_.. Phone No. ~.~..~..~...~..7
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor .~../~.,/~'~.&..,r~-h../...~..~.,4..-z.?.~. ...... Address ............................................ Phone No .....................
PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing ar proposed, and indicate all set~back dimensions from
property lines. Give street and block numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
1\
STATE OF NEW Y~,~K~[~ ~V~'~t~ --
COUNTY OF ..... ~/...%'~T...:L....'~~'~' ~ ,~
...... ~ _=~~ ........ ~~.~eing duly sworn, deposes and says that he is the applicant
' (Name of individual signing application)
above named. He is the .............. ~..T.....~...:'.~.% ...............................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file
this application; that all statements contained in this application ore 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.
before me this ,
Sworn to t~ ~ 9
L..(. day of .~; ..~ ,
.................... z~,~., ~ z, 7~ ~ / ~ ..... '~.~~~. .............
Notary Public, .~..~..J~L~. ...... ~.,....L~f~,?~ / - (Si~ture of applicant)
-lerm Expires ~arch 30, ~ .