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HomeMy WebLinkAbout3455-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...... Z.. 3t.'/.7:) ....... Date .............. As,~/~ t~..2.~, r .................. , 19.68. THIS CERTIFIES that the building located at .~tt~3,e..,~eco~L~..l~a.y..,~o~ ............ Street Map No.~asaa~...~t~BIock No ....................... Lot No. ~O0y...~&B~,~t~..~.~.,~,...C~t,~oS~ll~,...~l, ¥. ~ . . conforms su~c~nhally to the Application for Building Permit heretofore filed in this office dated ........................ ~.1...2.~..~. .................... , 19...6.'/. pursuant to which Building Permit No. 3.45~..~. dated .............. ~.~'.i.1...~9¥ ................... , 19.6~.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .... .p~:~Lv~te ..s.torage..bu,~l ¢1An9 ...(ac.~eeaor.y...b~ ~,lcl~ng.) ................................................ The certificate Js issued to IgO.~aatl..H,..~r,~o~E ..(.o~l~e~ .............................................................. (owner, lessee or tenant) of the aforeso'id building. ' 'Building In~'~'~ctor ......... ~, ' FOF~I 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? 3t55 Z Permission is hereby granted t0:~ H ]~p~ .................. ~~ ......... ~ ......... : ......... ~ ...... :... : to ~et ~ ~.ta~..~:.~.:.~..~.~..~ ................... : ........ : ............. located at ............................... ............. : ............ : ...... :'L' ...... ~ ......... : ..... : ......... ~'"-~ .............................................. pursuan~ to opp!idation doted ..,:..~ ............. , ...... ~ ......... ;.... ~ ......... ';.;., 19,.~...., ond Op~roV~ by the Fee $....;~ ........ ~ ...... ,.. , - FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ...................... .~.! ............... , 19....q.... Permit No. Disapproved a/c ............................................................. Application No.....~.....~.i...':~....-~.. ........ APPLICATION FOR BUILDING PERMIT Date ....... ......................... , 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 public streets or areas, and giving a detailed description of layout of property must 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 Jn 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 Lows, 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, buildipg code and regulatiot~S, .......................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premise~ ......... ~ .................................................................................... If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which pro~ed wor,~ill be done. ~ap No' [~...~..~ ~/~..~.~ot No' ~ ® - Stre~ and Number ......... ~...~..~.~.~m.~r.m...~.wr..~.~ ...................... n:.~.....,....~...' / Munici~li~ .... ~'""~ ~ 2. State existing use and ~cupancy of premises and ~tended use and ~c~pancy of propos~ construction: - ......... I0. 11. 12. 13. / Nature of work (check which applicable): New Building ....... ~......... Addition .................. Alteration .................. Repair .................. ,~Removal ................. Demolition ................. Other Work (Descr be) ............. Es 'mated Cost ....... Z.....~. ........................................... Fee .................................... (to be paid on filing this application) If dwelling, number of dwelling units ........ ~ ................. Numbe/~, of~welli,~g units on each floor ............................ garage, number of cars ........h.i,iJ. ~'~ .- . ~ ~ .,-~..~.....~...~.~..~....../~...~..].~~ ................................................. If If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 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 ................................ Dimensions~of entire new construction Front Z~.. ~ Rear ./...~...~. ........... Depth Height....~..'.~..". .... Number of Star,es ....... ./. .............................................................. Size of at: Front .~..~.....~ ....... Rear ./~....J~.. ........... Depth ~.~.'~ ,q .... Date of Purchase ........... ../.~.......'~... .................. Name f Fo-mer"~''''''~'''''~ Zone or use district in which premises are sitUated.........._...... ...... ,,~/~,, , ~j,,,~, ~.~, ~../F=:~=~.~...~...~...~..~./...~.~.-.~~"~..~..~..~..~.~......~.....~.... Does proposed construction v o at any zonina law,ordinance or,~eaulat~o~: ~ ~ ~ ~ .............. ~':r~ .......................... Name of Owner of premises-..,/~--~'""~"'/"~ddress .../..~~./~/~~ ~'l~one No...~...~.....~....-.'./..~'~' Name of Architect ..~... ~ .Address ............ Phone No Name of Contractor .......... ./.~ ~ ......................... Address ............................................ Phone No PLOT DIAGRAM Locate clearly ond 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 corner lot. /o 'h) Z. ;LZ], STATE OF NEW YORK, COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and says tho¢ he is the applicant (Name of individual signing application) 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 ma:kc 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 ............. ~..~...~oy of ....-....~~-' ~ .............. , ,~....~..~ ~/~ .... "z/~,, ' ...................