HomeMy WebLinkAbout2797-ZFOR~I I~0. 4~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
'I'OWN CLERK'S OFFICE
SOUTHOLD. N. Y.
CERTIFICATE OF DP.P-UPANCY
No...~. ].~$9... Date ..... ffmmar~.. 31 ............. 19. &?
THIS CERTIFIES that the building located at .ff~_.kl~ttOn ..................... Street
Map No..~ ....... Block No .... ~ ..... Lot No ...... ~ .......... !~. ~tll~O]~.
conforms substantially to the Applicati.on for Building Permit heretofore filed in this office
dated ....... . .J~..l~...~ .......... , 19..~.S. pursuant to which Building Permit No. 1~7.~?..~.
dated ....... ~.tll~l~ .22 ......... , 19.65, was issued, and conforms to all of the require-
ments .of the .applicable provisions of the law. The occupancy f. or which this certificate is
issued is .... ~..d.~.~..~.1..OJ)...~jl~..~.~..t~4l~:~:g.. llMSJ~,:~g ..................................
The certificate is issued t,o .... .~...~..8...~.0.nq.o.z'. .......................................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .........................................
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? 2797 Z Date ............................. ~.....~.~ ...........,
Permission is hereby granted to:
(ioldsmi-t~...~l.~rtg..&..Gen~t, · ...I:neeA/G..... Ja~e s Conno~
............ $o~tl~o'ld¥...g'~-¥'~ ..................................
to ....... ~1,l~..u..a~l.~.~ien.-~a..aa-.exi~,i~...d~et. Iir~ ...................................................
at premises located at .~/l~..,,.~'~,~ltM~t..~ ........................................................................................
.......................................................... N..-~.. S~.£~ -Z]I:.t ........ lf,.~., ...........................................................
pursuant to application dated ................ ~11~ ........... ~2 ..................... 19~..., and approved by the
Building Inspector
Building Insp~?tor (
FORM NO. I
~N OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ........................................ , 1~:~. ...... Permit No...~.. .... '~.........C~ ...... "~ ~__~.....
Disapproved a/c .~.....~.......~
APPLICATION FOR BUILDING PERMIT
Date ......... /~ .~... .................................. , 19...~
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
b. Plat 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 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 removal or demolition, os herein described.
The applicant agrees to comply with oll applicable laws, ordinances, building code and regulations.
(Signature of applicant, or name, if o corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engi,neer, general contractor, electrician, plumber or builder.
Name of owner of premises ....... ~~ ....... .~I~[~L~I~'j~, .......................................................
If applicant is o 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.: ........................
Stre~ and Number ...~'.~.....';~'..(4~.'~. ....... ~".".".".".".~...,/~,~.., .........~..~-...~..~.~-4 ...................
Municipality
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 .............. ~'.~iK'-~... ..................................................
4.
5.
6.
13.
Nature of work (check which applicable): New Bui'tdinfl ' Addition ....~ .......... Alteration ..................
Repair .................. Removal .................. Demolition .............. :... Other Work (Describe) ........................................
Estimated Cost ....... .~..,~.~...~.. ................... ......... Fee .~.~....~..,..../(~,.. ...........................................................................
(to be paid on filing this application)
............................ Number of dwelling units on each floor ..../. ......................
If dwelling, number of dwelling units
If garage, number of cars .............~.?...~..-~... .....................................................................................................................
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 additiq~s: Front ..... ~ ......................... Rear . '.,,,?~.. ......................
Depth ........... ~.~.../. ............. Height ............................ Number of Stories ................................
Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................
Height .................... Number Of Stories ......................................................................................................................
Size of lot: Front ....... .~'..~..~ ............. Rear ........... ~..~..~ .................. Depth ....~..4'.~...~.. .................
Date of Purchase .~...~'.~f,,¢~'../~...~.. .............................. Name of Former Owner .f,M'~zY. ig.~Z....~. .................................
Zone or use district in which premises are situated ............ ~.~7~f/g~'~//:g'~.~. ..........................................................
Does proposed construction violate any zoning law, ordinance or regulation? ....z~.~..~ ................................................
Name of Owner of premises ~'./,~',~;~,....~.'./..~...~'..o./~ .......... Address .~',~:~,.,'~.~/~:... .............. Phone No .....................
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ~/,,Z;~/~.lZ~....~-~f~.,....Address .~....~.~.~...~.. ........................ Phone No. ~.CJ..~.~. ........
PLOT DIAGRAM
Locote clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from
property lines. Give street and block number or description according to deed, and show street names ond indicate
whether interior or corner lot. "-~l'~q
1
STATE OF NEW¥ORI~I ~ ,~ ~c
COUNTY OF ;,..~~' ....
....... /~.~Z?..~.......i~..~J~'~/.~. ................................ being duly sworn, deposes and says that he is fha applicant
(Name of individual signing application)
above named. He is the ...~/'Z~./~].~]--~.~.....~...~'~,~.....~.'~.~..¢..~...~. ..................................................................
(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 conta:ined 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 befor~ me this
...... ? o, ..... .... ........................................
Notary Public, ~ .1~.. z.~ C~oun.ty --7 (S,gnature of applicant)
No. 52.0344963, Suffo!~ County