HomeMy WebLinkAbout4625-zFORM NO. ,1
TOWN OF SOUTHOLD
BUll,DING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z..~803 ..... Date ............ F.~ .... 39 ..... ,19.7O.
THIS CERTIFIES that the building located at l~..q. Smith..li&l'bo~..~ .... Street
Map No .... xx ....... Block No.. ~ ...... Lot No.. x~ ..... 8o~thold .... l~b¥~ ....
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ......... Feb ..... L~.., 19. ~0 pursuant to which Building Permit No.. ~627.7..
dated ......... Feb ...... 26", 19. ?(~ was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
Lssued is .... Farm 'storage'& 'on~.~re~J~ez' 1~o1-' '~1~ ........................
The certificate is issued to ...... Fre~ ,. LeFpe ....... I~ner ........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . see. ap3, .I~oll, .ea~p. pez~$t ......
TCY~N OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFIGE
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 4625 Z
Building Inspector.
...........
Permission is hereby granted to:
.............. · .~~..~.~..T~i~L .....................
..................... .~.~..,~t::~...iJmul ........................
........................ ~f.l~lii ......... ,~:~ .................
to ..... ImL1,cL ~m~..,f,z~.. ia~.~.L~...C..Zal~... ~e,~ ..~.. ~ta:mal:e...l~. .......................
at premises located at .........
....................................................J ~m:~L ......~.~,~ ........................................................................
pursuc~n¢ to application dated ............................ .~,~ ....... j~ ........... , 19]..~, and approved by the
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Appmvecl ~ 19....~.... Permit No. /'~(~ a~' ~
Disapproved a/c ........... ~ ....... ~..~,,~......~,~. ............. ... .........
Application No.....?..~.....~....-~. ..........
APPLICATION FOR BUILDING~ P~,I i~
............................... ,
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 pub c streets or
areas, and giving o detailed descriphon of layout of property must be drown 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 o 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 Bud ng Perm t pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ord nonces or
Regulations, for the construction of buildings, additions or alterations, or for removal or demo t on, as here n described.
The applicant agrees to comply with all applicable laws, ordinan/~,~ b~li?g ~ile, _ho~using cc ~ and regulations.
........
(Address of ap ,licant) //~/
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises
If applicant is a corporate, signature of duly authorized officer.
1. Location of land on which proposed w wi don Nt No.' ~ - /v~t o '
'~ Street and Number ~~ ....... '.'..iiiiiiiiiiiii iii ii
~'~3 ~ ' Municipdlity
2. State existing use and occupancy[~l~ses ~7 i~j~u~~of proposed, construction:
b. Intended use and occupancy/.~.~3c~'r(/~k~r~......'~-,~..~..~.... ....................... : ..............................
3. Nature of work (check which applicable): New Building ...,,~... ..... Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................
4. Estimated Cost ..... ~..~ .
N (to be paid on filing this application)
5. If dwelling, number of dwelling unit umber of dwelling units on each floo~ ............................
If garage, number of cars .............................................................................................................................................
6. If business, commercial or mixed occupancy, speci~ 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 ............................ ~q.urober~f Stories .................
8. Dimensions of e~tire new construction: Front ......... ~....~.... ............ Rear ......~...~ ....... ~ ....... Depth ...-~.. ...................
Height ........ ~. ........ Number of S~ries ..... .Z .......................................... : ......................................... ~ .......................
9. Size of lot: Front .,/~....'..~../~. Rear ...~ ................ Depth ................................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
11. Zone or use district in which pr~mises are situated .....................................................................................................
12. Does proposed construction v_io.I/~y, z~i.~w}~ordinance or :e~gu~lat~.~~_...~..~.~.~.--~~~o / .z~...~f.~...
13. Name of Owner of p~~dress~~
Name of Architect .~..t~ .~~ ................ Addre~..~ ..~.;~.... Phone "o
Name of .................
PLOT DIAGRAM~ ·
Locote clearly and distinctly all buildings, whether existing or prOPosed, and indicate all set-bc~,k dimensions from
property lines. G!ve street and block number or description according to deed, and show street names and indicate
whether interior or comer lot.
!!!T..N.E- -'~.0..F. · .0.! .~ ~::::~-;~~ ......... 3'~g duly sworn, d~oses and says t~t he is the applicant
......... ::: ............................................................
(Contractor, agent, co,orate officer, etc.)
0f said owner or ~ners, and is duly authorized to perform or have performed the said work and to ~ke ~d 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 fo~h in the applic~n~ ther~ith.
Swom to before me ~is ~ ~ ) // // , ~
.... ......... o, .......... ,
N~kRY PUBLIO. State of N~ ~o~
N0. 5~'8]25~O' Sul~i~ ~ '
Term ExP]r~"~h 30, t~