HomeMy WebLinkAbout6133-zFOEM NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTME, NT
Town Clerk's Office
$outhold, 1~. Y.
Certificate Of Occupancy
No. ~5779 ...... Date ...........F.e.b. .... .~. ....... , 19..7.4
THIS CERTIFIES that the building located at . ~,/$.. t~ol$~eau. 4are ...... Street
Map No..xx ......... Block No...z.x ...... Lot No. z. xx ..... ~ou.t, hoZ c~..~I,X~ .......
conforms substantially to the Application for Building Permit heretofore filed in this office
Sept
21
dated
pursuant to which Building Permit ~To..67~.Z
dated .Sept .21..~.72~..Aug..1., lg?~.., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . Pr.~.vate..e~.mm$ng..(~e$~$ory..)..9oo~ .~..th. Cenee. e.te ............
The certificate is issued to ... Oamrge. !%rz~e. ,Tr.... 0taxer ........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval I~ .IL ................................
UNDERWRITERS CERTIFICATE No... Kt09~95.... Aug...L6.. 1 ~.7.3 ..............
HOUSE NUMBER .... lb~o .....Street .. -Bel.$~e&~. -Ave .........................
Building Inspector
~OE]E NO. :~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y,
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CO~MPLETION OF THE WORK AUTHORIZED)
N? 6133 Z
Permission is hereby grcnted to:
6~aea'~e.. & ..Id~a.....~aa, g,a~ ...............................
........................ · ~t~]~.X~ ....................................
to ~e.~meta~a~-k~.a~M~.~c~t~re1:~1~a~T~.
......... l~Z~. J[,P~tL~.. eaat ..[a~q,r .. ~n$ ..1~.. ~£...~.~...[~~ ....................................................
ct premises Iocoted ct '"'~'~"']~l~.~l~l~'~'~r'~"~'~[ib'~"]~'~il~' ...............................................
...................................................... a o~Lt, ho.~.4 ......................................................................................
pursuant to cpplicotion doted .......................... ~$p~; ....... ~ ........ ~ ]9.~..., ~nd opproved b~ the
Building Inspector.
Fee $9,~], ........ :..
I~)BM BO. !
TOWN OF SOUTNOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y,
Application No. ~ (' ~ ~ ~
Disapproved a/c .......................................................... ~
APPLICATION FOR BUILDING PERMIT ~
...... ......
INSTRUCTIONS r~ww
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspecto
3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, am
giving a detailed description of layout of property must be drawn on 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 Bui]ding Permit to the applicant. Such permit shall be
the premises available for inspection throughout 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 Depertrnent for the issuance of a Building Permit pursuant to the Building Zo
Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations for the construction
buildings, additions or alterations, or for removal or demolition, as herein described. The appiicent agrees to comply with all applJceb]e laws~
ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections.\
(Signatu~ of applicant, or name, if a c~poration)
........
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~
................................................ ...............................................................................................................................
Name of owner of premises £.~. C ~ ~ ~ ~ ~ ~o~ ~-
If applicant i~.a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Location of lend on which proposed work will be done. Map No.: ........-~. ........... Lot No ........... *. .................................
Street and Number ........ ..~..,,~.,~. ........ ...~...~,/.~.~.....~.....~......~..d..~ ................................................. ,,,~.~.~..~..~.o..,/,,,~,. .............
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
I
a. Existing use and occupancy .............................................. ~. ..................................................................................
b. Intended use and occupancy ................ ............~...~.~....~...~.-~.... .............................................................................. ~.~,
I~ature of work (check which applicable): New Building ....................... Addition ..................... Alteration ...............
Repair ......................... Removal ......................... Demolition ........................ Other Work .,.~...E..~..4..~....~....~...~...~.'...
(De{cription)
4. Estimamd Co~ .......-- ~..~..E~. ................
Fee .....................~..............~....~.~.~....'..................~.........'...~.............
(to be paid on filing this application)
5. If d~lling, number of d~lling units ........ ~ .......Numar of dwelling uni~ on each floor .............. ~ ..........................
~ ..
If ~ara~, number of cars ..........................................................................................................................................
g. If busings, commercial or mixed oceupaneg, s~cif~ nature and extent of each Wpo of u~ ........ ~. ...........................
7. Dimen~ion~ of exi~tin~ structures~ if an~: Front .....(..~....~..... ~ear .......... .{..~-..~.... Depth ...... ~.5 ..............
Height ................... ~..[..~. ............................ Number of Stories ................ L ..........................................................
Dimensions of same structure with alterations or additions: Front ...... ~..Z..~ ...... Rear
/
'~ - ei ht
Depth ............................................. H g ......................................... Number of Stories ........................................
8. Dimensions of entire new construction: Front ....... .~. .......... Rear .......... ~.~ ........... Depth ...... ~ ................
f ·
Height ................................................. Number o Stories .........................................................................................
Rear ............. ~..~.~. .................. Depth ..................................................
9. Size of lot: Front ............. ~.~.~ ..............
Height .................................................... Numar of Stories ..................................................................................... .
10. Date of Purchase ........ ~....%.-:...~. .............. Name of Former Owner ....... f~..t ...............................................................
11. Zone or use district in which premiss are ~ituat*d .................................. ~......~.'..:.. ............... ~X~;~.~..;.~.tTx~ ...........
12. Doe~ propo~d construction violat~ an~ zoninfl law, ordinaneo or m~u~ation: ......... ~ ...........................................
13. Will lot be re,faded_~_...........................~ ~ill exe~* fill b~ removed from ~romises: [ ] Yo~ ~
14. Name of Owner of premiss .... ~.~:..~....~.~ ........~ .................. ~..~.~f; ...........
(Address) (Phone No.)
Name of Architect .....................................................................................................................................................
(Address) (Phone
Name of Contractor ...................................................................................................................................................
(Address) (Phone No.)
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block number or de_sl~ription according to deed, and show street names and indicate wheth-
er interior or corner lot. /~1 ~'~/- Pi,~
.%
STATE OF EW ¥O.K... I '
/~" ~,
........................... ~:~.~.C~'.~ ......... ~.,....~.~.~.~.~....~.~.,... being duly sworn, deposes and says that he is the applicant above named.
(Name of individual ~i~in~ con~ct)
He is the ........................................................................ ~.~..~.~ .................................................................................................................
( Co~tr~ctor, ~Ee~t, corporate o[~cer, etc.)
of said owner or owners, and is duly authorized to ~rform or have performed the said work and to make and file this application; that all
statements contained in this application are true to t~.best ~T¢~ and belief; and that the work will be ~rformed in the ~nner
set forth in the application filed therewith moto~ PuS~ic. Stele ~ ~e~ Y~>r~
·
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