HomeMy WebLinkAbout7531-zFO~ NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Ot~ice
Southold, N. Y.
Certificate Of Occupancy
THIS CERTIFIES that the building located at . Deep. H~le. Df. ire ......... Street
Map No...~_x ....... Block No ....... ~ .Lot No, . Y,~... ~4.a.~t..i.t.u.e.k....N.,..Y: ........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .............. ~ep~;.. %t19. .71~· pursuant to which Building Permit No.
dated ............ Sept...] ].., 19.?.~., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . .Prl. Va~;~..&CC~.s.~QI'y..($.~.o.l~.~g~). b.~.:~,d.~.r$~ ...........................
The certificate is issued to Mae. Mllle~... (. Nfo. ~.d.W, ) ..... ~. .................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . .N.*~.*. .............................
UNDERWRITERS CERTIFICATE No. 1~ ,~., ........................................
HOUSE NUMBER ...... g.~.00... Street .... J~W. ~.~f0~!~. A.v.e. ...................
Building Inspector
FOI~MI NO, ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
N? 7531 Z
Permission is hereby granted to:
r[a~..i~-~te~ ........................................................
.... .7..~.....;)..~.p..~.o ;l~ - ~).r ~.v.e ..............................
to B~f J~.. ~e;~...a¢¢ ~s a~r.~...( .s ¢e~a,~e... ~)-.bu~t&d..in~; ..............................................................
at premises located at -.?~.-..~.)-ee*I)..~o.l.e.-Dy.~v~ ........................................... ~ .................................
......................................................... ~%.t~.tue~ ...... ~g ,-Y- ..................................................................
pursuant to application dated ............................. S~:b....']..~ ........ , ]9~...~...., end approved by the
Building Inspector. j~tq~,' "~, Attac)'~ to d~e].li~g with lattice Or othe~ s~[3~ ~ate:[~
Fee ! $ .',1.¢~,¥,~,~. ...........
............ i t'~/ .........
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
ORDER TO REMEDY VIOLATION
Da te ~.,~7,,~.z.,.,_. r,.,~: ~ .~,~,~..,.~ ...... ~ 19 ........
~ ",~ y/, ' ,,.
· ........ ..........
towner or authorizea agent ot owner~
~dress ot o~ner or ~utnonzed ~genr or owner;
PLEASE TAKE NOTICE there exists ~ viobtion of:
Zoning Ordinance '~'t~ ~'~'"~'~
Other Applicable k~ws, Ordinances or Re~ulotions ..........................................
premises hereinoffer described in that
~st~te cn~roctor ot v,ol~on~
.A.~.:~......~. ::~:m7¢., v .~.....~r~d..~.¥/.~.~.....~.....~.. ~¢~..~.... -, .....~ ~ .......
...... . .............. ----' /~-' ........ ",:.~,~.~.,.,L...f.~,~-~--' ~ -" ' " ..... ~-:~,.~..,.~.
~,obt.o, o~ ...~],~:,.~....~.,.,., ....... =...~.~.-~: ........ .~.~...,, .I~ ...... : .....................
(~ta~e'~'~ion~ragra~5~pp~able Ta~, o~inance or regulation)
YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the
conditions obove mentioned forthwith in or before~the ..... '/~'*~'~'~';t,~';~'2 ....
day of .......... ~,....,;T,~.~...~,..~...~:~.,~~. ........... 19._
The premises to which this ORDER TO REMEDY VlO~TION refers are situated at
-,..,...:...,.,~,~,.,.z,. r~x¢....~.-...~..,.~.K,,.,...,~,~.~ ~ ~ /~ ~.~ ................ County of Suffolk, New York.
F~,ilure to remedy the conditions ~ores~id ~nd to comply with t~e
m~y constitute ~n offen~e punishable by fineor imp~}~ ~..~' , ,-~;~'*t Ot both~.
,
~uiDJn~ m~pector
FO~M NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined .
,,
Approved .............. .~.) ......... .~.) ........... , 19 ........ Permit No .....................................
Disapproved a/c~~.............~.~.___._.___
(Building Inspecto~
APPLICATION FOR BUILDING PERMIT
Date ........................ , 19...,.
INSTRUCTIONS
o. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the BuildingS.
Inspector, with 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 adjo n ng pram sas or pub ic streets or
areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. ~f,~
c. The work covered by this application may not be commenced befoFe issuance of Building Permit.
,d;, ,U,pon approval of this application, the Building Inspector will issue o Building Permit to the app cant Such perr~it~
snau ae Kept on 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 Occupan'~v
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 ~'e"~i
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, housing code, and regulations, and to
admit authorized inspectors on premises and in, buildings for necessary inspections.
(Signature of applicant, or name, if a corporation)
...........
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of p rem s es ~. ~~ ~J ~
If applicant is o corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .....................................................
Plumber's License No .................................................
Electrician's License No .............................................
Other Trade's License No ............................................... '7-.<3~ ~ ';-~- "~'- .....
Location of land on which proposed work will be c~one. Map No.: ................................ Lot No
Street and Number ....... .~....°~.~.~.~.~....~...'~.......~..4...'~......~~~.~...~'- .......... '.'"'"'"'""'"'"'""'""'
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
b. Intended use and occupancy ........................ ~....: ......... ~..: .............................. : .....................................
3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................
Repair .................. Removal .................. Demolition .................... Other Work ..................................................
4. Estimated Cost ......................... .~....Z.....] ................... 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 ........................................................ Rear .......................................... Depth ................................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
11. Zone or use district in which premises are situated .....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................
13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ~ ( ) No
Name of Architect .............................................................. Address ................................ Phone No .......................
Name of Contractor ............................................................ Address ................................ Phone No .......................
PLOT DIAGRAM
Locate clearly and distinctly ell buildings, whether existing or proposed, and indicate all set-back dimensions frore
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
il.'
STATE OF NEW YORK, lc c
COUNTY OF ................................
~--.~,~../'~.~ ................................... '~ mg duly sworn, deposes and says that he is the applicant
.................. .,.,. ............ ;.., ..... --~ be'
tmame aT 'ndividual signing contract)
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 make and file
this application; that oil stetements contained in this application are true to the best of his knowledge and belief; and
thor the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
................... /...{ day of ............................. ,...~..~...~...,
Notery Public,. ..................................... .~.m'ff~.~.... County .................................................................................................
(Signature of applicant)
M Ullll~l. BrtUSH
NOTARy PUI~L[C, Sfafe of New York
No. 52-4522026 . Suffolk Collnty
Commlss~on Expires March 30, J9 ........