HomeMy WebLinkAboutBrush, LillianSUPERVISOR'S OFFICE
16 South Street
Greenport, N. Y.
Tel. Greenport 7-0550
BUILDING DEPARTMENT
TOWN OF $OUTHOLD
SUFFOLK COUNTY, N. Y.
TO~I~I CLERK'S OFFICE
Idei. Street
Southeld, N. Y.
TeL Southold 5-3783
BUrLDING I'NSPECTOR'S OFFICE
307 Fourth Street
Greenport, N. Y.
Tel. Greenport 7-0101 J
CERTIFICATE OF OCCUPANCY
No. l~O Date I~.y ~b. 19.~L_
THIS CERTIFIES that the building located at ~_/ffi 1~m~n l~mrl. Id'./R ~'411=~ T.= Street,
Mnp No. 3QK3;.X , Block No. ~ , Lot No. ~ O~'tent;
in the Town of Sou~old, conforms subsfentlelly fo the approved plans end specifications hero.fore fi~d in ~is
o~ce w;~ Application ~or Building Permit dated ~ 1 ~ I~, pu~uanf to which
Building Permit No~ , dated ~ 19~, wes issued, end conforms te ell of the require-
ments of the eppfic~b~ provisions of the law. ~e occupancy for which this ce~ificete is issued is
Thls ce~cafe is issued ~ T.~ 1 1 ~ m~ ~11~ ~m
(owner, lessee or tenant)
of the afore~id building.
· ' - Bugd;ng Inspector
(The Ce~flcete of Occupancy will be issued only after the Building Inspector is convinced of the completion of the
construction in compliance with the Multiple Residence Jew and with other ]aws, ordinances ,or regulations effeGting
the premises, end in conformity with the approved Flens and specificafions.~
TOWN OF $OUTHOLD
Multiple Residence Law Permit
PERMIT NO,
LOCATION
19L APPLICATION NO.
X~8 lfobu~z'y ~t 19~;~
Application having been made on
covering construction on a ...... +A.~
_~tt..~._..~. 1_~ , 19_AA , for a permit
(new, altered, or converted)
multiple residence building, by or in behaJf of
Hunt. inrt, on; Jl.~'.
, for a dwelling located as above stated, and the said
application havincj been examined and recommended for approval on w.~...._..~,_ __:~__ 1~
is hereby issued for the performance of the mt.¥,.nt.u~.nl un~-~
(archifectur~l, structural, mechanical, etc.)
, I~__. a PERMIT
work described in the above numbered application and any accompanying plans and specifications.
If no work is performed within one year from the time of its issuance, this PERMIT shall expire by limitation.
Approved
Enforcement Officer (
TOWN OF SOUTHOLD
APPLICATION FOR BUILDING PERMIT PURSUANT
TO MULTIPLE RESIDENCE LAW
Altered or Converted Multiple Residence Building
APPL,CAT,ON NO. / ~
LOCATION '-~/-~ ~House'TNumber ~
Heighf:
Distance from Nearest Corn.r
to be altered or converted
(Permanent, Transient, or Pr;vela)
(2) Type of Construction ~'-/'~--
{Fireproof or Non-f~reproof)
(3) Use and Occupancy after Alteration
or Conversion
(4} A new C of 0 (will) ~e required
Sfory
(include EXISTING OCCUPANCY PROPOSED OCCUPANCY
Cellar &
Basement) Persons fo be
Apts. Rooms Apts. Rooms Accommodated
CorB
Seeo.d * ,.'q / ~ 6
Th;rd
Fourth
Rffh
Six~
Seventh
TOTAL
(6) Estimated Cost of Alteration or Conversion
(7) Is Application made to remove violations? If yes,: State Violation Number
(8) State what disposition will be made of waste and sewage .;~'/7- ~'
(Public sewer, private sewer, cesspool, etc.)
Page I
FOB~ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved .................................... , ]9 ........ Permit No ................................
DisopproYed o/c ...........................................................................................
(Buildin~ Inspector)
APPLICATION FOR BU'LDING PERMIT
Dote
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 end 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 port of this location.
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 Deportment 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, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
(Signatu~ of app'licant, or nome, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................ ...................................................................................................................................................
Nome of owner of premises ...... .~..'.~.~..~.~.~.~;.i. .......... /.~..~.f&.; ............................................................................
If applicant is a 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: ....................
Street and Number ~.<?~m.~.~..;.~..`."~..~...~....~...~.~..~...~....~...~..~".~..~....~ ........... ..~...~i..,5~....f...~..:~.......~.~..~,../. ....................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
o. Existing use and occuponcy ................................................................................................
b. Intended use and occupancy ......~....~.~.~~ .....................................................................................
3. Nature of work (check which applicable): New Building .................... Addition .................... AIteration..~ ...........
Repair ................... Removal .................... Demolition .................... Other Work (Describe) ....................
---~)-.
(to be paid on filing this application)
5. If dwelling, nut, her of dwelling units ~: Number
.......................... of dwe ng units on each floor....(.......~v.. ....................
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 ....?..~....?.~r ..............
Rear ................................
8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................
Height
9. Size of lot: Front ..... ~.... ................. Rear ............................ Depth
10. Date of Purchase ...==..-~,...?.7 ........ -.~......,.. ................. Nome of Former Owner .......... ' .......... ...... ~: ............
] 1. 7one or use district in which premises ore s tuoted ..... .~ ......................................................................
12. Does proposed construction violate any zoning Iow~ ordinance or regulation? ........................................................
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 numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEV~ Y~QRK~ ) S S
........................................................ being duly sworn, deposes and soys that he is the applicant
(Hr/me of individual signing applicotion)~
above named. He is the .............................. ~'.q~c~C-~- ......................................................................................................
(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 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
....... t..'..L2 ......... day of :..Rbt3~.. ............................. i9./a.~. ...... ~ ] ~-- ~7 ~ ~
Notory Public~...~.L~ .......................... Count~ ~gnature of applicont)
STATE OF NEW YORK
COUNTY OF SUFFOLK
(Typewrite Name)
being duly sworn, deposes and says: That he resides at
[Architectural, structural, mechanical, etc.)
plans and specifications herew~h submitted and made part hereof, and that to the best of his knowledge and belief,
the work or construction will be carried out in compliance with such plans and specifications, and that it will conform
to all applicable provisions of the laws governing multiple residence construction.
(SIGN HERE) , Owner
Sworn to before me, this
day of , 19
Notary Public or Commissioner of Deeds
If application is to be executed by someone other than owner, acting in his behalf~ the following additional inform-
etlon should be supplie~./~L?'
Owner's Name~' C~~dress /.~L~ ~.~, ,~- ~/~
Ill a corporation, give full name end address of at least two fflcers)
Sworn to before me, this ·/ GC'~ day of
No bloc or Commlss~oner of Deeds ;
~./
, Appficant
,
FOR OFFICE USE ONLY
Examined end Recommended '~c~-_b /' ~ ~0
for approval on 19
Approved on 19
Superintendent.
Work commenced on
19 Date Completed 19
I HEREBY CERTIFY that the above report is true in every respect and that the work indicated has been done
in the manner required by law and Rules and Regulations of this Department.
Signed
Inspector.
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~liea~. - ~ t~lo in tho office of the SUffolk ,,,..
~on~e:~ ~ hor~b.y ~'~'~u fc:r ~Lo filing of those
~is approval doe~
not include Structural features
condition that the proposed facilities are
~ermity wi'th those plans.
Di~tric~ .......