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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. Page 2 1' ? f?ouT,__: ~, 5 y'o u Nc~ ,fo / .bo,o ;: /'~ ~ LLOg~t ~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~ .......