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Home My WebLink AboutColonial Village MR 165SUPERVlSOR'S OFFICE 16 South Street Greenpod, N. Y. Tel. Greenpo~ 7-O~50 BUILDING DEPARTMENT TOWN OF $OUTHOLD SUFFOLK COUNTY, N. Y. TOWN CLERK'S OFFICE Mete Street Southdd, N. Y. Tel. Southold 5-3783 BUILDING I'NSP[~CTOR'S OFFICE CERTIFICATE OF OCCUPANCY No. THIS CERTIFIES that the building located et I~_/~ ~n R~ Street, Map No. ~ , Block No. ~ , Lot No. ~ in the Town of Southold, conforms substentinlly to the approved plans end specifications heretofore filed in this office with Application for Building Permit dated lqnv~ml~T, ] I;f~ , pursuant to which Building Permit No~m~3.~, dated ~ 19~.~ , wes issued, end conforms to ell of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P,e',~'~,.,e,~~ Oaeu~anc~' Apartmentl This certificate is issued to ~l~Ale~nk P. R~eh;~]nn~a] V~]]A_fe The (owner, lessee or tenant} of the aforesaid building. H,D, Appz'ova! · a~. 12, 1~ b~ R. Villa Bu,}ldlng Inspector {The Ce,fificafe of Occupancy will be issued only after tho Building Inspector is conv;nced of the completion of the construction in compliance with the Multiple Residence Law and with other laws, ordlnances.or regulations affecting the premises, end in conformity with the approved p~ans end *pacifications.) FORM/1(10. 5 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Affidavi of ginal Cost o[ Construction STATE OF NEW YORK ~ ss.: COUNTY Of ..... $.u$.£o l.k .......................... ~ ....... ...~./~...~..~.~....~.../...~.. ....... ~...~...~...~ ................. , being duty sworn, deposes and says: (applicant or agent) that he (she) is the applicant (or agent of the applicant) named in the Application. for Building Permit dated ..................... ~o.~.embe~......1 19..6~ ...... relating to construction or other work to be performed on, or in connection with, the premises located at ~/.~.' ~,~..~....~..O..~...~. & .~../..~. ...... ~ . Southold. N.Y. ..l~O.l~seau~..A,v.e .............. ; thor tee estimated cost stated in said application, of the construction or other work described therein was ............F~l~..t~...J~lrle..~h~tt$.aD~ ........................................... Dollars ($...br.9..~.QQ.Q ............... ); that the actual final cost of such construction or other work was ......... .~. .......... ~./..~..~ ......... ~".~...~.....~......; ..................... Dollars ($...~....~......~.........~......) and that the said construction or other work was performed in accordance with the ap, p,p~ovisions of law. ........... (applicant or agent) /Sworn to befor~me this ...... ~,~~, 19..~....~.... Permit No. ~'-'~'"'~"~"~' ............ [~esidlr~ in ~'~l~h County Filed Cost $.~.9 ~.QOD. ............ Permit Fee Paid $,115~.Q0 ............. / Final Cost $,...~..¢...~....~.......:... Additional Fee $ ....... ~ ................. (Costs for the work described in t~e Application for Building Permit include the cost of all of the construction and other work done in connection therewith, exclusive Of the cost of the land, If the final cost is less than the estimated cost stated in the Application for Building Permit, no portion of the fee paid upon the filing of the application will be refunded.) SuyffOLK COu~£! DEPA~T OF HEALTH JAN 12 19b~ Date ~.dg, Permit ~o. TO WHON 1T ~! The sewage disposal facilities for a structure located at (Give deed location) t~aand v / have been inspected by thAe Departmen found to be satisfactory. District Engineer TOWN OF $OUTHOLD Multiple Residence Law Permit ~, 19_~.~APPUCATION NO..,.v.,,"z~' ~-Q.--- I 19 v.,~' Application having been made on covering construction on a new mz~ipie , 19~ , for · permit multiple residence building, by or in behalf of .................. ,, .... · ...... ~. · , for a dwe~ng located as above stated, and the said · ppficetion having been exernined and recommended for &pproval on ~.G~,° ~, , 19..~, a PERMIT is hereby issued for the penCormance of the ~ k.~ ~4~ ~.r.u. ~. W~rc~fect~r~l. structure,|, mechanical, etc.) work described in the above numbered epplicetion end any accompanying plans and specifications. If no work is performed wffhln one year from the time of its issuance, this PERMIT shall expire by limitation. Approved ~t subJ~t ~ fee ~Jus~ent u~n ~1~ of f~l co~t--~da~t~ ~led esti~ted cost $ ~9,~.~, ~e Paid - $ I1~. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ~..l ............. , 19...~...L- Approved ......... I~....~ ...... ..~......, 19..~...~.~ermit No...~....~....~....../....~...)...~ Disapproved a/c ........ ...... .~.~::.~.. ................ .~..~--~.. :~ ............... ~... .............. ~-.; .......... ,.~.~ ............................................. (Building I ;;l~'~gr) Application No ......... ./..~.:...-~. ........ APPLICATION FOR BUILDING PERMIT ......... .,. ................. 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 public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of thi~ applica- tion. c. The work covered by this application m~y not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applico:nt. 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 pa rt 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 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulationm /, (S'g ~ure o~pplicant, or name, if a corporation) ............. ........................ (Address of applicanlO State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ...... C~'.~~.....~....~..'.....~.~......r~...~~~.' ................................ If appJic~s~authorized officer. .............. (Na'me and ~i'~i'e"~)f co~'l~'C~'~'t'~"~'~i'c'~'~i'~'' 1. Location of land on which proj~osed work will be done. Map No.: ....... ~ ............................... Lot No.: ." ................... Street and Number .~...~~..~......~.~......~...; .......... ~......~...~...'.. ...................... / Municipality 2. State existing use and occupancy of pren~:ises and intended use and occupancy of proposed construction. a Ex stng use and occupancy ....///'~...~~ .............................................................................................. b. intended use and occupancy ~~~ 3. Nature of work (check which applicable): New Building .................... / ~ Addition .................. Alteration .................. Repair .................. ~.~ova! ..........~.;.. Demolition .................. Other Work (Describe) .................. Estimated Cost ........... ~,~....~....~..~ .... 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 /m~(" ' Rear ....... ./....~....~.. ......... Depth ........... .~. ................ Height ...... ./...~...-.. ............... Number of Stories ...~....: .......... 9. Size of lot: Front ...... ~'..~'..~'.. ............. Rear ...... ../...~....~.. ................ Depth ..... ~.~.~ ................. 10. Date of Purchase .......................................................... Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................................................... 12. Does proposed construction violate, o ~ - ~,,, ~ 'any zoning !aw ordinance or~..;re~ulation~ ..... ?...z~.. ............ " premises .~~...~__ Address ..~.~/...~.' .~..,..... Phone No ........ iiiiiiiiiii 13. Name of Owner of Name of Architect .... ~ ....... ~"~iZ~' ................... Address iiii~~i~i~iiiiii Phone No ................... Name of Contractor .~..:...~..'.~..~.~.....,~.. Address Phone No .................. PLOT DIAGRAM Locate dearly and distinctly a!i 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 NEW//FORmV~ ,, / ) ~ ~ ,- being(i~qome duly sworn, deposes ond soys lthot he is the opplicont of individual signing a 'pp~~ 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 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 ......... /.~.. day of~:~ ....... , 19..~...... .... _-- ............ ........................... ~'~o a y t'um~c/~..,~:~.~:.~~:.~ou~~ ,~/~ (S~gnature of app cant) C0m~rl.~ss[~Ii Expires March 30, ii j,,~, ,'= I~0't ,~?,: ~ 7 .r