HomeMy WebLinkAbout130-zFOI~[ NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No...Z.....2~ .......... Date ........ Oc.t, ohel*......~. .......................... 1 (~. ....
THIS CERTIFIES that the building located atl~ltt/~lS...R.f~..2.~...(a~a.~.n...ro~d.) ............... Street
Mop No ..................................... Block No ..................................... , ~t:~'~c~G~.eenpo.~......N...~L.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
............. Oo.t~O:be~'.-.-.-2 .................. l~:~t ...... , pursuant to which Building Permit No ...Z...1.~.0 ............. ,
dated .......... .0~tO.be~...-.~2 ..................... lC~.~....., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ............
........................... P..R ?.V.A~. D~LL~NG ...........................................
This certificate is issued to ...E~a~.d...l/'al'lC~ra, ............... (...o.*~na~.) .............................................. (owner, lessee or tenant)
of the aforesaid building.
Building Inspector
FOBM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S O~:FICE
SOUTHOLD, N. Y.
BUILDinG PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES W~T~,~j~T~'~:
e,~,~l~~~,*&l~F~~ UNTIL. FULL COMP. LETION
OF THE WORK AUTHORIZED)
Permission is hereby gronted to:
. .. 1~'3... ~ ~l...~.o~u:t ~ ...........................................
..... ~.~.e. ~.,..... ~...~T ~ ............................. · .......
to ....... ~...~..~.~.~..~...~.~....e~i~.t~i~4~...~e~ing......~.d~b~e..d~"me~..) ........................
ot premises located at ..~,~.l~.....~O.l~te...~......(:...l~?.~..D~t~e.) .......................................................
......................................................... .~.~.e.~.~r.~ ,... ,. ~, Y, .................................................................
pursuant to application dated ................ ~0.~]~.~ ....... ~. ..................... 19..~.., and ap,proved by the
Building Inspector.
TOWN OF SOUTHOLD
.BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ......... : ....... '~ ....... .,-~..? ......... 19...../..
,, . .....
Approved ........................................ ' ¢~ 19 ........ Permit
Application No.....(....~....C.). ...........
Disapproved a/c ............................................................................................
·
;-' (Building Inspector)
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and sabmitted in duplicate to the Buildlng
Inspector -
b. Plot plan showing Iocatio~ o3 lot and of buildings on pr~r~ises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram whi,ch is part of this location.
e. The work Covered by this applicatio~ may not be commence8 bef'or~ issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such
permit shell 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 dntil a Certificate of Occupancy
shall hove 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, additiops or altera~ior~s, or for removal or demolition, as herein described.
The applicant agrees to comply wi}h all applicable laws, ordinances ap,d, regufations¢
: I '~ ~~c' apriori;, 'dr ;ame] if d ~orporation)
(Address oLopplicant)
State whethe~ app!!cant i~'o~ne,~ less_ee,~agent, archit,¢¢)engineer, general~con~actor, electrican, plumber or builder.
.................................................. ...........................................................
N~me of owner of premises ..............................................................................................................
If ap~plicant is a corporate, signature of duly authorized officer.
3 (Na~ of~',~orporate officer)
1. Location of land on which proposed work will be done. Map No ............................... B ack ...............................
St reef and N umber ..~.....~,..~...~.. ~ .,~... ~
2. State existing use and occupancy of premises and i n~use~nd occupancy of p~oposed construction:
a. Existing use and occupancy
.............
b. Intended use end occupancy .......................................................................... . ......................................................
3. Nature of work (check which applicable): New Building .................... Addition ...... ~ ....... Alteratlon....~ ........
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost ........................................................... ee ..........................................................................................
(to be paid on filing this application)
FEES:
If dwelling, number of dwelling units ....... ..~'. .................. Number of dwelling units on each floor ...... ./. ....................
ff garage, number of cars ............................................................................................................
6. If business, commerical or mixed occupancy, specify nature and exten[~ of each type of use ................................
7. Dimensions of existing structures, if any: Front.......fT.......~. .......... Rear ..... ../.....~.......~.. ....... Depth .......'~.......~.. ............
Height ............................ Number of Stories ..... /.....~ ..........................................................................................
Dimensions of same stracture with alterations or additions: Front ...~...~.~...."...~...~ ........... Rear .....Z~..~...~...~ ..........
Depth ........ ..~....~ .......... Height .............................. Number of Stories ..... ~ ....................
8. Dimensions of entire new construction: Front .......... ..~....~....~ ...... Rear ......... ..'~..~...f ......... Depth ..../...~...../. .............
!
Height ....... ~ ............... Number of Stories ....... ./. ..................
9. Size of fat: Front ...... ./.....'~...q...~',.~ ...... Rear ..... ../.....'~....~....~ ....... Depth ...../...~.../. .......
10. Zone or use district in which premises are situated....~. ....... ~ ...................................................................
proposed construct oH v o ate any zon ng aw, ordnance or regulation~
11. Does ................ .~.~. .............................
12. Name of Owner of premse~/'b'/~p-/-) //~'v'..~...~...~ddress
Name of Architect ..................................................... Address ............................................ Phone NO .....................
Name of Con~r~r./...~../..~..~....~..../~...~..../..~...~...~.:../.~./~....c~..~Address/.~(~/.~..~..~.~..~.~...~...~...~f.~.~N~Z~.~z~.~.~
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from
property lines. Give street and block numbers or description according to deed, and show street names and indicate
STATE OF NEWYORK, )
couN, OF
S.'
..~...~.~.........~....../.'..~...~ ................... being duly sworn, deposes and says that he is the app,lcant
(Name of ind~idual signing application)
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
(Singature of applicant)