HomeMy WebLinkAbout504-zFOR1VI NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFF~CE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at~/.J~.....J~l~.~h..]~Ol~]. ................................... Street
Capt Kidd
Map No ......................... Block No ....... ~X ..........Lot No...'.2,,0..],..,.......~.~..~.~.¥:g.~,.......~..,...~., ............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
....................... ..O..g..'q..O..~.~'.....3.g......, 19..~i'J~.., pursuant to which Building Permit No. ~.,.~..O~, ..............
dated ................... .O...~..~..O...'g..e...~........~..O. ........ 19.~.~.., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupa, ncy for which this certificate is issued is ................
................... .............................................................................
This certificate is issued to ......?..~..t..~t.......g..~.~.~...~.¥.¢) ................. .(.(~4/~'.) ..............................................
(own~'r, lessee or tenant)
of the aforesaid building.
Building Inspecto~
FORM NO. 1
TOWt,,I OF SOUT~OLD
BUILDliqG DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, iq. Y.
Examined ....... ~..~,~. ....... ...~.. ......... 19~..~...
Approved ............. t ............. : ............. 19 ........ Permit No ...............................
Disopproved o/c .........~ ............................ .~.:~:~_> ......... ~.~; ........................
............ ....................................
(Building Inspec/or) /
Application No ...... .?..?...~/. ...........
APPLICATION FOR BUILDliqG PERMIT
Dote ................... ..........
INSTRUCTIONS
e. 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 this location.
c. The work covered by this applicotion moy not be commenced before issuance of Building Permit.
d. Upon approval of this opplication, 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 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 or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
(Signature of applicant, or name, if a corporation)
..........................................
(Address of applicant)
State whether applicant is owr~er~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Blame of owner of premises ............ · ....................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate ~ficer) . ,
1. Location of land on which proposed work will be done. Map No: ............................. t No: ~....O...(.' .......
Street and Number ..l..~.~..~..k........~...5.~..::..~:...~· ....... ?. ....... ~'.~.C"~t'~'.~"'"' '~'~"~'c'/i( ........................
Municipality
2. State existing use and occupancy of p~emises end intended use and occupancy of proposed construction:
Existing use and occupancy ....................................................... .~ .....................................................................
b. Intended use and occupancy ....................... · ~.;~ ...................................................... : ..............
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....................
Repair ............. ~.....Removol .................... Demolition .................... Other Work (Describe) ....................
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 alteratlons or additions: Front ................................ Rear ................................
Depth .............................. Height .............................. Number of Stories ................................
8. Dimensions of entire new construction: Front ........ ~...'.'i-~/ ........... Rear ....... i.~....~.. ............. Depth
Height ............................ Number of Stories ...~ ..........
9. Size of t' Front / O ~/~ Rea ~ ~' De~th /~//'/~
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 regulatign? ........... ..~.....O. .................................
13. Name of Owner of premises~...~ ............ Address ~.~'./..5-..~.~.~.~.d.~.......~ne NO .....................
Name of Architect ........................................................ Address ............................................ Phone NO .....................
Nome of Contractor.. ~. ........................... Address ............................................ Phone NO .....................
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 NE~0~-¢(~¢r~/~ )L'~ S ~
................................... /.~..~.......~.::...7. ...... ~ .......... being duly sworn, deposes .end says, thot he is the applicont
(Name of in'dividua, signing applicati~t~)(~ .~.-~o~--~,~,...,~ ~,~ ~..~.-~.~ ~. '. ~
(Contractor, agent, corpor~fice~etc.)
of said owner or owners, and is duly authorized to perform or have performed the sai~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'm the manner set for~ht01~in the application filed therewith.
Sworn to before me thls _ ~ ~,.,. ~o~a~
TOWN OF $OIJTHO/D
BUILDING DEPAR. TMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ....... : ................................ 19 ........
Approved ........................................ 19 ........ Permit No.
D]sapproved a/c '%~ ~ · ..............................................
Application No ............. ~ .............
Date .................... T ..................... .7; .............. 19..:....*. ....
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 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 issuonoe 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 a Iterations, or for removal or demolition, os herein described.
The applicant agrees to comply with oil applicable laws, ordinances and regulations.
f r,: '-7
(Signature of applicant, or name, if a corporation)
(Address of applicant)
State whether applicant is owr~r, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premise,....~:..~:~/.:~'~ ........ ~C~:;:>~ .....................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer) , ~ ~-
.......
]. Location of land on which proposed work will be done. Map No: ...:.....&. ............... Z:;...' ........... hot No:
Municipality
2. State existing use and occupancy of ppemises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .................... ~;t; ........
b. Intended use and occupancy ....................... ~'; .........................................................................................
3. Nature of work (check which applicable): New Building......~.......Addition .................... Alteratlon ....................
Repair ............. ;~....,Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cast ....... l.~...~....~.....,= ................................... Fee ./,......~....~. ..........................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling umts ................................ Number of dwelling units on each floor ............................
If garage, number of
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 ../'..~?~..~.....~..~; ..........
/ ~ *~;; ~ *'~ Owner ....................... L"'~'" ......... : .......................
,0. Date of Purchase ........................................................ Name of Form .
11. Zone or use district in which premises are situated ..................... c~,::}~.~.:...~...=:. ....................................
12. Does proposed construction violate any zoning law, ordinance or regulatiqr~? ....................................................
13. N ........ ~, ~,,,, ..................... :.:.;. ............ ,~aaress ................. : ................ .~..:.%;X~Phone NO .....................
Name of Architect ........................................................ Address ............................................ Phone NO .....................
~7
G ~,~ ~,~ ....................
Name of Contractor...¢.~. ............................................. Address ............................................ Phone NO.
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 NEVV~O~I~/~ )
COUNT O.)
(Name of individual signing applicot~q~) . ~~ ~ ~ , n
~~=::.::~
above named. He is the ...................................... ........... ~......k~.~..~ .............
(Contractor, agent, corporate off~er~ ~tc.)
of said owner or owners, and is duly authorized to perform or have performed .th~ sai~ork and to make and file
this application; that all statements contained in this application are true to the ~st o~ his knowledge and belief;
and that the work will be performed in the manner set fort~,~_the application filed therewith.
Sworn to before me this
......................................................... .,.,:,.... /? ,':, _