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Home My WebLink About213-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located agll~lltlte~;~/~. Map No ...... ~ ..... Block No ...... ~.~. ..Lot No.. ~ ........................... co~orws substantially to the Application for Building Permit heretofore filed in this office dated ..... ~~ ~ ..... 19.~.. pursuant to which Building Permit No. dated ........ ~~. ~ , 19.~., was issued, and co~orms to all of the require- merits of the applicable provisions of the law. The occupancy for which this cert~icate is issued is ................... ~A~ ~. ~..~ ............... This cert~icate is issued to ..~..~..~~...~.~ ............... (owner, lessee or tenant) of the aforesaid building. · '~u'ii~i~' i!spector . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION No OF THE WORK AUTHORIZED) pursuant to apphca ion dated ................................... /. ......... ]9 ....... , and approved by the Building Inspector Fee $ [...0.......~.. ...... NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit ........................... Disapproved a/c ....................... ~~.~~r.::,..~::~_ _ ................ .......... ...... ................... (Building Inspector) / Applicotion No ............................. APPLICATION FOR BUILDING PERMIT Dote...~.......~.....~ ..................... 19.....~-....~t~.. INSTRUCTIONS a. This application must be completely filled in bv 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 odioining 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 coYered bv 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 port for any pu~'pose whatever until a Certificate of Occupancy shall have been granted bv the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of a Building Permit pursuant to the Building Zone Ordinance of the Town of So~thold, Suffolk County, New York, and other applicable Lows, 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 owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises......~..~.......~.....'../....'~ ...... :~~ ................................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wiJI be done. Map No: ............................ .. .............. Lot No: .................... Municipality 2. State existing use and occupancy of pr. emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... occupancy b. Intended use and .................................................. .~ ............................................................................ 3. Nature of work (check which applicable): New Building ....... ..'~.........Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost...../../.~..~..~.u.......'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 alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ..~....~... ....... Rear ........... ..~ZI.......[~.. ...... Depth ....."~'...~.. ................. Height ............................ Number of Stories ....~ ........ . . 9. Size of lot: Front ........~?....~.:.....~?..... Rear ...... f~..~.: ............... Depth ........................ 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 regulation?~" ............ ~ ............................... 13. Name of Owner of premises....~...]../."...:'.4~..~ ....... Address ............................................ Phone NO ..................... Name of Architect .......................................... ,~ ............. Address ............................................ Phone NO ..................... 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 NEW YC~I~K,, ~ ) S S COL~ITY OF~,~) ' ' '] / 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 knowled~ and ~elief; and that the work will be performed in the manner set forth in the applicati~filed therewith~ ~ ~ /) ~ Sworn to before me this ~ ~oi~ -- L I d ~?~ ,~ 7 /, / ~ ~- ! ~ ~ ~ day of ......... ~ .......... 19 .~ .... Re:i~i,,'.' '~:~ ~, n ute of applicant) ....................... .... ,_ . . .~.~~ ~c ~- ~;',.,~,'~,,~?~ '~ ~ Notaw PuN,c, ...... ~w~'. s~,~,., ~ ~