Loading...
HomeMy WebLinkAbout225-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the build,ng located at Mop No ....... ~'~it ......... Block No ......iii'ii .......... Lot No .................. W'iiii .............................................. conforms substantially to the Applicat,on for Build,ng Permit heretofore filed in this office dated ................... ~.~;1~'¥..8 ....................... , 19....R~1. pursuant to which Building Permit No .......... dated ........ ~];)~n~ll~..~ ..................... , 19...~j~, was ~ssued, and conforms to all of the requirements of the apphcable provisions of the Iow The occupancy for wh,ch this cert,ficate is issued ~s ........ ......... I~:~.. L~:...g~...~./~;1:~. ~l~:~:l~ ...................................................................................... The certificate is issued to .............................. ~l~J:jj~l~..~f~.~...¢~//~ ........................................... (owner, lessee or tenant) of the aforesaid building. Building FORM ~lO. 2 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 A~* ~ ~g *A~[~ ~'~,~ ~)~,~ ~1~ ~: U L L COMPLETION Permission is hereby granted to Date pursuant to apphcat~on dated ... Budding Inspector ., and ap,proved by the Fee $"~';'0~ ........ FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~ N. Y. Examined ...... C~....~ .......... 19...~.....~' ,, , . ~_. ,~z .)_ ~-- Approved ........................................ 19 ........ Permit No ............................... ............ ...... ............ (Building Inspector) App,cotion ,o.....)...~.~ ........... APPLICATION FOR BUILDING PERMIT Date ....................... ...... ........... ..... 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 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 dicgram which is part of this location. c. The work co~ered 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 pui'pose whatever until a Certificat, e 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. (S'gna u e of applicant, or na~poration) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................. ~.:~.~. ................................................................................................................ Name af owner of premises .......... ~ .............. ~ ...... : ....................................................................................... If applicant is a carporate, signature af duly authorized afficer. '~ (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... and Numbei .~....~.i.....~...'/':~:..~~.,....~.~ ............. ../~.~..I,.~....~....~..... .............. Street [ ~ Municipality 2. State existing use and occupancy of pr.emis~e~,and intended use and occupancy of proposed construction: a. Ex st ng use and occupancy ................... ~~;..~.. ~...~ ..................................................................... b. Intended use and occupancy ................................... .~ ............................................................................................ property lines. Give street and whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ..~ ....... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost......-...~...~....O....;..-~7. .................................. 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... ~., u~ 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 ..../...O,: ................... Height ............................ Number of Stories ..... ~ ....... .. .... 9. Size of lot: Front ...... .~...~.. ............ Rear .......... Z/...~.. .......... Depth 10. Date of Purchase ............................ ~ ................... Name of Former Owner .....,....:......'. ..................................... 11. Zone or use district in lvhich premises are situated ...... ~....~.~.~.(.:.t~h.~}.; ................................................ 12. Does proposed construction viol?.te any z,~ina law, ordinance or regulation? .,.~..L~G.~ ....... ' 13. Name of Owner of premises~....?.?..~..~.~..~..~.~...~.~...~..~ ...... Address ...:}..~.':..[..~£.iil.....Phon~' '~'."iiiiiiiiiiiiiiiiiiii Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor ........ ~.K~:.:.::.:....~..d...~..J ......... Address ..llx.t:¢:.~....:..(r.....~...: .......... Phone NO. PLOT D1AGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from ~,..~.rs or description according to deed, and show street names and indicate STATE OF NEVi' Y~DI~K,,,~ ) S S above named. Ho i~ ~he ................................. ~"~z.' ...................................................................................................................... (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 m~ set forth in the application filed therewith. Sworn to before me th~s ...{~ ........ day of ......... ~'"'"",'%'d,''''J~'