HomeMy WebLinkAbout226-zFORM NO. 4
TOWN OF SOUTHOLD
BUll.DING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the budd,ng located at .~1~I0.1~. ~:..~lI~g.toI~..tJ~ ...... Street
Map No ]~e.s~i~.l~..P.t..B,~opo. Block No ............................. , Lot No
conforms substantially to the Apphcation for Building Permit heretofore filed ~n th,s office dated
............ ~.~..b~aZ'~ ...... ].0 .......... 19.~., pursuant to which Building Permit No ...... ~.~?,.~ .......... ,
dated ............ ~.e~Ll~.~.~'... ~LO ........ 19...~., was issued, and conforms to all of the requirements
of the applicable prowsions of the Iow The occupancy for which this certificate is issued is ............
..................................... }~r~..~Z~'~....~i~b~T.!,~P~ .......................................................................
..~ ............. (...~,e~.)...
Th~s certificate ~s issued to .... ~I~..~,~ .~¢~p]_~ ~ ~?r~ .........................................
(owner, lessee or tenant)
of the aforesaid building
t,,I .. . 0 -,
..L..~.:.-...~...&.'. ...... :-. ...... :.::.':......~ ...... :;:'.~. .............
Building Inspector \
FO~ NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
fl-HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N.° 22§ Z
! Dote ................ Ji~L~....-~ ............. 19.~...
Permission is hereby granted to:
~,te~ o~.~.~......~...c.....~...~.~L,T.,...~'~ ...........
....... .~.~., .................................................
............................. ~.~, .......................................
to ...~...~...~r.~.t~oa...t~...au..ex.ta:U,~_,-..d~l. lanj ..................................................
ot premises located at ...~..J....~....~......~,..~,~[t~a..~.l~ ......................................................
............... ~ ................................... ~..~.~..~.L~ ...............................................................................
pursuant to apphcat,on doted ................~];~t~....~J.~J .................. 19...~., and c~pproved by the
Budding Inspector
i
~ee $.~.*.~ .............
FO]~M NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examine .............................................
Approved ........................................ 19 ........ Permit No ...............................
Disapproved a/c ..............................................................................................
Application No .............................
APPLICATION FOR BUILDING PERMIT
Date ............................................................ i 9 ............
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 o detailed description of layout of property must be drawn on the diagram which is part of this location.
c. The work coYered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, tho 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 Certificate of Occupancy
shall have been granted by 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 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, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
...... .r ............................
(Signature of applicant, or name, if a corporation)
.............. ..........................
(Add~iess of applicant)--
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of promises ...... ..s........~: S~....r,!j.: ...... :.~...~..f.~.~..~.. .............................................................
If applicant is a corporate, signature of duly authorized o~icer.
(Name and title of corporate officer)
1.
Location of land on which proposed work will be done. Map No: ~.:~...:.t'.~.~..'~.. .................... ~....~'...~...
Street and Number ...~:.....::.':..~.r.h.,~..k?..x~...s;...../..t..~:...: .......... :,,,,...'¢z.t,o,~....~. ...........................................................
MuniciPality
State existing use and occu~ncy of pf~mises and intended use and occupancy of proposed construction:
a. Existing use and accupancy ......... :,.~ ....................................................................................................................
b. Intended use and occupancy..~..~.~ ~ ...~.....~ .................
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ...,.~.. ...........
Repair .................... Remove, ., ~. .................. Demolition ............... ~..Other Work (Describe) ....................
(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 ........ .~-Z...'?. ......... Rear ...... .S.~...~ .............. Depth ......~..;~..~. ..............
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 ..,~...L..~. ............. Depth .../....~.....-t~...
12. Does proposed construction violate any zoning law, ordinance or regulation? .... .b.~..: .....................................
Name of Architect .......... ;. .................. ~.....,. ................ 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 ~ORI~,,. ~/}. )
cQu_ TY OF ...... S S.
.... ............................. : ................................................................... ~ duly sworn, deposes and says that he is the applicant
(Name of individual signing opplica~n)
above named. He is the ................................... ..C.:~...kf~....;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 manner set forth in the application filed therewith.
Sworn to before me this
..... .~..~...~.. ....... day of ..... ~.,,,~..., ...................... ,~...Z~.~ ....... (S,gnature of applicant)
Notary Public, .~.J ..............