HomeMy WebLinkAbout240-zNO. 4,
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No .. Z...186... Date ...... Septembe~c .... 10 ........ 19~.d ....
THIS CERTIFIES that the bu,ldmg located atW.unneme.t,a.. Rd. ............................ Street
Map No .~aSsa.1/.... pod. l%t .. Block No ........................... , Lot No. 17.k0..~..22.1 ..........
conforms substantially to the Apphcation for Building Permit heretofore fried in th~s office doted
................ F~S~I~.O~.... ~12 .............. I9.~8 ....pursuant to which Bu,ldmg Permit No .....Z...~.O.. ............ ,
doted ............ Fla~'O)~ ..~l~. ............ 195'~...., was ,ssued, and conforms to all of the requirements
of the applicable provisions of the law The occupancy for wh,ch this certificate is ,ssued is ............
This cert,ficate is ,ssued to ....... ~;~D.~.~..]?.,~../~iDltO3.S ........ ~ ..C.1~0.f?l".) ........................................... (owner, lessee or tenant)
of the aforesa,d build,rig
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CI?ERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N.° 24o Z
Date ............ Xm~eh ...3.Z ................. 79 :ia..
Pen ~ission is hereby granted to:
t,, lie:t:kjr & So~a...Zn~, .... A/C~....)~anh;..Tt,..~oho~...
to ..~ ~ ..Wow..4~X~.~ ...........................................................................................................
at prem,~es located at ...... M~ed~&..~ .... ~ .~--~O ~..~ ......................................
......................................................... hsm..~t ...................................................................
.............. ,. ......................................................... ~~, ..... ~. ...............................................
pursuant'to apphcat~on dated ................. ~..~ ........................ 19..~.., and approved by the
Building Inspector
Fee $..~LI
t
Building Inspector
FOI~M NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ......... ~..~. ~.....~/... ~.../......'~..... 19...~...J~
Approved ........................................ 19 ........ Perm:t ~o ...............................
Disapproved ~/c ................ ~:~.~ ............................. ~ ....................... ~
....... ....... ..............
(Building Inspector) [
Application No....,,,~..k!..g .........
APPLICATION FOR BUILDING PERMIT
Date ........... .'. ):: .?. ,~.. ~..... (..~... 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 /V~DE 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 a Iterations, 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 ~L<~_~r,_ /~o ...~....,4.~,~
of owner of prem ses ........~ .....................................................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map No:...~...~.~..~?...~.... ......... ,Lot No: .~....'~......~...~....~..'~
Street and Number ..~i'~.....-~.....~-'."~"......~"".'-~· ''~'''''~''''~' ........ ~~"
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .............. ~ ..................................................................................................................
b. Intended use and occUpancy ......... , ' ..................................................................................
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost.......~.....~..~ .................................... 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 ......... ~ ........... R_ear ....... ~ ............... Depth ...'.~..-~.. .................
Height ............................ Number of Stories .~ ..........
9. Size of lot: Front ....... ~.~....'~.....~. ....... Rear .......... !.'.?..?.. ........ Depth ..~..6....~/....../...~...~...
10. Date Oofr Pu~Chd~::r .................................................. ~.~ ~_ .N.:.?~.?. ~ .O..w..~:. ........................................................
11. Zone ict,, w,,~. p,~,,,~s are situated ............................................................
12. Does proposed construction violate any zoning Iow, ordinance or regulation?
13. Name of Owner of prem~ses...~..:..:~ .......................Address ............................................ Phone NO .....................
Name of Architect...Z~...~ ................................ Address ........................................... Phone NO .....................
Name of Contractor.A....~...~....-~..~..'~<... ........ 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
COU~
..~.........~..~/k.! v,.- - ............... being duly sworn, deposes and says that he is the applicant
(Name of indi, signing application),,,/~ ~ _ ~ . /{~.~_~ .
aoove namea, me ~s tne ...............................................................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to~r have performed the said work and to make and file
this application; that all statements contained ~. thi~g~re true to the ~st of hi~ knowledge and belief;
and that the work will be performed in the moh'~t ~ ~ application filed therewith.~ ,
Sworn to before me this '~.o~ ~.~ ~ ~__ > ~, .,,~ [~, ,~
. - ~.¥~ ~o0 ~ ~
..... ........
Nota~ PubHc,~...~ ........ ~ ' l*