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HomeMy WebLinkAbout261-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING D£PARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building Iocated at ....O&.~.~..l...~....[~--~? .......................... Street Map No .... ~ ................ Block No .......... . .~L.1~.. . , conforms substantially to the Apphcat~on for Building Permit heretofore filed in this office dated , Z 261 ................... M.~.?.h....~.~ ............. 19...~..~ pursuant to which Bu,ldmg Permit No ............................ , dated ........... ~.~..~..... ,~.]' ........... 19. ~...., was ,ssued, and conforms to all of the requirements of the apphcable prows~ons of the law The occupancy for which this certificate ~s ~ssued is ............ PRIVATE DWELLING Th,s certificate is ,ssued to Russell Ca~ (o'~ner) ; (owner, lessee or tenant) of the aforesaid bu,ldmg Budding Inspector FO~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDI~4G PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 261, Z Permission is hereby granted to: pursuont to apphc*t~,n doted ..................... ~"~t ...................... ]~ ..., ond *pproved b~ the Bu~ldin~ ~lnspector Fee $[~ ........... Bu[Idin~ Inspector FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined....~..:..~..'...: ........ ..)...~. ...... 19..>..~.. Approved ........................................ 19.: ...... Permit No. ,,T~-r......~...~:../.. ............. D:sapproved a/c .............................................................................. ~ .............. ............. ...... ............ (Building Inspector) ! Application No ............................. APPLICATION FOR BUILDING PERMIT ........................... ~. ......... ~ ............. :,, .......... 19 ............ 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 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 shah 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 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. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, le/~e~,~ agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................................... .......................................................................................... Name of owner of premises ........ /.~~.~. ........... ..~....~ ............................................................................ 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. M~ap No: ........................ [..~:.~i ........... Lot No: .......~...~ ......... 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 ~ost.. 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 ...... ,?....~. ........... Depth ............................ Height ............................ Number of Stories 9. Size of lot: Front ...J..~..~.~.(..~. Rear.~.............~ ~' ......... ~ .... Depth ~.Z~.~.: ..... 10. Date of ' ~ ~ Purchase ................... .~..~...~..~ ..................... Name~ ~ ~°f Former Owner ...~ ................................ 11. Zone or use district in which premises ore situated ....... ~.,....~.~'-....... 12. Does proposed construction violate any zoning law, ordinance or regulation? 13. Name of Owner of premises..~;..~¢~...Address ...... ~ ..................................... Phone NO ..................... f r t ~*'~'~ ~' · '' ~'~ Name o A ch ect.~...~. .......... .~..~..~.J....¢~.....Address ..~T&F. LL.~ ............... Phone NO ..................... Name of Contractor.~......Cj~ Address Pho~ 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, Id show street names and indicate whether interior or corner lot. · above ,amed~ ~e is the .................................................. ~~j: ~ ~ ......................... (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 mann~ setE~h in the application f~ed therewith. Sworn to before me this , ~%~, ~ ~ l~ ~, ~ ~ -,, ......... ...... ............