The URL can be used to link to this page

Home My WebLink About277-zIN)~3~ ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ..... ~...9I~ .... Date .................. ~u~.. ~,9 .......... 19..6~ THAIS CERTIFIES that the building located at ~;~A ~ ~...$~.~.~;i.~.~4~Street Map No ........ .~WW .... Block No ...... W.~* ......Lot ~o .... *.~.~. ...................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... A~IX ~.2 .......... 19~ .. pursuant to which Building Permit No ...... ~....~.77. dated ......... ~p~i~ ............. 19.~..., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ............ ~"]~...O]~...][q~[~.~..]Y~. ,./~.:~.G ............................................ This certificate is issued to ..... ..~.~ .~.~.~..~...~. ...................................... (owner, lessee or tenant) of the aforesaid building. FO~O. 2 TO~N OF~O~THO~D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Perm~ssmn is hereby granted to: pursuant {o application dated ....................... .~.i~....~.~ .................. 19~..~...., and approved by the Budding ?spector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ........... ................ (Building Inspector) ~, Application No.....~.~...?...~ ............. APPLiCATiON FOR BUILDING PERMIT Date ..................... ~ ........ ~...~.-... 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 shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 oll applicable laws, ordinances and regulations. (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Z " ;'511'i;"iZZiiiiiii .... ........................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work ~ill be done. Map No: .........................................~..ALot No: .: .................. Street and Number ....... ~~~ .......... '"~"~'~;'~'"~" ............ "~""~"~'"~' ~'~/ ............. Municipality 2. State existing use and occupancy of pr,emise~e and occupancy of proposed construction: a. Existing use and occupancy ......................................................... ~ ~ .......................................................................... t~ 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 ....... ..~...O....?:....~ ................................... 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...'.~7.....O. .......... Rear ...... ./..~ ............ Depth ......~....~....0. ........... 10. Date of Purchase ........................................................ NameA ~O ~ n~-~,J/~°f Former Ownej' .,.Z.,~.~g ................................................... 11. Zone or use district in which premises are situated ....... ,,'~T......./.~.~..~........~..~.. .............................. 12. Does proposed construction ~iolate any zoning law, ordinance or regulation? ....... ~ ...................................... 13. Name of Owner of premise~....~.....~........Address .~.~.~.c~.....~...~.....~...r-t~none 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~YOJ?,J(,, I, ) S S ..... being(Name o{ ~.n i~ duly sworn, deposes and says that he is the applicant signing application) 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 containeo~,Jt~j~gpplication are true to the best of his knowledge and belief and that the work will be performed in tt~ mcfl~J~ f~,.t h in the application filed therewith. Sworn to before me this ....... ~..Z.~.. day of ......... ~ ........ ~1~4~ (Signature of applicant)