HomeMy WebLinkAbout287-zFOR~ ~0, ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at
No. *** Lot No.
conforms substantially to the Application for Building Permit heretofore filed in th~s office doted
........................ A~j~;I,~,..,1,.~ ............ , 19...~., pursuant to which Building Permit No .... ~...2.~?. ...........
dated ........................ ..~..~..~?...~.....]'.?. .......... 19...'5...~.., was issued, and conforms to all of the requirements
of the applicable provisions of the low. The occupancy for which this certificate is issued is ................
This certificate is issued to .... ~QTC. t~..~.R~.[,,...C;~q~.~. ....................................................................
(owner, lessee or tenant)
of the aforesaid building.
FOH~ NO. 2
TOWN OF SOUTHOLD
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)
Date ........... A~r~ ..19 .............. 19.%8...
Perr~lssion is hereby granted to'
~1',,, Weta~re ~/~.C ....... ]lo~.t, o13. ,1~.rr ..................................
, - .............. i~k~lho~e' road ...............................
........................ fl~'aenpor ~ .... .N..[. ..............
to ......... ]h~.t~l. ~u e~l~E.~.o~...to...a~ -e~r~l!t:~3~-d~e't~ing .....................................
at premises located at ..... ~,~J..,,1;~II.1,~'~I~J..~W ..;[,~tn~ ........................................................
..................................................... G~.eent~r.tt .... li.~. ..................................................................
pursuant to apphcation dated .................. ~pl~41jl ....... '~9 ............... 19~J..., and approved by the
Budding Inspector
Fee $..~.0~ ............
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Exo mined......~.....!...eJ..... 19...~..?'
Approved .................. !.~. ............ !..c(...19..j.~....Permit No...,.~......'..~Z......?....~ ......
,//O r,
Application No ...... .~.....~..~ ..........
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
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 coYered 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 o 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 Count,/, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or o 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 OT applicant}
State whether applicant is owner, lessee, agent, arc_~hitect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ............ Z.~ ....... ..~...~..~ ............................................................................
If applicant is a carp?rate, signature of duly authorized officer.
(Name and title of corporate officer)
l. Location of land on which prol:~sed..work w,.ill be d~o~e. Map .N~o: .~....l~..~.~'....c~...J'..~.~...~....~ot No: ....................
Street and Number ...~./~........~~........?.~.......~.,.~'~'' .............. ~....~....~...' .........
Municipality
2. State existing use and occupancy of pr,emi/,e~and i_nte~nded 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 ....... l..~..0. ............................................ Fee ...~......~... ..............................................................................
(to be paid on filing this application)
.5. If dwelling, number of dwelHng units ................................ Number of dwelling units on each floor ............................
If garage, number of cars ............................................................................................................................................
6. If business, commercial or mixed occupancy, specify ngture and extent of each type of use ..............................
7. Dimensions of existing structures, if any: Front ............ ~ ............. Rear ........ .~.....G.. ............ 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 ....j....O:.. .................
Height ............................ Number of Stories ............................
9. Size of lot: Front ........ .'~..~. ............ Rear ........... ~. ......... Depth ....../....b..? .............
10. Date of Purchase ............~.......~ .................................... Name of Former Owner ......... -~. ..............................................
11. Zone or use district in which premises ore ...... ~.: .................. ~ ..................................
12. Does proposed construction violate gn¥ zoning law, ordinance or regulation? .......... ~ ...................................
13. Name of Owner of premises....~...~.Address ............................................ Phone NO .....................
Name of Architect ............................ .....:.....~ ................. Address ............................................ Phone NO .....................
Name of Contractor ........ ..[~....v~...~.......~..~;;:..Z ........ Address ............................................ Phone NO .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate
property Iines. Give street and block numbers or description according to deed, an,
whether interior or corner lot.
all set-back dimensions from
show street names and indicate
STATE OF NEW ~Y~OR,~,, ~ ) S S
COUNTY OF ..... ~'"~'""")~/ I , J'-~ [,~ J, t~-'-._...- '
................................. -..- .......... ..~..v.............C,.?..~ ....... being duly sworn, deposes and soys that he is the applicant
(Name of individual 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 end file
this application; that all statements contained in this application are true to the best of his knowledge and belief;
and that the work w I be performed in the manner set forth in the application ~iled therewith.
Sworn to before me this_ ..~ L __ . 9..~.....j~.' ~~ ca~n~~
.......... day of ........... ........... ....
Notary Public,. ........................................................... County