HomeMy WebLinkAbout312-zFOlg~ NO, 4
TOWN OF SOUTHOLD
BUILDING DEPAl{TMENT
TOWN CLERK'S OFFICE
SOUTHOLD. N. ¥.
CERTIFICATE OF OCCUPANCY
No. Z 7.0.9, Date Ju~y~ 1.8.,~ .! .6,0.?,
THIS CERTIFIES that the building located a~ ~Ol~.S.~a~ ~,~,e~.. SO.~ ..... Street
Map No. *~.. . , Bl~ck No... *~.~.. Lot No ............. *** ......................
conforms sabstantially to the Application for Building Permit heretofore filed in this office
dated ........... ~ay.. 1~ ........ 1~.~ .. pursuant to which Building Permit No ...... ~...~ ....
· lated ............ ~aY..12 .......... 19.. ~, was issued, and conforms to all of the requirements
of the apphcable prowsions of th~ law. The occupancy for which th~s certificate is issued is
PR~A~ O~ F~ILY D~LLXNG
This certlflca~e is issued to
(owner, lessee or tenant)
of the ~oresa[d building.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST 13E KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 312, z
Dote ....................... ~...~ ................ i~..~.
Per ~ission is hereby granted to:
...... P~ar~a~ee....1~.~I~;~ ................................
............. ~Bo~aea~'~....A.T.~ .................................
~.~.,......1!..:~: .....................
to_ ........ -!~t:!~..~.~t~l~..~a~e...t~.. ~..~.t,..L~..~..Z..L..~ ................................
I
at premisbs [ocated at .J~.~....]~D.J.I~I~I~t.....~L~I~I ............................................................................
.......................................................... {~m;l,%~m ....... ~][:. .................................................................
pursuant o apphcat,on dated ........................ ~ ........ ~ ............... ]0...~.~, and approved by the
Budding Ijqspector
Fee $..-~.,,00 ..........
Budding Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ~ ..'..~
Disapproved a/c ......,~,.... 7.?;':.,~.... -- ....... ,"~ .......... ~j ....... ~ ........ ,~ .............
............................. ......... .....
· .....................
Application No. ~>/ ~
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 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 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 alterations, 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 of owner of ' ~/~:~ ~e ~- /-7~ ~ .
prem.ses ........ ~ .......'~...~' ........ ~ ...................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Location of land on which proposed work will b,e. dOne. Map No: ............................................ Lot No: ....................
Street and Number .~...~..{..~..~.~'.1~......~.. '~'~'i ........... · .~...~....~'.....'~..~....~../(~... ......................................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing useandoccupancy ....../'~..~....~.....~....Z./../...~.~.. .........................................................................................
b. Intended use and occupancYl....G~J..J~...~::~..~.i~_~?[~ ~, ...... i ............ i ........ '.
""
.9.
10.
11.
12.
13.
Nature of work (check which applicable): New IBuilding....~ ............... Addition .................... Alteration ....................
Repair ................. ~ff, emaval .................... Demolition .................... Other Work (Describe) ....................
Estimated Cost ........ ~...~...Q..~ ...................................... Fee .~.~.'..'~.. ............................................ i ...................................
(to be paid on filing this application)
If dwelling, number of dwelling~its .................... : ........... Number of dwelling units on each floor .....................j ......
If garage, number of cars ...........~..~ .............................. ~..~ .......................................................................................
If business, commercial or mixed occupancy, specify nature and extent 0T each type 0F'u~ .......... Jj. Jj]~j ............
Dimensions ~f existing structures, if any: Front.....~.~. R~r":,,~..~..~.~Depth ...-.~.~...~.~.~
Height ............................ Number of Stories ....... ~..,~: ............................................................... ;"...'..-~,~,o,.......~
Dimensions of same structure with eltemtions or additions: Front ....~....~z., Rear ..;..~.~...~.... '
Depth ..... ~..~.~.~... Height ........ .~ ................. Number ;~ Stories ...~.~'~..~.~" .,, ';~" ~
Height ......;;..' .................. Number o~ Stories ..~.~.~v~..~" ~ ~ ~.
Size o~ lot: Front ....~.~..~...~ Rear ~ ~ Depth ~ ~ ~
D~te o' Purchase ............~.~ ..................................... Name of Form, r Owner ..~.~.~.~..~ ....... ~.~.~;' '~
Zone or use district in which premises ere s~tu~ted ...................... , ........................................................... .
Does proposed construction violate any zoning law, ordinance or regulation> ....... ~ ~
- .... ..............
Name o~ Owner of premises. L~.~...~.~.~.~Address .~.~.~;~..~. ................ Phone NO ....... ~.~.~ ~
Name of Architect ........................................................ Address ......... ; .................................. Phone NO .....................
Name of ~ontractor .................................................... Address ............................................ Pho~ NO .....................
-' ' PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from
property lines. Give ~treet and block numbqrs or description according to deed, and show street names and indicate
whether interior e~.~mm~r lot. '"
?
\
STATE OF N~( ~ S S
COUNT .. V'Y:/'> ......
......................................... L..-'~.~...~~.'C.. ........... bmg duly sworn, deposes and says that he ,s the apphcant
above no(Name of tindividualmed. He is he. signing applic~tio?iY . .....
(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 IjJi~r~h in the application filed therewith.
Sworn to befpre me this ~ --'~_~., ~l~le 0~_~.. ~ /'~ l/
......doy of .......... ,Signoture of opplicont) .
' ' ~ ' ~:~6 , ~ ' ~' :~ '