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HomeMy WebLinkAbout338-zFORI~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERKTS OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No Z..2.2~+.. Date ............... /~o. vemb.er....P~9 ........19~.8... THIS CERTIFIES that tke building located at .~.~.....]~f~.~hQ~e ~Qs.d ................... Street Mop No ~..~.~.O~:~.~ ]~..E~.~I~$. No ......................... , Lot No ~9..Jc~..3.0.~..C~e. er~port~ conforms substantially to the Apphcat~on for Building Permit heretofore filed ~n th~s off~ce dated .f...~1~'~I...~.lg..~..e...~.~}..~...~.~....1.3. .... 19 ~.~.., pursuant to wh,ch Building Perm,t No ....... ~..~3.~. ....... , dated ............... J~:le..~,.~ .......... 19...~, was issued, and conforms to all of the requirements of the .applicable prows~ons of the law The occupancy for which this certificate ~s ~ssued is ............ ............. PRI~%TE .~NE..FA~4IL~. D~ELLING ......................................................................... Th,s cerhficate is ,ssued to .~0~.. Tr~x~ll(~ ......... (...o~ner) .......................................................... (owner, lessee or tenant) of the aforesaid building rocOCo. ~ 'rowN O~ SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT COMPlETiON Or THE WORK ^UmHOR~Z~D~ 338 Z Date ......... Per~ssion is hereby granted toL ~~ ~...~.~..~.~ ..... ~ .... ~ ..... T~~ ,o .... ~.~..~ ...... ~..~ .......................................................... ........... ~s ........ ~~:~ ..... ~: ~ ................................................... .............. ,, ....................................... ~~ .......... .~...~ ................................. ' pu~uant to apphcat~on dated ................................... lg.~..~nd approved by the Building ~nspector Fee $.j Bu,ldmg Inspector'~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................................ ! 9 ........ Approved ........................................ 19 ........ Permit No......~.....~..?..~... Disapproved a/c .............................................................................................. Application No ............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........ ~..../...?...~. ................................. l g.~..(~. 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 o detailed descript!on of layout of property must be drown 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 o 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 pu~'pose whatever until o Certificot, e of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or o Iterations, or for removal or demolition, os herein described. The applicant agrees to comply with oil applicable lows, ordinances and regulations. (Signature of applicant, or name, if a corporation) . ....... ..... (Address of ap~olicont) State wheth.er applicant~,-~#ner, lessee,~agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises....~...~.~..~ ......... ~../,~'..X~.~I~.,~'.~:;~ ................................................................................ If applic~3{ is a corporate, ;,s~nature of duly authorized officer. 1. Location of land on which I;a:oposed work will be~do.n,e. Map No: ~~.~,..~..~. Lot No: Street and Number ' /r 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 ond oceupan . ......................................................................................... 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 ............ .~'...../~..,~[~.~.~.~ff~lumber 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 ....... ~....*.~....Z. Depth ...~..~..:.O...~...,r'()-o~, Height ........ .~..~. ........... Number of Stories .......... .~. ............... 9. Size of lot: Front .......... 7.....~./~....'.. Rear ..... ..~....;~...~ ........ Depth .....~..~...~....~...'.'...~'o" 10. Date of Purchase .............. .......................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ............ ~ ............................................................................... 12. Does proposed construction violate any zoning law, ordinance or ragu at on? ..~._..~ ............ ·~'' ~ ~ ° /'~ ...... ~...~.Phone ~ ~z.~' Z';~; ............... 13. Nome of Owner of NO Nome of Architect~....~..~...c...~...~...~'.....~....~.....~...~...~,'./'' ........ AddreSs~ ..~. ~ ~..~......~..e~..~...p~ n~e 'N~b~tJ~.~,~ ,~ Nome of 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. e STATE OF NEW,,YOR~,, x/ )~SS cou - ....... >,,~.....~..~:f.......%:~...~ ................................... being dUly sworn, deposes and says that he is the applicant above named. He is the....;.....~......~ .................................................................................... (/ (C_~r~i'actor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to p~rform or have performed the said work and tO make and file this application; that oil statements contained in this app~kc, g~,q~,gre,~t~L~ the best of his knowledge and belief; and that .the. work will be performed in the manner s~e~l~t'~ ~t~.~e~ied therewith. Sworn to betore me this ('"'l b~o,~-~gtl,?~ - Su~otk Ceta~t~ .................... y [~.~~ .................. ~.~.'_j..~. · (Signature of applicant) Notary Public ............. ~ ................... County'"~~' ./~--/~l~Z~ ~.~,~"'~,r_.....