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HomeMy WebLinkAbout388-zFOB.~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, BI. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the budding located at ~J.S.~o~th~....S.~ ....................... Street Map No .0..~.o.o...~ .~.f~.~ ....... Block No ................. , conforms substantially to the Application for Building Permit heretofore filed in th~s office dated ............. ~T1]]~ ........ ]L~ .........19 ~., pursuant to which Building Permit No ..~r.',~ .............. , doted ................. ~T~:il,....,~ ........ 19.~'8..., was issued, and conforms to oil of the requirements of the applicable prows~ons of the law The occupancy for which th~s certificate is issued is ............ .............................. Plq I~.A~.E.. ONE .. FA~LY...~ELL~.I~G ....................................................... This certificate Is ~ssued to ..... (~l~'~e,~t,...~].-~ a~S ............ (..G~'~e~} ....................................... (owner, lessee or tenant) of the aforesaid building FOF~ NO. ~ 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) N? 388 z Date ............... ~lL~!r.... ~ .................. 19~..~.... Permission is hereby granted to' ................... ~,t~old .................................... to ........ ~l~l.a~l .ae~ .~we.l~Lng. .............................................................................................. at premises locoted at . G"I:L~.~I~;~.I~.~. ~.~ ............................................................................. ...................................................... O~eo4..F~rk ..................................................................... .............................................................. ~..o.~. ~.h...q.Z~t ..... .~!....Z..: ................................................. pursuant to apphcahon dated ...................... ~l'l,~]r .~l,~ .................... 19..~'~1.., and approved by the Budding Inspector Building Inspector FORM NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE .~. SOUTHOLD, N. Y. Examined ....... i;' .... Z..~.. 19.....~...a~ , ,. .... Approved ....... ,~ ....... :./ ................ 19 ........ Permit No. Disapproved a/c ..... ~. ........... :.~. ............. .~ ............. >~ .............. .~ ................... ......... ....................... .................... .................... (Buildin~ Inspector) ~' Application No. APFLICATION FOR BUILDING PERMIT lb' 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 description of layout of property must be drown on the diagram which is port 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 pro~ress 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 MADE to the Building Department 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 all applicable laws,~.~..ordino~es~ 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 premises...~.../~ ........................................................... If applicant is a corporate, signature~of duly authorized officer. of land on which-.~.A4 ...~.,....:,, ~.. ~ Lot No: .....~... Street and Number .... 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 occupancy ........................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair ............... L~Removal .................... Demolition .................... Other Work (Describe) 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 ............................ ] 1. Zone or use district in which premises are situated ......... ~ ............................................../' '"'"~' 12. Does proposed construction violate an~ zonina aw ord nonce or re ulati :~ 13. Name of Owner of premises.~~Address . ~ Phono tun 4~./ Name of Architect ................. ;-]_.._...~ ......... Address ............................. Phone NO PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and ndicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, ~d show street names and indicate whether interior or corner lot. STATE OF NEW_.YOR~,, ,~ ) SS COUNTY OF ....~,,~-¢c/././././.~..(,~_),., ' ................................ · ~..-( ....... ~~Z~..~..&.~.being duly sworn, deposes and says that he is the applicant (Name of individual signing application) /~ above named. He is the ................................................. ~;~; ~;.~ (Contractor, agent, corporate officer, ~.) ...................... 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~ppli~jon are true to the best of his know edge and belief; and that the work will be performed in the ~nner sef'~t~,~lic~ion filed therewith.~ Sworn to be~me this ,-~ ~ ~ .' ~t~;~.~t , ~ ~ __ ,_.~ ...... /.. of ........ ...... ot Ii '