HomeMy WebLinkAbout922-zTOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD. N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located al ~g~.~;r~. ~t.~[~....~;~0ett~O.t.~ .... Street
, s~se ~?~o%~'~o. *** .~,ot ~'o... ~9 ...........................
Map ~o ........................
eonfol~ns substantially to the Application for Building Permit heretofore filed in this office
dated ..............D,e.~..e.~,~.. 1. ..... 1~;9.... pursuant to which Building Permit No ....... ~..,.9.~ ....
zlated .............. December ~ .... lt~9, , was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is
PRIVATE ONE FAMILY D~B~,?,II~G
This eertifma~e is issued to ......... ~;~b~.r.t Ao Ma~omber~ .nwner .............................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspectod
FO]~i~ 1~0. 2
TOWN O~ SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS I~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No. 922~ Z
Permission is hereby granted to:
~....~..~.~..~ ..................................................... ~.~..~ .............................................
....... ~..~.....~:~.: .........................................
to ..~..~..',~.~. ::.~.t,~.~...~...~..~C~.~.~..~. ..e...~. ~..g .........................................................................
at premises located at ~t/~..,~l~.ll.]l~l~fl,~....([~l~,~.[l~ ..........................................
................................................... .~P.~r~.~....~,~., ...................................................................
pursuant to apphcat~on dated .............. ..~j~..l~.~... ~1, .................... 1~1 ....... , and approved by the
Building Inspector
Fee $~ ~, .1~.. ................
Budding Inspector
FO~M NO. I
TOWN OF SOUTHOLD
BU,LD,NG DEP^.T, ENT
TOWN CLERK'S OFFICE
SOUTHOLD, N: Y.
Examined ..........~....c~....~, i 9...~...~
Approved .................................... , 19 ........ Permit No ................................. ~--- -- --
Application No ..... ?.......~......~'.. ............
APPLICATION FOR BUILDING PERMIT
................... ........
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink end 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 drawn 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
perr~it shall be kept on the premise§ available for inspection throughout the progress of th~ work.
e. No building sh011 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 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 alterations, or for removal or demolition, as herein described,
The applicant agrees to comply with a Iapp icable laws, ordinances and regulations,
(Signature of applicant, or name, if a corporation)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.................. .............................................................................................................................................
Name of owner of premis~/..~.~.......~.......~...: ..................... ................. ' ............................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which~groposed work wi,Ll~be~lone. Map No: ..~....~ Lot N°:~.~..i ............
Municipality
2. State existing use and o~'~pancy of pr~'nises and intended use and occupancy of proposed construction:
o Ex,st,ng use and ........................................................................
b. Intended use end occupancy ....~.~..)~..Jrz?....~...~..C.......'{m......~...~...~..~,.~..; ................................................................
3. Nature of work (check which applicable): New Building .................... Additio~ .......... AIteration...~ ........
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost .........-~......4~....C~... ..................................... Fee ~...: ...................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ....... ~....Number of dwelling units an each floor ..................................
If garage, number of cars ............ ~..~..~... ...............................................................................................................
6. If business, commercial or mixed occupancy, s~cify nature and extent of each type of use ................................
7. Dimensions of existing structures, if any: Front .........~...~ ....... Rear ....~.~.[ ............ Depth ....~..~..~. ...............
Height ~ ....... ~..O..~ ..... Number of Stories ....... ~.~ ...................................................................................
Dimensions of same structure with alterations or additions: Front ........ ~ ............... Rear .~..~. .................
/ ...~.~. ................. Number of Stories ....~ ..........
Depth .~....~.~. ............... Height /
8. Dimensions of entire new construction: Front ....... ~.~.~. .........Rear ...... ~..~ ............. Depth ....~.~ ..............
Height ....~~. Number of Stories....~.~ .............
9. Size of lot: Front ..... ~.~ .............. Rear ...... ~..~.J"....J~... Depth ...~.~..~ ............... ~
Date of Pu~hase ~ Name of Former ~ner ~~ ~ -
11. Zone or use district in which premises are situated .......................................... ~~.._.~ ....................
12. Does proposed construction violate any zoning law, ordinance or regulatlon~ .................................................
13. Name of Owner of premise~~ ........ Address ~..'~.r ........... Phone NO. Z~ ....
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,~YOR~K~ ~)4,) ~ S
COUNTY ,OF ..~..~3 ~' ' .
...... :. ........................... being duly sworn, deposes end soys that he is the applicant
(Name of individual signin~3_application)
above named. He is the ~ 6<~ A/' '.4~'//
(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 the manner set forth in the application filed therewith.
JUDITH T.
Sworn to before me this ~otaty Public, State o! New York
...................... ..... , ...........
Notary Public, ,~V,,C~.,~..~.. County (Signature of applicant)