HomeMy WebLinkAbout746-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at s/.,s Pecooni~
Map No...~..~..~. ................. Block No ......~.~.~ ............. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
................................ ~..~: ............. 19..~.~.., pursuant to which Building Permit No. ~..~ ..................
dated ..................................... J~.[...., 19...~., 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 ..............
~ATE O~ F~I~ D~L~
This certificate is issued to ..~.,~]~ ..........................................................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
NOWABD M. TERI~
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)
No, 746 Z
Permission is hereby granted to:
C~n%i~e~tal ~o~ermi~i~g ~o. ~ i~.
·. a~e' ' ,~s ~?' · C'~'~ ~w~:e ..........................................
.. ~.. ~,.....~..t...m.~t,r..e.~.t. ...........................................
.$.. m~%ht~n,.. N~.. ~.~r.k .......................................
s/~ Peeo~te Bay BoulevardS ~a~el New Tork
at premises located at .................................................................... '~ ........................................................
pursuant to opplicotion dated ...................................... ..~-~..~..-.]: ............. 19.~...,
ond
approved
by
the
Building Inspector
HOWAPd) 1~. ~P~ ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined .............. ~.....~.. 1~).~.~..~.
Approved .............. ~..19..,~'ermit No ...... · .~-....Z ...~.~.....
Disapproved a/c ..............................................................................................
Application No ....... .~........~.. ....
......... (uilding"i~ctor) ....... ~
APPLICATION FOR BUILDING PERMIT
Date ' /. 19 ~ ~
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 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, ordinances and regulations.
, ,.
(Signature of appl~.~~_
If applicant is ~l~ora,~/~i~/f~.o.f_duly. outho,~J officer.
(Name and title of corporate officer)
Location of land on/ ~'-~ ~ // ~, .,/~whicl~ proposed work w~ill be done. Map No: ....................... ~ ................ Lot No: .......~.. ...........
Street and Number .~.~....~.~.~i~~--~~., - · ..,~,-~,~,, J-- ........ ..~..~..~}..., ...............
/ ~ Municipality I C, ~'
State existing, use and occupancy of pr,emises~__and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..............~~J-~ ......................................................................................
b. Intended use and occupancy ....... ~~....~.~../...~z~..~
3. Nature of work (check which applicable): New Building .................... Addition ....~,~..............Alterat~on .~.~¢~.;%;.~, _
Repair .................... ,~s~ ~.~Rem°val ~ .................... Demolition ............ -~',,'~'"~"O"th~r Work (Describe) ....................
4. ~s~ ma~ea ~ s ........ /...~.~ ................................................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ................. /. .......... Number of dwelling units on each floor .......... :~.. .............
If garage, number of cars ......................................................
6. If business, commercial or rnixed occupancy, specify nature and extent of each type of use .............................
7. Dimensions of existing structures, if any: Front ........ ~ ........ Rear ........ ~ ......... Depth ..~.~.'~i ............
Height ............. .~i ............ Number of Stories .... Z ............................
Dimensions of sa.m/e structure with alterations or additions: Front ............ ~ .......... Rear ....... ~ ...............
De,-th ,~-.,(_:2 Height ~ Number of Stories .~. .,..
8. Di~ensi~"~;";~;;;';"~ construlfi~:"';';~';iiiiiiiiiill .~.... ........ Rear ....iii.iii~Ziiiiii'"l~;';th ...... ...~..~i .......
Height ............................ Number of Stories ...... ~... .................
9. Size of lot: Front ......... .~.~...O. ......... Rear .......... .~...~....~...... Depth ........ ~....O.....~.. ......
10. Date of Purchase Name of Eormer Owner ........................................................
........................................................ ,,
11. Zone or use district in which premises are situated ........................ ~ ...~ ...................................
12. Does proposed construction violate any,~nin~l~law,~ ordinance or,, regulat~n~ ...~ ................................................
13. Name of Owner of premises.~.~~-~ddress~--C-~<~.~...:,~....-....Phone NO
Name of Architect ....... ~,~ ................. ~' ........................... Address ................... ;...¢....~..¢ ........... Phone NO .....................
Name of Contract~.~~ ...~'.~,..~"~*' ~~
· ' ' ~ -- .~..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
~r lot.
whether interior or corn
STA'FE OF NEW ,~OP.~. ~' ) S S
(N~ig~g ~licati~on~)
obow~, 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 and file
this app cation; that aH statements contained in this application are true to the best of hJs~ knowledge and belief;
and that the work will be performed in the manner set forth in the applicat~ f~the~./~
Sworn to before ~e this
~. ~ day of ....