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HomeMy WebLinkAbout792-zNO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ....t~;/~...~m~n..[iss,~ao~..~ ....................... Street Map No.~,~ .................. Block No.......~...~.. ............. Lot No~......~..~.°.~.d..s..,..~.*.~.: .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................... A~'e~t,..~ ............. , 19..~9.., pursuant to which Building Permit No...~..~)...~. ............. dated ...................... ~.~.....~ .............19.~.~...., wos issued, and conforms to all of the requirements of the applicable provisions of the law. The occuponcy for which this certificate is issued is ................ ..................... ~,.~.~ .......................... ~ ..................................................................................... This cerHficate is issued to ....~z~.~,~..~¢~.~zP, ............... (~.~ ........................................................ (owner, lessee or tenant) of the aforesaid building. Building Inspector / FORM NO. 2 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.° 792 z Permission is hereby granted to: Walter Adamson Southold~ N.Y. Build ney one family dwel] ~n£ at premises located at ...W/..~.....T....~_......i~...r...'~...r.....L~...~.e. ............................................................................... .......................................................... ~.*.~,...~-.~.: ........................................................................... pursuant to application dated ................................. .A....~l~..li.t.....~ ............ 19~.?...., and approved by the Building Inspector Fee ~..0......0~.. ............... Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Ex°mined ....... ...... Approved ........................................ 19 ........ Permit No. -- ~' Application No ............................. Disapproved a/c ..~ ...................................................... _ ._ (Building Inspector) 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 coYered 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 alterations or for removal or demolition, os herein described, The appl cant agrees to comply w~th all opphcable laws, ordinances and regulations· (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. r ise ................................................................................................................................................ Name ofownerof pem s ~k.~~ ,,,~.,.~ ................................. If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Mop No: ..... ~ ............................ Lot No' ...~. ..... S~reet and Number .....~..if,~,~ ........ i.~..'~......~.~.~-~.......~.-.~.~ ........... Municipality 2. State existing use and occupancy of premises and intended ,~a]d occupancy of proposed construction: a. Existing use and occupancy ............. .~...'.'~...,~'Z....C7.....~..~... ,.?... .......... ~..: .................................................................... b. Intended use and occupancy .................... 3. Nature of work (check which applicable): New Building ....... ~ .......Addition .................... Alteration .................... Repair ............ ~i[.....Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.....~.....~..,~..Q.r~...O. ................................... Fee .1...O. .................................................................................... (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 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 .....~........~....~.~.. 9. Size of lot: Front ....... ~...0.. ............. Rear ........ !...O....~.. .......... Depth ..~.... ...~....O..~. 10. Date of Purchase ............L~..~...?. ............................... Name of Former Owner ...~j~)...o~....~..~.....'~..... ........ 1 1. Zone or use district in which premises are situated ................. ~ .............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... ..~.....b. ........................................ 13. Name of Owner of premises...-..~.....~... ........................ Address ...... ............. Phone NO ..................... NameName of of A rchitect'"'"~"~'"~z" '~"'~'"'~"~ Cont ractor~.~,*.....~~C~o ......... i ........ ....... Address Address ........................................... ........ '~'~..-,~..........~....,. .......... Phone Phone No.NO' I/ v 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 N~O~(,i'I ~, ) S S COUNTY OF ...~f~......) ' ......................... ~./~.~.....~...~.-~..~...being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ........................................ ~..: ....................................................................................... (Contractor, agent, corl~orate 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 applic~tion:~filed therewith. Sworn to before me this ........