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HomeMy WebLinkAbout624-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCC~UPANCY THIS CERTIFIES that the building located at ....... ~/~....]).~l~..:~e,~ .............................. Street Map ~o ...... ~ ........... Block ~o ....... ~ .......... Lot ~o..~......~.~.~.°..~..~.....~:.~:. ............................ conforms substantially to the Application for Building Permit heretofore flied in this office dated ....................................... ,~,~,'1,~....~, 19..,~.c).., pursuant to which Building Permit No...~...(?.2..Jt ................ dated ................................. ~17.~.:~.~....,~....., 19.~c)...., 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 .............. ............. ~ri.~a.~..~me..£~JJl,Y...~.~ll~g ............................................................................................ This certificate is issued to ...J~.'r.y..~.~i~fl~....~V. ............ [..~,~.~.~,). ............................................ (owner, lessee or tenant) of the aforesaid building. FOE~ 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.o 624, Z Date ........................... Jt,i~]....3 .............. 19~9 .... Permission is hereby granted to: I~z,~..Fq,~isohmi~..J~' .......................................... .............. ~)e~o~... ,~ ........................................... to . .l~e.. ~ Xt, ~ ~: ~.~ J,.~ ~.~! ~.¢~.~-.~.~9.~,~...9.~..~....~..:~.t,~g.. ~.~. ~..~.~..~ ....................................................... at premises located at ..~,,/'~...~.~,,~..~,~1 ............................................................................................ ..................................................... ~.~l~g~,..../~...~.., ............................................................................ pursuant to application dated ........................... A~:ll ...... ~] ................... 19.]9..., and approved by the Building Inspector Fee $ .~..0~ ................ Building Inspector [ .. FORM NO. 1 TOWN OF SOUTHOLD BUILDING D EP.~P, TN~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×omined ......... I Appraved ........................... .......... ........ Permit ....... Disapproved a/c .............................................................................................. (Building nspector) Application No ..........~.....%...~.. ........ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su~omitted 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 cov. ered 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. (Signoture of applicant, or nome, if o corporation) ............. ........ .... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameof owner pof remises 1.~...~ ........ L~'~..~. ..... ~-~~e.~m4~ ........ ~.. : ............................................ if applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done._ Map No: .................. ~.....~-%. ................. Lot No: ...J~.iZi ........... Street and Number .... ~. ................. .~/ .......................... ~r~'~ Municipality 2. State existing use ~nd occupancy of pr~mise~ and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................... ~'..~.. · .~.. :.'. · .~. ........ ~ ..................................................................... b ntended use and occupancy .......................... ~,.*. .............. .~.~.~~~../. ..................... ~,:,::.. ............. f Vr 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair ........... ~. ...... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.7.~.'.l~. ................................................... Fee /..~. ~ .... (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 ar additions: Front ....... ~ear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front.....~,z... ................... Rear ............................ Depth .:...-m..'- ................ Height ............................ Number of Stories ...~ ...... 9. Size of lot: Front ......'~'....~.. ................ Rear ....~..O....~. ........... Depth ... ..'-~. .. ?Z...~.:. ..8. ........ 10. Date of Purchase ........................................................ Name of Former Owner ............................................ 11. Zane or use district in which premises are situoted ......................... t. ........................................ Does proposed construction violate any zo 'rig law, ordinance or regulatio_~n~) ~ 12. Name of Owner of premises.~.~....~..2~z.z::Address ..... ~.~--";' ~ ......... ~"~) ....................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor ............................ :..~ .................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly aad 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 s~reet names and indicate whether interior or corner lat. STATE OF NEW...YOI~I~ /~-. ) S S COUNTY OF .,.~..,) ' .................................................................................................~J! 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, etc.) of se d owner or owners, and is duly autho/.]zed to perform or have performed the said work and to make and file this application; that all statements contaiRt~ ~,i~,,!~t~,is application are true to the best of his knowledge and belief; and that the work will be performed in,the rf~'~,?¢-s,e,~f/f}]'~h in the application filed therewith. Sworn to before me this ~u~a~- ,~^f r-~,~(~,~,%~. .' 1. O~':'/k°'o~r~' '"'"~r~t~re of applicant) .................... .~.. u[ .......... ;~.~ .................. ¥ Notary Public, ~.~/,~w,.J, '~...~ ......