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HomeMy WebLinkAbout1048-zFOP~I MO. 4 TOWN OF SOUTHOLD RUILDING D~PARTMENT TOWI~ CLERK'S OFFICE $OUTHOLD, 1~. Y, CERTIFICATE OF OCCUPANCY No ...... ZlOt9 ..... Date ................ THIS CERTIFIES that the building located atW/~.....~[Ol, tlq..~3rV.~.e~d...~Oa~.... Street Map No. ~,~X....~ ..........Block No ...... XX;~ ........... Lot No..= .......... ~o.~thold~......I~,X, .............. conforms substantially to the Application ~or Building Permit heretofore filed in this office dated ................... /~f~.};.....~. ........ 19.~0. pursuant to which Building Permit No....~.(~,~ .... dated ...................... .Apr..]...~......2~ ..... 19..~0, was issued, and conforms to all of the require- merits of 1he applicable provisions of the law. The occupancy for which this certificate is ~ssued is .-..t~-:~a.~a-..o~e..-f-am~-~. dwa~l.~ng- ............................................................................. This eert';ficate is issued to .1~O¢h~e.~.-~l~la.~..~}r. .................. 01ql~e~', ......................................... (owner, lessee or tenant) of the aforesaid building. FOE]~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE .KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THI~ ~v'ORK AUTHORIZED) N? lo48 Z Permission is hereby granted to: I~xl~.....~a~.~. .............................................. ....... ~ho;l~l ......... ~.lt;. ................ ~ .................. pursuant to application dated ........................, ' ........... ~li, pltl~....,~.L....] ~J~.O,...,' end 0pprovedrby· the Building Inspec~tor , , · Examined ......... .~...~..~ ............... , Approved .................................... , FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ Permit No....~..!..-O...,.~...,'..~..... Application No ..... !....O.. ~ .q.'...~L~.. .......... APPLICATION FOR BUILDING PERMIT Date ............... ...... 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 ava. Jlable 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 ktEREBY MADE to the Building Department for the issua.nce 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 all applicable laws, ordinances and regulations. State whether applicant is owner, lessee, agent, architect, engineer, general confractor, electricianl plumber or builder. Name of owner of premises ....... ~:] ........... x~.t..~...~¢?::..:..'~.m[.-~ .............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ............. 1. Locution of [and on which proposed work will be done. Map No: ............................ : ............... Lot Street and Number .................................................. I ................................................................................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy ........ b. Intended use and occupancy ......... .~?.~.,~.'..,L~... .... .:~ ..... ~ .......................................... 3. Nature of work (check which applicable): New Building ....'..~-.. ........... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .~-..~,)..~ ........................................ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~.....Namber of dwelling units on each floor .................................. cars ;.~ . .,)~'..O. ....~.....k:~...: ......................................................................... . . . If garage, number of ~ 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 'q-uarr'~ Height ............................ Number of Stories....~ .............. 9. Size of lot: Front .....~....oz.L..~...: ......... ~ -ff' Depth ..../...¥~.0. .............. Rear ............................ 10. Date of Purchase ....... ./..?....~.....~.. ................................. Name,,of.,~ I~. t'F'°r~c~.O~vner .... ........ il. Zone or use district in which premises are situated ............... .~..4.......~...: ............................................................ 12. Does proposed construction viol, qte,0,ny zoning law, ordinance or regulatio, p? ..... ...~....~ ......................................... Name of Owner of premises ..~.r..~'~: ... Address ~~t Phone NO 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. STATF OF NEWc.,YqI~I<~ ./. ) S S ....................... ~ ......................... being duly sworn, deposes and soys fl~et he is the appticam (Name of individual signing o.ppli above named. He is the ..................~~..~ ............................................................................................................ (Contractor, agent, corporate, officer, etc.) of said owner or owners, and is duly authorized to perform or ha~e 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. Sworn to before me this ~ day of ................. ........................