HomeMy WebLinkAbout1074-zFOR~ NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N, Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located aJ ....~ ... ~.~.~.~....~.~ .............................. i Street
Map No..~.X.. .......... Block No .......... :/C~...Lot No .... ~ ........~.~J;~.~.~Ct~.....If/~.~o ...................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .... ~.l_a..y. ........ ~.. , 19...~..0. pursuant to which Building Permit No....~...~..0.~. .....
-tated ................. !.4.[1..~. .......... .6.. ........... 19.~.Q.., 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
.......... .p.F..i.y..~,.~ ~....o.11~....I'anl:t l~... d~ 11 i,rig ..............................................................................................
This certiflcale is issued to Cltal les 3azombek Qklil~r.
(owner, lessee or tenant)
of the aforesaid building.
" Building Inspector
FOI~M NO. 2
. TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y,
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 1074 z
Date .......................
Permission is hereby granted to:
............ I~ ~,.t,l t,.uetl: ~..... N.,X, ..............................
t o .. t~aild.. ~n.. a~d it I au.. &.. liak~., alter, a~l~ns., ua.. ~n.. ~xia .ttp~.. ~w~ll.~t~g ..........
at premises located ot ...~..O...t~...~......A.~.t ............ ..~.tll,.~il.¢~ ....... .I~'~,.~, ..............................................
pursuant to application doted ..................................... Hi~.~.....t~ ............ 19.6:0.., and approved by the
Building Inspector
Fee$~00: ..............
Building Inspector
FORM NO. I
TOWN Or. SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTi'IOLD, N. Y.
Disapproved a/c ..................... ~~.~~...~Z~...~~ .........
Application No ...... !...?..2..-c,[ ............
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 ardetailed 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.liable 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 Deportment 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 all applicable laws, ordinances and regulations.
(Signature of applicant, or name, if a corporation)
............ .....................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ....... ~....Z.~...~. .......... : .~...Z,./~../'~,,,~..~ .................................................................
If applicant is o corporate, siqnature ~ duly/e~thorized officer.
(Name and t~J,e'of corporate, officer)
1. Location of land on which proposed work will be done. Mop No: ............................................Lot No: ....................
Street and Number ...... h~..~z~.~ .~........~....~...~'~-~ ......................... ~~ ~ .....................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..~'.~...~..Z~..Z....'~.'...'.~.. ......................................................... : ..........................
b. Intended use and occupancy ......~. .~.~/.~C.~..~...../..."~...~. ..................................................................... ~ .................
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....................
Repair .................... p,f~moval .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost ........../. ................................................. bee ..........................................................................................
t /~ (to be paid on filing this application)/
5. If dwelling, number of dwelling uni s .......................... 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 ....... ~;.., ....... ~t ..........
7. Dimensions of existing structures, it any: I-ront.....~ ............. Keor ............................ Depth ................................
Height ............................ Number of Stories .............................................................................
,, ? ' ..~ ..... .......;¢.....;.,. .......
Dimensions ,oJ.~sgme sJructure with alterations or additions: Front ................................R ar ................................
Depth ................................ Height ................................ Number of Stories .....'-%...C..~. ..................
8. Dimensions of entire new construction: Front "2tZZ,;;'~ ................ Rear ............................ Depth ............................
Height ............................ N,umber of Stories .......... ) ..................... , ¢.
9. Size of lot: Front ............................ Rear ...... C ..................... Depth ............................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
1 1. Zone or use district in which premises ore situated ................................................................................................
]2. Does proposed construction violate any zoning ~ow, ordinance ar regulation? ........................................................
13. Name of Owner of premiso~.-~.~..'~../.c.'..~.....~.~...~?...~...~..'~.'.~...Address ...~.~...~..../~'./'..~.~.~..."~... ....... Phone NO .....................
Name of Architect .................................................... Address Phone NO .....................
Name of Contracto~..~...'~.../¢'....¢.~.q..q/Z.z..¢~......'8~-"..q//..Cc.~....../c..AcC.~....~7'q..'c~-..Address ii3:;i~'~.~.~::i:JilJ.:ill Phone NO.~......~..Z.~..~...~..Z
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 NEWr~,YO~I~ ~ ~ ) S S ''~ o~D ~"
COUNTY OF ...~~..) ' '
........................... ~:.l~ ......................... ~2...:~.being duly
sworn, deposes and soys that he Js the applicant
(Name of individual signing application)
above named. He is the .......................................... :~ ....................................................................
(Contractor, agent, corporate office?, 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 an~J belief;
and that the. work will be performed in the manner set forth in the application filed therewith.
Sworn to before me '
..................... ~, day o{ ...........................
Notary Public, .~~...~ ........... County ' (Signaturel~f applicant)