HomeMy WebLinkAbout1608-zFOR~I NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
............................ ~ 1294 ,Y&nuary 24 62
No. Date ................................ O~,d. · i~,.1.~..: · · ,M~,.~;tU(~.:~
THIS CERTIFIES that the building located at II/e M~.].], ~li~e · ~ Street
Map No ....................... Block No ....................... Lot No .....................................................................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.............. .N...O~..~..~.....]:..3. ........................... 19..??'... pursuant to which Building Permit No. ?....~.?...0~....
dated llovell~Z' 13 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 ..........
B~SI~BS BV:LLDZJ~ -
..............................................................................................................
. . Mattttuck Inlet )tartnn,/~-..er~/~
This certificate is issued to .................................................................................................................. ---
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
FOR~W 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.o 1608 Z
Permission is hereby grante~l to;, f~.' _
o,,:,,.,m,,es,oco.,-,c,,:,,,-,~....~...~,~..~C. ........ .(.~.,,.....~.e..~). ................
pursuont to opplicotion doted ................... ~~....../..~;~ ........... 19~./..., ond opproved
Building Inspector
Fee $...~.~ ...i ~. .....
FO~M ~qO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ..... ~.../.,...~. ......... , 19,~. [....
Approved
........................................ , 19 ........ Permit No .................................
Disapproved a/c .... ~~~..
........................... ...............................
Application No..~..~...~...~... ...........
APPLICATION FOR BUILDING PERMIT
Dote ................ ................. , .........
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 application.
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 o 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 po rt for any purpose whatever until o 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, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
(Signot~z,~ ~f applicant, or name~ if a corporation)
(Address of applicant)
State whether ~s_see, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ...~...~.?.~.. ...... ~.........~.....~.m ........................................................
If applicant is a corporate, signature of duly authorized officer.
.... ...................
(Name and title of corporate officer)
1. Location of land on which proposed work will b,e~done. M~i~ No: .....~...~.~'~.. ............ ,~ ....... ,.~.... Lot No: ..../~.....'~.. .........
Street and Number ....~..'./..~......~~...~...~.~....Z~.....X..~...~:
Municipality ,. ,,
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
3. Nature of work (check which applicable): New Building .................. Addition ...,~,L.~... 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 .............................. Number of dwelling units on each floor ............................
If garage, number of cars .............................................................................................................................................
6. If business, commercial or mixed occupancy, specify natureond extent of each type of use~ ...........
7. Dimensions of existing structures, if any: front ........ .~.....~.. ......... Rear ......... .~....G':.. ......... Depth .....-~....O.. ...................
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 ....::~...~c? .................. Depth .....~....~.. .................
Height ............................Number of Stories......~ ............
9. Size of lot: Front ................................ Rear ............................ Depth ........................................
10. Date of Purchase ........................................................Name of former Owner ........................................................
1 1. Zone or use district in which pr~mises are situated ...........................................................................................
12. Does proposed construction violate,~a, ny. zoning) law, ordinance or r~aulation> ~.~.
13. Name of Owner of p, remises,,_ .~ ,~-- w ~ ~'~._ _ .~..~'....~...~.~aFdr'~s · ......... [r '-"-'" -'": "'"'" '"'"'"' "'"' '"""'"'"'"'"'~...~...~.........'phone'No,'....................
Name of Architect/~........~...~..~. ................ 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.
STATE OF N E'W~YO~,
·
............. : ............ ~-~-.'~ ............. u ....... bei6g duly sworn,~epos~ and says that he is the applicant
(Nome of individu~ging a~cation)~
named.
.bo~eH. ~, the ...~..,..~....~.~.~.~.....~.~.= .......................
~ / (Contractor, agegt;,,co~orate officer, etc.)
of said owner or owne~, and is duly authorizedJto perform or have performed the said work and to make and file
this ~lication; that all st~ements contained rn th,is application are true to the best of his knowl~ge and belief;
and that the work will be performed in the manner set fo~h in the application filed therewith.
Sworn to before me this JUDITH T. BOKEN
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