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HomeMy WebLinkAbout1760-zFOlh~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, ~1. Y. CERTIFICATE OF OCCUPANCY No ..~:~3C~2 ............. Dote .......................... ~U~:~....~ ............. , 19.~... THIS CERTIFIES that the building located at ..8~l~]...,~r~J~.t~...~EL[q.~ .......................... Street Map No ...~...x~.jr~ .......... Block No ........ ~ ....... Lot No ...~:~ ......... ~O~l~;J~.'l~J .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................................... ~t~.~I.....2 ...... 19..1~.-q-. pursuant to which Building Permit No dated .............................. ,,T..I~. ...... .~., 19..~2., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued ~s .......... ........ ...~...~.~.~..g~...~....c~.~:L~,~ ................................................................................... This certificate is issued to ...~,,~0~ ................... (~/J~. ............................................................ (owner, lessee or tenont) of the aforesaid butldmg FOII¢'*d ~TO. ~, 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? 1760 Z Date ......................... ~'11~1~.... ~. ......... 19.(~.. Permission is hereby granted to: ............... [ ............................. ~u-t~aZ~ .............................................................................................. pursuant ~,o opphcot~on dated .................................. .,~r~.....~ .......... 19...~12, and ap~proved by the Budding Inspector ~'~ Building Inspectbr 2, / i, ' ,, \ , FOI~I NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..........~ ...~r, 19..~....~- Approved ............................... ~*..T......, 19...L,..Permit No...Z..L..~..,(~...~ ....... Application No.../...~.....~.....O. ......... APPLICATION FOR BUILDING PERMIT Date .................. ....... ....... .... INSTRUCTIONS o. 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 thediagram 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 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 pa rt for any purpose whatever until a Certificate of Occoponcy 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 t° c°mply with all applicable laws' °r din~es~i°ns' I~ ~ (Si~ture of applic~a~name, if o corporation) (Address of applicant) State whether applican.~j~s owner~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) l. Locotion of land on which,.,propc~ed wor~ willie~ done. ~v~op ~o: ...............................~ ...... k~r No.: ~ ................. Street ond Number .......................................... Municipolity 2.Store existing use and occuponcy of~nlse..~s ~n~ i~n.~epded use ond occuponcy of proposed construction: o. Ex,st,ng use and occupanc, ................. ................ .................................... b. Intended use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ......~.t~...~....~ ............................. 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 or additions: Front ................................ Rear ................................ Depth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front .............J. ................. Rear ............................ Depth ............................ · Height ............................ Number of Stones .................................. 9. Size of lot: Front ................................ Rear ............................ Depth ........................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning aw, ord nonce or_regu at 13. Name of Owner of premises ......................... Address ............................................ Phone No ..................... Name of Architect ....... .~ .................................. ~ddress .................... ............... Phone No ..................... ~d Name of Contractor ...J..~..'..~....~. dress ...... ~.....: ................. Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property tines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, _ ) SS COUNTY OF ~....) ' ' ......................... /~'.!..~ ............... .-/~.'..cfj,~x~.....being duly sworn, deposes and says that he is the app~ (Nam ' ' ' ~ ' g C~lSpli~otion) above r~amed. He is the .................. ~.~...¢.~.~. ..................................................................................... (Contractor, agent, corporate 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 j'~fft~i~ o~[~cation are true to the best of his knowledge and belief; and that the work will be performed in tl~uta~rcc~j~S~j~~ lJog~the application filed therewith· Sworn to before me this No. 52-0344963. Suffolk County,., ~ ~ /q Commission Expires March 30~ 19~ ............. ~ff.-...--.'. davy of ............... ~; ............ , ) 9..~1~. .......... Notory Public, .~.~ ..~¢~......~ (Signature of appl;~;;~i .............................