HomeMy WebLinkAbout1779-zNO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CL.ERK'S OFFICE
SOUTHOL. D, N. Y.
CERTIFICATE OF OCCUPANCY
South
THIS CERTIFIES that the building located at .Sm.~t~.D=,.,...SouF/Iolc~...N,.Yo ......... Street
Map N .o~..?..~.?.....~...e...C~.... Block No ....................... eliot No. 112
conforras substantially to the Apphcation for Building Permit heretofore filed in this office dated
G~'~fa 11~ 19 ~o2 pursuant to which Building Permit No. Z 3.779
dated ........ ..~...~....e.....~..8. ............................. , 19...~.2., was ~ssued, and conforms to oil of the requirements
of the applicable provisions of the law The occupancy for which this certificate is issued is ........
The certificate is issued to .............................. .~...~.~..~..~.~..?..~..~[~l..~..=...~.f...~..e~... .................................
(owner, lessee or tenant)
of the aforesaid building.
· ' Building Inspec~ ................
TO~N OF SOfT,OLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 1779 Z
Permission is hereby granted to'
pursuant to application dated ............................. iTl:I:!~ "']L~' ......... 196~..., and approved by the
Building Inspector
FOI~,M NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
E×om ned .........
Approved ........................................ , ]9 ........ Permit No ..........................
Disapproved a/c .........................................................................
INSTRUCTI'~~'(~'~'''/~~ .............. , 19~............u.
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 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 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~r demolition, os herein descr bed
The applicant agrees to comply with all applicable laws, ordi~ces and regulation./
ame, if o corporation)
(Address o f"~'l~'~'l'i'~i ...............................
State whether applicant i.s owner, lessee agent architect, engineer, genera contractor, electrician luml)er or builder.
Name
of
If applicant is a corporate~nature of duly authorized officer.
(Name and title of corporate officer)
1. kocation of land on which p~posed work wl~ll b~e done. JAap N~~ ....... kotNo: ..~'...~......L... ....
Street and Numbe~~.r..,~....~~ ..............................
Municipality
2 State existing use and occupancy of p/~ses and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~~/~-'~ ·
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 ................... ~...~..~...~. ........................ 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 ..... 3...~.. ............. Depth ....,~-.....0~'.. ...................
Height ..~....-~... ................ Number of Stories ...... ~ ..................................................................................
,/
Dimensions of same structure with alterations or additions: Front ..3.~......f. ................ Rear ~,~..~. ........................
Depth ..~..~..~ ........... Height ....~..~ ...............Number of Stories ..... ~ ....................
8. Dimensions of entire new construction: Front ................................ Rear ............................ Depth ............................
HeigHt ............................ Number of Stories ..................................
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 law, ordinance or regulation? ....~ ............................................
13. Name of Owner of premises .~/'~...~.Address ............................................ Phone No
Name of Architect .................................................... Address ............................................ Phone No .....................
Nome of Contractor~..,r:...~...~..~...'~.~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.
t
STATE OF'"'-NEW.~C"r'OR, K/ .//' .) - -
COUNT
................ ~~..~.~ .......... being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
~-..~:.~ 7-~
above named. 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 contaj[j~ i~ 'ljl}j~Happlication are true to the best of his knowledge and belief;
and that the work will be performed ij~,~ur~p~rots~i~fYJ~h in the application filed therewith.
Sworn to before e this h, hz- :~4..'.963. Suffolk County ,~
Nato. ...........................