Loading...
HomeMy WebLinkAbout1863-zFO'EH NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the bud ng located at~ .~....~...~.,'.~*.~...*...~../...~....?~.~.,~..~{.?.~..ttO..?.~ Street Orath'~ohl O,D,J.~,, ...... XY, X ~u~hotd~ ~L~. Map No ....................... ~loc~ ixlo. ~{~':~ ...................... LOT INO ....... ; ...................... : ......... ; ...... ; ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............................. ~'~l~.~...~......~.J~.. ........... , 1~..~.. .... pursuant to which Building Permit No. ~]~[{6~ doted ......................... t~t~,.~;.,...,~ ........ , 19.6.~{..., was issued, and conforms to all of the requirements of the applicable provisions of the Iow. the occupancy for which this certificate is issued is ........ ........ ...................................................................... ,._ .............. The certificate is issued to ~f,Bt~;l~iel~ OOO~e~ ~ (owner, lessee or tenant) of the aforesaid building. ~t. D. approval Afar. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1863, z Permission is hereby granted to: .......... ~otc~z~].t~ ........................................ : ......... FORM NO. 1 TOWN OF $OUTHGLD . TOWN[ CLERK'S OF~:IC£ SOUTHOLD, ~. Y. ~em~ned .................. ~7 ................ ' Approved ......................................... 19 ........ Permit Disapproved a/c ............. .... ................................. ............................ Application No ............................. INSTRUCT)ONS a, This application must be completely filled in by typew, riter or in ~nk ond submitted in dupllcote 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 port o~ this appJic¢ion. 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 t~) the applicant. Such '~ermit shall be kept on the premises available for inspection throughout the progress of the work. '~. · 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 Department for the ~ssuance 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 o iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ......... ................................... (Signature of oppJicant, or nome, if o corporation) State whether oppJicant/s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ...!-.~....,.....5 ......................................................................................... if applicant is e corporate, signature of duly authorized officer. (Name end title of corporate officer) 1. Location of land on which proposed work will be done Map No: .......................... ~ ................. Lot No: ...........-~...: .... 2. Store existing use ond occupancy of premises and intended use ond o~cuponcy of p~posed con~'~u~fi~n:, ~ a, Existing use bnd occuponcy .................... ~.~/~ ....... ~ ............................................................................. b, Iht nded use nd c up cy ........... ]~..~.....~~ ................................................................... ',. 3. Nature of work (check which appllcable): New Building .................. Addition .................. Alteration .................. Repair .................... ~ ,~Rem°val .................... Demolition .................... ~,~ Ot~er Work (Describe) ........................ (to be paid on filing this application). 5 If dwelling, number of dwelling units ........ ./ ..................... Number of dwelling u,nits on each floor ............................ If garage, number of cars .............. ~(~ ................................................................................................................... i ........ 6. If business, commercJo~ or mixed occupancy, specify nature and extent of each type ofuse .~ . 7. Dimensions of existing structures, if any: Front ........... '--: .............. Rear ...:..~:..z ................. Depth Height .............. '-% ............. Number of Stories Dimensions of same structure with alterations or additions: Front ........ :-:'..-: ................... Rear ........... --% .................... Depth ............. ~ .............. Height .......... ...--m:... ................ Number of Stories ..:....]. .............................. 8. Dimensions of entire new construction: Front ........ ~.......~ .............. Rear ....... ~..L...~ .......... Depth ,,.~]~.....~ .............. Height ............................ Number of Stories .......J. .......................... 9. Size of lot: Front ...... J/,~.~ ................... Rear .././~') / Depth ~¢c) 10. [)ate of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district,in ~.ich premises are situated .. .i~. ~ ..'~'.... ]2. ¢C)'6es' ro osedconstYucton v, an zonin law ordinance/hr renu[ationD ./~..o p p ~o~ g , ._...., ~ ........................................................ 13. Name of Owner of premises -.~..-.~.;..~..¢~':~....Address~Cm'~'"..:" ' ...... Phone No Name of Architect .4../ .................... ........... ,~ ............. Address~..~ ..................................... Phone No Ix ame of Contractor--S"/~' ~ ..l~'....¢lZ¥,~...~.,. Address~,,z~.....'-' Phone No PLOT DIAGRAM Locate clearly and distinctly all build'ings, 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. (Signature of applicant) Notary of said owner or owners, and is duly authorized this application; that all statements contained and that the work will be performed Sworn to before me this N0t~ry ..... :.....~¢~ ......... day of · , agent, corporate officer, etc.) ~erforrned the said work and to make and file true to the best of his knowledge and belief; :arian filed therewith. STATE OF NEW yf~R~,,,/i ) cc COUNTY (DF ,;,.,,~_,) .... ...... ~,~r,~ ...... ..~.~ ............................................... being'duly sworn, deposes and says that he is the applicant (Name of individual signin.g application) above named. He is the ...... ~ ............................................................ : ..................................... ' ............................