HomeMy WebLinkAbout2070-zFOKM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
November 4
No.....~.....'lt. ?...2...9. .......... Date .................................
THIS CERTIFIES that the building located at llJ~.~..~o.lcJ:;h..j~oaJct,,...~o.~lJ:ho[d ............ Street
Map No .........~.?.. .......... Block No ........*..~. ............ Lot No .......... .~..*.. ......................................................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
................................ .~...~.~',,.,2,.~.. ................... , 19,,...,~..3pursuant to which Building Permit No ...... ~....~...0..~0
dated ...................... Jt~.~,~...~,~. ................... , 1 9 ...... .~,~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 ........
of the oforesoid building.
Building' Inspecto~ [ '
FORM 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? 2070, Z
Dote ..................
Permission is hereby granted 40:
Helmut..~a~s ...........................................................
· .N~P~.h..:~ad ......................................................
....... ~e~At~l~l ................................................... :..
to ....]gu.~.td...~..a4raf. tien...om..~,.re~t.t..~.t.Z.i~ ............ i ........................... : .................
at premises located at .~/¢'~-...-~O~.,~,*~t~[ .................................................... ~ ...................................
............................ -: ....... : ....................... ~u~t~l ................................................................................
pursuant to appJication doted ................................ ¥~.~ ....... ~[.~ ............19.t~...~.., and approyed by the
Building Inspector
Fe~ $.....'5:.0~ .........
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CILERK'S OFFICE
SOUTHOLD, N. Y.
Exomined ......................... ..~..
(Building'inspector)
Application No...~.6~...~....C.'.) .........
APPLICATION FOR BUILDING PERMIT
Date .................... ~/f~.. ...... ~ ................. 19..63 ..........
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 part for any purpose whatever untda 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 afl 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.
.............................. o:~........l~t~t:l.&e~ ................................................................................................................................
Name of owner of premises .~e~..~:;~B .........................................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Nome and title of corporate officer)
1. Location of land on which proposed work will be done. Map No: ................ ~ .................... Lot No: ........ ~ .....
Street and Number ...~/~...~fl~.~.~D.~t......~OZ~ .......................................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...¢~e~ .............................................................................................................
" with an additio~
b. Intended use and occupancy .................................................................................................................................
3. Nature of work (check which applicable): New Building .................. Addition .....;lf,:lf~,~... Alteration
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................
4.
Estimated
Cost
Fee
'"'~'iO~t~ be paid on filing this application)
5. If d~velling, number of dwelling units ..........OIlIJ ............ Number of dwelling units on each floor
If g.,arage, 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
DepJ~h ............................ Height ................................ Number of Stories ........................................
8. Dimensions of entire new construction. Front ....... ,.~,~, .................... Rear ..... ,~1~, .................. Depth ....... '~Jl' ............
Height ............................ Number of Stories.....Ol~l ......................
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 ........ ~...btlm;J,t~e~ll.
12. Doe~ proposed construction violate any zoning law, ordinance or regulation? ........... 1}0
13. Nature of Owner of premises '"'JJl,'"'H&'~IIJ ................... Address ........ ~O1~i~[~O'~ ................ Phone No.
Nar~e of Architect ...................................................... Address ............................................ Phone No.
Name of Contractor ..............JJ.,...JJ&~.$ ..................... Address ............................................ Phone No.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
property lines. Give street and block numbers or description according to deed, and show street names and indict
whether inferior or corner lot.
STATE OF NEW YORK, )
COUNTY ~.OF ...... S~.~.,f,O..j~....) S.S.
.................. , ........ ~'ll~lt,..~&i~ ............................................ being duly sworn, deposes and says that he is the
(Name of Jndividual signing application)
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 f
this application; that all statements contained in thL~.,~plication are true to the best of his knowledge and bell
and that t~e work will be performed in.the ~e~'~D~t~( in the apDlication filed therewith.
Sworn to b~fore me this ~r~,~,~:~ ~,,~:0~ c~ur~t~,,.~ ~ // ~ ,
.... .... , .............. ................ /
· ' ..........................................................