Loading...
HomeMy WebLinkAbout2768-zFOI~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at l~.:L.=sea~..Aveo.,.-.l~ou~ho~d. ............. Street Map No...~:~(: ............Block No....~ ........... Lot No .......... }Q{~ ................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............................. _1~,...2.], ..................... , 10.6,~.. pursuant to which Building Permit No ..... dated .................. J~ty...2~. ....................... , 19..65., 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 ........ The certificate is issued to ....... (owner, lessee or tenant) of the aforesaid building. Building Inspector FoI~M NO. 2 TOWN OF $OUTHOLr D~ 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? 2768 -z Vote: .......... , ................ :'~r"','~ ............. ~ ~6Y'" Permission iS hereby granted to: ............... · Sou%hOld ........................... :.: ............... .................... .N...~. ................................... : .............. to ...I~u:l,1 d...an:, e~,dt, tlt,~r~ ..ol~.. e~rV. ex.t.s ~i.n~...d~e.;L-t~'l~ ................. .. ............ · ........ ;..~. ~ .......... at promisos located at ..... W/.8.,...iBot, sNau..Ave....' ......................... · ....................... :.. ......... .. ............... ............ ' .............. ................... 8ot~;hold. r · ...N.,.g, .................................................................................. pursuan:~ ;0 application dated .: ........................... .~,~*.....: ........ .~L. ..... 19~.., 6~nd approved by the Building Inspector Fee $.~.Q0. ............ uud&ng inspector ~ FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ 19 .... Approved ........................................ , 19...~.~....Permit No ........................ (Building Ins~ctor) Application No, ...~...~.....~......~... ........ APPLICATION FOR BUILDING PERMIT Date ................ 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 Jot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. ....... ....... (Signature of applicant, or name, Jf a corporation) (Address of appl~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ~.~.~ ~.~ ............................................................................... Name of owner of premises ..~.~'/./.~' ....... ~.'.'~...~.~...~'.~J~..J.~' .................................................................................. If applicant is a corporate, signature of duly authorized officer. ........ ........... .......... .... (Name and title of corporate officer) ~. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ~'.-~.~ .~14~.~ ~]g./J~f/.. ~.~.'~.l,~ ..... ~'/~'~ZZ~'~'/"~"~'4~"]"~'"-7 Municipality 2. State existing use and occupancy of premises end intended use and occupancy of proposed construction: a. Existing use and occupancy ..... j(~r.~.~.~..~..~,~. ...................................................................... .... .............,..... ... b. Intended use and occupancy .......... :-~?. '~ .~.... ,......~../....~ ....~. ~..~.~ ~ .................................................................. 3. NatUre of work (check which applicable): New Building .................. Addition ...~. ..... Alteration .............. Repair .................... Removal .................... Demolition ...... Other Work (Describe) .................................. ~.. 4. Est,mated Cost ......... .................................. Fee ............................................................................. (to be paid on filing this application) 5. If d~elling, number of dwelling units ............................ Number of dwelling units on each floor .~. if g~roge~ number of cars ........ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .... 7. Dim msions of existing structures, if any: Front ...~. ............... Rear ....~ ................ Depth .~ ..................... Hei[ ht ............ ~.~ ..... Number of Stories ..... J.'.~ Dim msions of same structure with aIterations or additions: Front ..... ~ .................... R~r ..~ .................... Dep . .......~ ................. Height .....~.~ ............ Number of Stories ...j.~...,~ ........................... 8. Dim ~sions of entire new construction: Front ............................Rear ............................ Depth ........................ Hei ht ............................ Number of Stories ............................ 9. Size[ of lot: Front ......... f~ ............ Rear ........... ~. ..........Depth .....~.~'~ ................... 10. Dat~ of Purchase ........................................................ Nome of Former ~ner ................................................... 11. Zon~[ or use district in which premises are situated ............................................................................................ ~2: Doe~j proposed construction ,violate_~ _~any zoning law, ordinance or regulation? ................................ ~ ................ 13. Na~e of ~ner of prem.se~ ~7~Z..~t~...Address ..~E.~. .................... Phone No.~.k~:.~ Name of Architect ...................................................... Address ............................ . ............... ~one No ................ Na~e of Contractor ~.~lZ~..~.~..Address .~~ ...................... ~one No. ~,.2f.~..'~.' PLOT DIAG~M L.ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property lipes. Give street and block numbers or description according to deed, and show street names and indic whether in~erior or corner lot. STAT[ O~ ~[W YORK, ~ S.S. COUN~ IOF ................................ /~X ~e~ ~/'~z~/~ ~ be n duly sworn, deposes and 'says that he is the appli, '(Name of individual signing application) above noted. He is the ...~W~.~d.~ .......................................................................................................... (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 this application; that a I statements contained in this application are true to the best of his knowledge and be and that fhe work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ ~ .