HomeMy WebLinkAbout2734-zFOI~M NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at I~iIi~I:I-QIIL.~UlI.~..~'I.~., .......... Street
Map No...~ ............ Block No ....... ~ ......... Lot No ............ ~ ...........................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
................................... .~.$~,..,J, .............. , 19.~... pursuant to which Building Permit No.~.~..~ffJ....~....
dated ...................... ...IJ~..~..~ ..................... , 1 c~...~....., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ........
........................... . .a_d...4.t..~..t..o.~...~;.o....~..e ~,.~ .$ng ......................................................................................
The certificate is issued to ....~.~¢~J~..V.o...[Q~,I,~..,~Q~..~,~.~...~QJ~,J~II.~I~...~.~ .................. (owner, lessee or tenant)
of the aforesaid building.
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.° 2734 Z Dote ................................ ~.....~, ............. ,
Permission is hereby granted to:
l~'ehard'"Foyte"-"~""~d'~ 0 ~...l~ob~on. "r
................... F~her~..[$t~d ............................
to ...... B~.l~..~..ad~l$.t$on..~..a~..e~.~tt~g..~l~e.l.l$~g ....................................................
ct premises located at ...W./L~.....A~sl~..Hou~e..])z.i~e .................................................................
................................................................. ~sher. s...l.s~aml ................................................................
pursuant to application dated ................................ ~.pl'.~.]. .......... ~1. .... 19.~,~.., and approved by the
Building Inspector
Fee $..~X~ ............
FOEM NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, N. Y.
Examined ...................................... , 19 ........
Approved ........................................ , Ig...~.....Permit No ....
APPLICATION FOR BUILDING PERMIT
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 loco~ion of lot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and giving o detailed description of layout of property must be drown 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 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 all applicable laws, ordinances and regulations.
(Signature of applicant, or n(~e, if a corporation)
...................... ........... .....
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nome of owner of premises ...~.~. :.~.' ~ ~.~.~.~ .~. · ............................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
t. Location of land on which proposed work will be done. Map No: ............................................ Lot No: ....................
Municipality
2. State existing use and occupancy of premises 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 .,(.~-, .~. o o
(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: Frant.......~....~ ............. Rear ....... ..%:...~ ............ Depth z_-~_
Height ......... ./.? .............. Number of Stories
Dimensions of same structure with alterations or additions: Front ......... ..~...~. ................ Rear ...~..~ .......................
Depth ....... .?-.....~t.. ............ Height ............. .,'.j.7. .............. Number of Stories
8. Dimensions of entire new construction: Front .........../....(~ .............. Rear ........ ./...~ .............. Depth .....t...~.,'. ...............
Height ......... ./...?.. ............ Number of Star es ....... ~ .................
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 zonina law ordinance or re ulation? ................
Name
of
Contractor
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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.
STATE OF NEWQYOP~/ ~ ) cc
COUNTY OF ..~.~.T.......~'~...) °'°'
........................... . . . · ...... .. ....... : ......................... being duly sworn, deposes and says that he is the applicant .
(Nome of individual apphcotion)
above named. He is the .......... .~...~ ..........................................
(Contractor, a~ ~'~'f i ' ~'~';1~';~'~ '~ ~ ~'i~ ~; ~i' ~ ii ...............................
of said owner or owners, and is duly authorized to aerform or have performed the said work and to make and file
this application; that all statements contained in tills application are true to the best of his knowledge and belief;
and that the work will be performed in the manner set forth in the application filed therewith
Sworn to before me this I ' ~c¥ ! ~N ~ ~ , x
...................... aay, ot ..::."z..:.g,...~.....'-.~ot.Jb:,~.~??' ......... / 19 ........ ~, ¥/~-~--~zt.~_~_~\ ~/, '~rv~.
~ ~r~;/~, ~:,:~i~,~t~ C,~/ ........ ..~. ~-4. ............................ ..'fi.. ,1 ~
Notary Public ....... ~...~2,.~.~'~,z~ ...... (Zounty ~ (Signature of ~""ii~'~'i''~ ........................
PP