HomeMy WebLinkAbout3980-zFOB~I NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
3?3?
o ............. Date ............................ , 19. ?.0
THIS CERTIFIES that the building located at . Il/.8. ~/tOlr, h~ .A~r~ ......... Street
Map No .... v~ ...... Block No ..... ~...Lot No.. ~1~ .... .}~.t~;.~.$~. 0.k....N.e~? .....
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ....... J~®.. 8 ..... , 19~8.. pursuant to whieh Building Permit No...]9..~..Z
dated ......... .A.~ ..... I~ .... , 19. ~, was issued, and conforms to ail of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is ... l~.~te, olle. f~0,].y..~w~ll~,~g ....................................
The certificate is issued to ... Pa~S~lO .i~e~k~ ........ 0will' .......................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Heaith Approvai ....... [.~ .~ .~., .....................
FOI~I NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 3980 Z
Permission is hereby granted to:
at premises located at ........~...~.........~.~.~...~.,¥~. ..............................................................................
~att~tuek
Building Inspector,
' I ~- -Building~nspec'[or /
'IY:)WN OF SOUTHOLD~
BUILDING
DEPARTMENT
~/I ~f/l~
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ............. ~. .................... , 19 ........
Approved ........................................ , 19 ........ Permit No .............................
Disapproved a/c ..... ~ .................. -
(Building Inspector~
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 location 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 drawn on the diagram which is port 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 part 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 or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations.
oration) ~,.~
(Address of applicant)
State whetherapplicant ~engi.n'eer, general contractor, electrician, plumber or builder.
Name of owner of premises
,
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
· ..g p ...............................................................................................
b ntended use and occu anc ...~....--~..
3. Nature of work (check which applicable): New Building .................. Addition / Alteration
Repair .................. c:~moval ..................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 ~,_~pe of use .......... ~ ...........
7. Dimensions of~xj~ting structures, if any: Front ............................ Rear ..... .~..._..~...'..~....~ ....... Depth .~.~.' .~ .
Height .~.~.: ....... Number of Stories ..... ...~....~ .................. ~ .................................... ,.....~'.., .........
Dimensi~s of sgme/structure with a.lt~eratioj~s~or additions: Front .....~.....~.~....,;.,. Rear .../.~..: ......
.~...~.r ......... Height ~'. ......... Number of Stories .(~...~....., .....
Depth
8.Dimensior(y'of~entire new constructi6j~./'/" 'Front ........ L ........................... Rear ........ .................... Depth ........................
Height .................... Number of Stories .......... ,,~ .........................................................................................................
9.Size of lot: Front ..~..'~..~ Rear ~~.'~... Depth .3..4~...~..-..
10. Date of Purchase ......... (/. ............................... : ............ Name of Former Owner: .......................................................
] 1. Zone or use district in which premises tire situated .....................................................................................................
12. Does proposed construction V~e~,,~r~z,~la~w,~,,inance ~~-,.....~ ................. Z4Z:;'_' ...........
13. Name of Owner of ~~.~Addres~-~,~..~~ 'q .,~~~"~ ..... Phone No. ~'c~'"' '~' '~/~ N .e~'.~.,.. ·
Name of Architect~....'Aadress ....... Phone
Name of C°ntract°~~':''''Address~PLOT DIAGRAM ........ Phone N~..~...~..~..~.,~..,~
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner 16{;~ ,'
/-/6
STATE OF
COUNTY OF
S.S.
( ,lication)
above named. He is the
~g duly sworn, deposes and says that he is the applicant
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to ma:ke and file
this application; that all statements contained in this application are true to the best of his knowledge and belief; and
that the work will be performed ij~kthe manner set forth in the application' filed therewith.
Sworn to before me this
Notary Public, . ........................................................... County (Signature of applicant)