The URL can be used to link to this page

Home My WebLink About3785-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFF~GE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ..... Z...32.2Q ......... Date ............. Atl~u~.t ..~7.., ................... , 19.~.~.. THIS CERTIFIES that the building located at ........ H~...~$~..~Qa~ .............................. Street Map No ....................... Block No ....................... Lot No...~a[chog.~e.,...[~...~[~. ..................... conform~ substantially to the Application for Building Permit heretofore filed in this office dated ............................... ~z~...4, ................ , 19..6.8. pursuant to which Building Permit No...~.~...~ dated .................... ~az. ch..~.~ ............... , 19...6.~, 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 ........ .............................. ~ar~..b~il~Xng .................................................................................................. The certificate is issued to .......... J~e~..[...Cr~s~ ........................................................................ (owner, lessee or tenant) of the aforesaid building. FORi~ 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? 3785 Z Permission is hereby granted to: _ , _ at premises located at ...................... pursuan¢ to application dated "'%11~: 19 and approved by theI: Building Inspector. Fee $.~ . TOWN OF $OUTHOLD BUILOING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 1 .......Permit No ............ Disapproved a/c ...... ..-~;......'~. .................... ~ .......................... ::'.." ' 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 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 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 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or alterationS, ~ for removal or demolition, g~herein described. The applicant agrees to comply with all applicable laws, ordinance~ bullding code, h~ing code, ~'d regulations. ............. · ........ !....: ....... ................ '(Signature of applicant, or name, i;( a co~por, qtion) ........... .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, 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) 1. Location of land on which pro~o, sed work. w},ll be done~. 6Agg N.o.: .... h ......... ,~ ..................... ~Lot No.: ........... ~ ........ ~. Street OhO I~m~ .~s.....: ...... ~...~.~ ............. r..l) ................................................................................................. ~,~~' ~5 ~ Munici~lity 2. State existing use and occupancy of premises an~ inte~e~ use and occupancy of proposed construction: a. xlsting use and occupancy ................... ~ ............................ ~;.~. ..................... ~z .................... ~'"'"~ ........ b. Intended useandoccupancy ........................... ~.1. ............. ......... 3. Nature of work (check which applicable): New Building .... ....... Addition .................. Alteration Repair .................. ~Removal .................. Demolition .................. Other Work (Describe) ........................................ (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: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Nu[nber of Stories ................. ~ .............. ~ 8. Dimension~fl~,.n~fire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... ~mber of S~;ies ..................................................................................................................... 9. Size of lot: Front ...... ~..~ ................. Rear .................................... Depth ............................... ~ 10. Date of Purchase ........ (.~.~.~ .................................... Nar~ fi~Zx~n~"~~'~ ................... 11. Zone or use district in which premises are situated ...................E.~:T.~ ................ ~~ ........................... 12. Does proposed construction violate any zoning~w, ordinance or r¢gulat[~ ,,.,~l,,~JJ,.~ .................... ~ ...... ~..~.~ ~kOT DIAGRA~ Locote clearly ond distinctly ~11 buildinos, whether oxistin~ or proposed, ond indicate ~11 set-Bock dimensions from proper~y lines. Give street ond block number or description ~ccordin~ to deod, ond show street homos ond indicate whothor i,ntorior or comor lot. STATE OF NEWc O .J./c ....... ' .... J /(Name of individual signing application) ~, , ~ b abov~med. 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 file this application; that all statements contained in this app!icat~e true to the best of his know~dge and belief; and that the work will be performed in the manner set forth in the~pplic~tlon filed therewith. Sworn to b~f~re me this ~ ./, / ~ ' ~ ............... o, ...... ...................... Notary Public, 2M~;.~.¢;;,f;;;;f~ County / (Signature'o~applicant) ~OTARY PUPil. If;, Stero ~/ I' ~o, 52-3233120 Suf[olk I NO ~EC~'~ON -FUTUmE p'LATFOP-,M' o Llo~'r RICHAIRD E. ALLEN, P.E. CONSUL]lNG ctv'~t ENGtNE E~ P).'Ah, I ~ ~LEVA'~ION5 ~U~LDIN C~ ,24'.O, "Z4"o ' - F o u t-,IDA')' )o N PLAN o '~{of Pos] - A~CHOE, 50LT, PLA~", oDET~I,L. LL~-'f PL)P';LHq 4 ?U~LIN CLiP o P-,iGID FRAM~ bET/L[L~_ o 5 ~C~ION op'OSl SEcTIoN 'C.C"