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HomeMy WebLinkAbout4316-z~NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..'~lJll-.JJ~ .................................................. St~ee~ Mop No~la~M..J~JK..~itl~k No ....................... Lot No. ~.~.JJ~. ....... JJ.Jtlt,t~tOJ~......,.~.~.~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....................................... ~ ....... J~ ....... , 191.. pursuant to which Building Permit No...~.~JJ.~.... dated .............................. ~ ...... ~ ......, 19~...., 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 ........ t B b2.o Oe~ez The certificate is issued to ...~...~ ....... ~ ........................................................................................ (owner, lessee or ter~t) of the aforesaid building. House ds 280 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? 4316 Z Permission is hereby granted to: ............................ ~.~.t.e~e~e ............ ~ ................. to ..............~l~:JJ~l~ .. ~,~ · ~ ~f, ~,~F.,.. ~, · .~':~. · e;~ ~.,~. · ~ ~,~,.:~ ......................................... at premises located at ............... ~g.~,~...~.~.~,....~...~.~,~..~ ............................... ........................................................... ~J-,.s.....l~lr,,..~¥e. .............. i~Je'et,~e],~ ...................................... pursuant to application dated .............................. ~t .......... ~ ........ , 19..~., and approved by the Building Inspector. Fee $...~.t;~0 ............ L ~uilding inspector~ TOWN OF SOUTHOLD ........... A~li~tion No ............................. pp ed ........................................ . .... Di~ppr~ed a/c .............................................................................................. APPLICATION FOR BUILDING PERMIT ~ ,te ...... ................... ........... , 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 issuence 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 shell 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 Laws, 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, housing code, and regulations. ....... .................... (Signrdure of bpplicant, or name, if a corporation) (Address of applicant)r~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a co~orote, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done~ Map No.: ..~....~.....~......~[. Lot No.: ..(..~...~ ./..../...~..~.... Street and Number ...~..1:~ ......... ~.~.~.t~L.~...~-. ................... ~ .......................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ~xisting use and occupancy .....~I~....~.~.~...~. ........ .~..~..~..L ..~.~..~..~.. ........................................... 3. Nature of work (check which applicable): New Building .................. Addition ......~... ........ Alteration .................. Repair .................. Removal .................. 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 ~m ............................................................................................................................................. 6. If business, comme~ial or mixed occupancy, speci~ nature and extent of each ~e of use ............................ 7. Dimensions of existing structures, if any: Front ........~..~ ..........R~r ....~.....~ ............ Depth .................... Height ...... /.~../. ......Nu~er of Stori~ ............ ~ .................................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ......J.~. .............. Number of Stories ........ L ...................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ D~th ........................ Height .................... Number of Stories ...................................................................................................................... Size of lot: Front ..... .L.~.~...~. ...... Rear .......... L~.~.~ ............Depth ...... ~..~...~. ........... Date of Purchase ........................................................ Nome of For~r ~ner ........................................................ Zone or use district in which premises are situated ........ ~ .......... ~.~.~ ............................................................. Does proposed construction violate any zoning law, ordinance or~egul~n? ......................... Name of Owner of premis~~....~l~.~..A~ress~~~..~. Pho~'~~ Name of Architect ...................................................... A~ress ............................................ Phone No ..................... Name of Contractor ~]t.~...~.~E~.~ ....... Address~..~.t.~R. Phone No~.T.~.~.I PLOT DIAG~ Locate clearly end distinctly ~11 buildings, w~ether existing or proposed, and indicate all set-~ck dimensions from prope~ lines. Give street and bilk number or descrJpHon according to deed, and show street nam~ and indicate whether interior or corner lot. ~ ~. ~ e~~ ~ ~ .- ~ 10. 11. 12. 13. STATE OF NEV~XPFJt~,, / ,tc-~ ~r COUNTY OF ~.~...~. ............ .......................... · ~..~...~ ...................... .?....O..~e~ng~'duly~sw~r~ ~'~o~'~ses and says that he is the applicant (Name of individual signing application) above named. He is the ....................................................... e.~~ ................................................................. (Contractor, agar, corporate officer, etc.) of said owner or owners, and is duly a~horized to perform or'have performed the said work and to ~: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 in the manner ~t 'fo~h in the 'application. filed therewith. Sworn to before me this ~,,~,.~..~ ......... ~.~ .... pp MARION A. RE~E~T NOTARY PUBLIC, Sta~e of flew Ho. 52-3233]20 Suffolk County .Te? ~pires ~rc~ 30. Z~