Loading...
HomeMy WebLinkAbout4986-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE: OF OCCUPANCY THIS CERTIFIES thot the building Iocoted ot ~..,~.~..A11~ ................................. , .......... Street Map No.~lt,~..~l~,Block No ....................... Lot No. ~...~r~ ....... ~at,4tl~l~ ....... ~[,~.m ......... conforms substontially to the Applicotion for Building Permit heretofore filed in this office doted ............................. ~[~tt~ ......... 2 ................. , 19..~0. pursuant to which Building Permit No....~18~.. doted ........................ I~t, ......... ~ ............ , 19...~0, wos issued, ond conforms to oil of the requirements of the opplicable provisions of the Iow. The occuponcy for which this certificate is issued is ........ ............ l~,~,a.te..~ae..f~l.l~...d.~mlLtn~ .................................................................................... The certificate is issued to .~,gJ~l~...~..~ll~.lll~'. .......... ~11]1~. ......... .-. ................................................. (owner, lessee or tenant) of the ~foresaid building. .... ~' ................ [iuii~ii~;~"i~;~];~;~?! ....................... BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL Permission is hereby granted to: : ...... ~.~...~T~...... .......... :.,...i ................. ~ at premises located at ~.~ ~J~. ':~' ................................................... ~ ........... ~l;.e~....;.~i ;'""~'"'?'5:'~"~ ................................. pursuon¢ to application dated Building Inspector. IPOu-Mr NO. I 3~)WN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. xomin ?0 Approved ........................................ , 19 ........ Permit No .......................... Disapproved a/c .................... ~~... ~ __ ..............................~'~'~'~,',';iJ~ ............................. Application No....?...~...~..~ .......... APPLICATION FOR BUILDING PERMIT ......... ............................. , ,9.Z..o. ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und 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 wl'dch is pprt of this application. c. The work covered by this application may not be commenced before issuance of Buildir~ 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 port 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, or for removal or demo ition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildin~l code, housing ~ Ia, and regulations. .... ..... ~/ (Address of applicant) ~./ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. ...~.......~... ,~.. ~-.~ ............................................................. i .............................................................................................. Name of owner of premis .... ~..~...'~.,.~.. ...... "~""~"~"~"-'7" ...................................................................................... If applicant is a corporate, s~gnature 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 ............ ...~..../..~...~.~..~. ................................ ...~...~..~...%.~...o...~....~...--~.. ............................................. 2. State existing u~ and ~cu~ncy of promises and intended use and occupancy of prapos~ construction: ' n .~- ~ Z~--~- ...... a. ~isting use and ~cupa cy ....................... ~ ..................... .~, ................................................................... b. Intended use and ~cuponc, . ........... ~.~.~.~.~ ....... ~.~ ..................................~ .......................... 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 fi~ing this application) 5. If dwelling, number of dwelling units ............. ..o. ............ 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 ..... 0. .................... 7. Dimensions of existing structures, if any: Front 30 Rear 3 o ............................................................ Depth ....~. ~,. o- Height Number of Stories / Dimensions of same structure with 0Iterations or additions: Front ~ 7 ............................ ............................. Rear Depth ....... .~....~.. .................. Height ............................ Number of Stories ! 8. Dimensions of entire new construction: Front ................... ~'. .............. Rear ........... ~...~. ........... Depth ...../...o. ............... Height .................... Number of Stories ........................................................................................... 9. Size of: lot: Front ........ ./...~?. ............ Rear ........ ././.~.....7.~ .............. Depth ......... /...~....-~'. .............. 10. Dote of Purchase ...........~ ....... ., ................................ Nome of Former Owner /~. ~'. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning I_~aw, ordinance or regulation;~ /1/o ]3~-" Name of Owner of premises~.~.~.~..~.i ./..~..~.~,~'...Addres, ..~...?~...~..~.~,..CF~,~/oc~.~. Phone No. 7..~.~'.;...-~..~../...~... / Name of Arch tect . Address ~... '" / ...................................................................................... Phone No ..................... ~ Name of Contractor ....... ..-~....~ ~ A4H,~, ,,, -~ ............................................................ ~none No ..................... / PLOT DIAGRAM "/' Locate clearly and distinctly all bui d ngs, whether existing or proposed, and indicate all set-back dimens OhS from property lines. Give street and block number or description according to deed, and show street ,n~a, m~ and indicate whether interior or corner lot. STATE OF NEW YORK, l S.S. COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ................. .r (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 application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ........................ day of ............................................ , 19...i .... Notary Public, . ........................................................... (Signature of applicant) County ...........................................................