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HomeMy WebLinkAbout4695-zFOB, M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at '"J~....JJf~F,-.J~JJlJ ............................... Street Mop No...~i&Fl~..k~j~lock No ....................... Lot No...~1~ ........... ~ItJlA~J.~J.....JJw~, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................................... &pJ'J~J...-.;...JJl....., 19.~J~lJ.. pursuant to which Building Permit No. dated ......................... &JJB';~ ...... 2J ....... , 19....~0 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 ........ ...... P .w e.. texa-ge ......................................................................................................... The certificate is issued to [owner, essee or tenant) of the aforesaid building. ~0~ NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMIT ('THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4695 z Permission is hereby granted to: .............. ~....s~..~..~...~e~.~ .......... at premises located at .................... ~k~..~J ......................................................................................... ................................................... ¥/J....J~a~t~..~ ......... i~a%..~laz.%Ja ....... I.X. ................... pursuant to application dated Al~z'il ~ 19...~..?.., and? a~ppmved by the J~uiJding Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ^ppmved ........................................ , ~ ........ Permit Na ............................. 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 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 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, as herein described. The applicant agrees to comply with all applicable laws, ordinances,,building, code~ housing code, and regulatlons.. .... ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Mop No.: .f.~.....~... ....................... Lot No.: .~.ff.. .............. Street and Number ~ 7'/~/~ ~/~L~) ~ ~f' /~. ~ t ~ ~' 2. StYe exi~Jng u~ a~ ~cu~ of pmmigs a~ intended use and ~cu~ncy of pr~ con~m~im: a,,,n,-- ..d .............. ............................................................................................ b. Inte~ u~ and ~cupan~ ............ .~ ............ , .................................................................................................. 3. Nature of work (check which applicable): New ;Building.................. ix/ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ ............................. : ........ Fee .................................................................. 4. Estimated Cost (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 c~rs ................................................................................. : ......................... ~ ................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .?-...-~..~...'~....~.....~...-~'. 7. D mens OhS at ex st ng structures, if any: Front ............................ Rear ......... ..~.. ................... Depth ...~...' ........... Height .....~.../. ........... Number of Stories ....... ..~.....,~.....~.. ............................................................................................ Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ...................... L....Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Numbe/r Of Stories ...................................................................................................................... 9. Size of lot: Front ..... ./../...~...i ........... Rear ....... ./../....~..'x. ............... Depth ...Z..~..~...'~.. .............. 10. Date of Purchase ...... /.~....~...~...~.. .................................. Name of Former Owner ......~....~..~..~....~.~...........~..?~..../~..L...~.....~.~ 11. Zone or use district in which premises are situated .................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM 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 lot. STATE OF NEW ,~RIC ~ ~ ~.- - COUNTY OF ....~ ................. )' ?~) ............................. ~...~-.~./..~.~... ,/~.. ................... be,ng duly sworn, d~es and says t~t he is the applicant (Name of individual signing above named. He is the .................. j (Contractor, agar, co~orate offic.r, ~c.) of said owner or owners, and is duly authorized to perform or haw performed the ~aid work and to ~ke and fil. this application; that all statements contained in this application ar. tru~ to the b.st of his knowledge and b. lief; and that the work will b. performed in the manner set fo~h in the application fil.d ther~ith. Swam to b.for, m. this .............. o, ................. ........ , ........ . .......... ~ot~ Public, . ........................................................... ~oun~ {~n~r~ ~opplic~nt) ..................