Loading...
HomeMy WebLinkAbout4770-zFOR~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE: OF OCCUPANCY No. ~'...~DO.~[ ............. Dote ............................ ~*p.t, ......... 29...., 19.~[1~0.. THIS CERTIFIES that the building located at .~/~J~..~J~,~:t..]~ ..................................... Street Map No..;~1~1; ............. Block No~l[2~. .............. Lot fla. ~'~z~r.....l~t.t~;~l~k .........!1,[, .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ......................................... ~ .......... 26.**, 19.*.~0. pursuant to which Building Permit No...~.~.. dated ............................. ~a,~r .......... ;~6....., 19....~O, 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 ........ ..... B~I ,tZte~ S...b~:t & ;1~ ......... £~L t~t~.. · · · l'e p~ ;[ ;'.S · · ® te ....................................................... The certificate is issued to ~g~s~K~'~1~e~.t~e~.~`~bu`1~d`tazt~F&~r.~["1z~bs3~'~1-em[se~~ - ---- - [owner, lessee or tenant) of the aforesaid building. House d 112~0 FORM NO. ~ 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? 770 Z Permission is hereby granted to: ...... ~m~ ..ltl~eff....w.. t~mmm~.t...{~al,..~Amlml% mmeff) ..................... 'K~'~'c~X'k~mll: ....... ~['~' ................. to ..... ~t .-~u..~a~e~scr~....bu~.m~ s~..b~Al~g ............................................................ at premises located at .................. ~,~'~....~i~l~..~d~ ........................................................................ ........................................................... · '~t ~.~a~ ......... ~l~.Z~ ........................................................... pursuant to application dated ........................ ~ ......... ~ .............. , 19...~, and approved by the Building Inspector. tee $'"~Ot~ .......... ~OWN OF soUTHoLD BUILDING DEI'AItTMENT TOWN C:UqUC'S OFFICe= SOUTHOLD, N. Y. Approved ........................................ , ~9 ........ Permit No ............................. /- ?~ -~ Application No..../...~. ................... ~ APPLI~.,ATION FOR BUILDING PERMIT R,~ · Date INSTRUCTIONS a. This application must be completely filled Jn by typewriter or in ink und submitted itl duplicate to the Building Inspector. b. Plot plan showin.~ location of lot and of buildings on premises, re ationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. B APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appllcoble Laws, Ordinances or Regulations, for the construction of buildings, add tons or alterat OhS, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hous~g code, and regulations. ......... ....... ................ (Signature cf applicant, or name, if a corporation) ..................... · . ............................... ~.....~. ............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ ~..E..$.~...£.~ ........................................................................ ... Name of owner of prem sss .~.~. ..~...~. ~ If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Locotion of lond on Which proposed work will be done. MapNo,: .......... .~............~... ............ LotNo.: ~/ Street and Number .................................................................................. ~: ~'/ -- // o~ ,2~ 0 Municipality '" 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... - .................. ; ..................... . .................. 3. Nature of walk (check which applicable): New Building .... ./~..... ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .... .~...~....~..CR....,...~..~.. ............................ Fee .......................................................................................... (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ...... t~....~.. ........... Number of dwelling units on each floor ............................ If garage, number of cars ....................... .~...0. ............................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing s~ructures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories 8. Dimensions of entire new construction: Front ...... ~..0. ...................... Rear ......~..~.. ................ Depth ........................ ' FT. Height .../...~ .......... Number of Stories ...........~ ............................................................................................. 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10.Date of P~irchase ...P:..W.~..L~...../?t..6'...'~ ................ Nome of Former Owner ..... .~ ...... ,&..~/..~ ........................... 1 1. Zone or use district in which premises are situated ....... ?. ~..~ /*7 ...................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ./T.~..~.....~.../....kf?..~.~.././. ....... Address ............................................ Phone No. ~fl~..¥.2.~,.'Z 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 dimensicns from property lines. Give street and block number or description according to deed, and show street names and indico~'e whether interior or corner lot. STATE Of NEW(~'OR/~,_/?~ / S.S COUNTY o f ~ ..,~¢¢,&f~,~ ........ $.' .................... · .~.~....~/.~ ........................ being duly sworn, deposes and says that he is the applicant (Name of individual sighing application_)_.....__ above named. He is the ............................. r! -- ....... ~.~ ...................................................................... 6(Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 thor the work will be performed in the manner set forth in the application filed therewith. Swom to before me this ^ .~ / / -- -- /? ...... day of ......... ................ . Z / ~ f ~ ,y,~ .~ ... : ....... ~...u~...:. ...... :.~...~... Notar/Public,~ .(,:~(~..t..)~..~ ~li~, t~,~ ~,~ ...... i~[~';~'~'t:ure ;~';;~;~;i[~';;;¥i .............................