Loading...
HomeMy WebLinkAbout4820-zI~LM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF' OCCUPANCY No.:~...3.~6~. .............. Date ........................ 2U,~r.....Zt ............ , 19~.0... THIS CEP, TIFIES that the building located at ..... ~[/~..P~,~,~;..~O,a~ ............................... Street Map No...-X~; .............. Block No .......~ ........... Lot No ......~ ....... O~':~eat' ...... ~q~'~ .................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................. ~T~:I~e' ......... 2ts ......... , 19.~.. pursuant to which Building Permit No. dated .......................... ~1"'[~.' ............. , 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., ..... ........... i'gr~cu~.t~r~l"'t~'~'"s't~rage"l~u~'d~n~ ............................................................. ~ ...... The certificate is issued to "~t~,~,~l"e~l~ .......... oO~wn~['j;~'~"~;~i .............................. of the aforesaid building. House # 1680 FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEF'ARTMENT 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? 820 Z Permission is hereby granted to: at premises located at ................ Jllsf$..~.],&l~&.~14~4, ......................................................................... ............................................................ (~lr,....~,Z, ....................................................................... pursuant to application dated ................................. ~:IilB41. ...... ~...., ]9...~Q, and approved by the Building Inspector. Fee $....'lO.e,O~ ........ Building Inspector { TOWN OF soUTHoLD ~/'~ ~/~' BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............ , 19 ........ ^pproved ........................................ , 19 ........ Permit No ............................. Application No ............................. Disapproved a/c ........................................................... .......................................................................... "_""7"'7'"'"' ............. APPLICATION FOR BUILDING PERMIT Bt, ....... .............. .......... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot pJan showing location of lot and of bu_lldings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which Is part of thle 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 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 pumuant 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 al.terations, or for removal or demolition, os heroin described. The applicant agrees to comply wlth all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, If a corporation) (Address ofeappllcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. ....... ....................... ................................. Name of owner of premises .......... ,~,,,,~,. ,~,,,~,,/,, ,.~,, ............ C,L,i~-"~'~,,~,,,,-~., .................................................................... 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. Map No.: ~" Lot No.: ')~ Street and Number.....:~....,~,,,~,,~l,.,'Z-, ,Z~-.....~,.,~,,,'~,,,,~, ......... .~...,~,.g.l..,~,,,~., ,"~,, ........................................................... 2. State existing u~ and ~cu~ncy of Pmml~ and Intended use and occupancy of pmp~ construction: aa 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 fi!lng this application) 5. If dwe~llng, number of dwelling units ............................ Number of dwelling units on each floor ............................ oroge, number of cars ......................................................................................... 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 some structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .............. ~......~...~.~..~... Rear ...... J~...~..~.~..~..... Depth ...~......~...~'~.~ Height .....~.....~.~-~.. Nurnber of Stories .............. ~.~'.~.. ......................................... 9. Size of lot: Front ........ .~.~..#....~-~.~Rear ...... ~..~.~....~...~.~f~.. ..... Depth ...~..;~..~....?..~'~;~... · 10. Date of Purchase ........ ~.~..~....~...,J..~.~...~.. ............. Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ....... ~....~........~...~..~'.~. .......................................................... 12. Doe~ proposed construction vioIGte any zoning law, ordinance or regulation.;> ~...~) 13. Name of Owner of premises ~T~'"s~[~' C~'/-..E-~"~./~'dress ~.,~-~.. ~../-///.~......'~'.. Phone No .~X...~.....~'...-~,..~...~'3 Name of Architect ...................................................... Address ............................................ Phone No. Nome 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 Jot. STATE OF NEW' YORK. [ ~ ~ COUNTY Of ...... ~.~'.e. ~, .~..~, b;... J~'~' .......... ~ ........ ~ ..................... being duly sworn, deposes and says that he s the app cant (Name of individual signing application) ' ~ ' - ~,~ ~ ~ ~ above named He s the ~.~... ~.~ ......... ~.~ .~..~ ........ (~ntroctor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke ~d file this application; that all statements contained in this application are true to ~e best of his ~owledge and belief; and that the work will be performed in the manner set foffh in the opplicati~ filed therewith. Swam to before me this _ ..... - ' ' blatant Publi~.~~ ..... ~ (SJg~mTM of applican~ ....................