HomeMy WebLinkAbout743-ZFOI~M NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at..~I/J...33eel~.,lioZe.J31d,~l ......................... Street
Map No.....3~; .............. Block No....~ ............... Lot No....x:~.. ....... .ll&%tl.%lil~e....li,Z,, .......................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
................................... ~....~.~....., 19..~.~..., pursuant to which Building Permit No....~3~.. ...............
dated .......................... ,T~,~ ....... ,3(1 ....... , 19~...., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ..............
.................. .......................................................................................
This certificate is issued to .. tl,~,ll&rrlla. ......... J~l~ll: .....................................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
FOI~M NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
N?
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
743' Z
Date ................................ ~..3..0. ......... 19..~..~..
Permission is hereby granted to:
at premises located at ..W..~...~.......~...,~.,.~......]~..,.~.~.....~...~..?.~..t.....~. ~.~..~...~..~.~.~.$*....1.~....:~...~....~.~..~ AVe.
pursuant to application dated .................................. ~...~...~.. ............ 19..~.?..., and approved by the
Building Inspector
F~e ~.:....09.....~..~...
Building Inspector
HOWARD M. ~!
FORM ~0. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ............. .~..~-~).... 1 ~
Disapproved a/c ..............................................................................................
Application No.....Z~.. ...........
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be comple~'eIv 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 orea~, and giving o derailed description of layout of prolSerty must be drawn on the diagram which is part of this location.
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 fp,r, any purpose whatever until a Certificate of Occupancy
shall hove been gr~nted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuonoe of o 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 oll applicable lows, ordinances end regulations.
(Signature ot'-applice~t, ~r name, if a corporation)
............... ~ (Address of ~:~l~'ii~;~')' ..............................
State whether applicant is ow~ect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ...... ...~..'..~...-.~/.~.~ ........................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Location of land on which proposed work will be done. Map No: ............................................ Lot No: ....................
Street and Number ...~.~.~j...~,~.~c~..~. ~~
......... ~ ......... ~un 'c 'p;~'" "~~~~.
State existing use and ~cu~ncy °'~;~;~~ed use and ~c~ncy ~&p~onstr~n:
....... ...................................................
3. Nature of work (check which applicable): New Building .................... Addition ....... .~5...........Alteraflon ....................
Repair .................... Removal .................... Demolition ............. ~....Ot~hej' 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 cars ............................. ~ .......................................................................................................
6. If business, ~:bmmercial or mixed occupancy, specify nature and extent of each type of use ..............................
7. Dimensions of existing structures, if any: Front ......... ~.....~.... ..... Rear ......... ...~....~.... ...... Depth .../~. ...............
Height ............................ Number of Stories .......... /. ........................................ ~/_. ......................... .-.~ ................
Dimensions of same ructure with alterations or additions: Front ........... ...... Rear
Depth .......... ~....~...~'/--~ ....... Height .............................. Number of Stories ...~'/ ...........................
8. Dimensions of entire new construction: Front .......... /...'...'~ ...... Rear ......... ./...~... Depth ....... ,¢~.... ............
Height ............................ Number of Stories ...../.. ...................
9. Size of lot: Front .......... /~ ..... Rear ............ /~. .... Depth .......... ..../~..~....~.~?..
10. Date of Purchase ...... ; ................................................. Name of Form~r Owner .....................................................
11. Zone or use district in which premises are situated .................... ~ ............ ~.~.........~.~:~¢CT¢¢~ ..............
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 numbers or description according to deed, and sh.)w street names and indicate
whether interior or corner lot. ~
STATE OF NEW
COUNTY OF
~ ........... being duly sworn, deposes and soys that he is the applicant
· :' (Name of individual sign~p_p,li~on)~),j~, '
above named He is the
................ ~,entra~t;, agent, corl~orate officer, etc.)
of said owner or owners, and is duly authorized to perfor~or have performed the said work and to make and file
this application; that all statements contained in this application are true to the ~st of his knowledge and belief;
and that the work will be performed in the manner set fo~h in the applica~n ~iled therewith.
Sworn to before~e this ~ ~
'~r f ~''-~ 19~ ~~t~re of ~pp cant)
........... ~.... a~ o ;'":'"7"'~~ ....... ~'" JU~T~ ~.
........... NO. 52-03~g~3, Suffolk