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HomeMy WebLinkAbout43-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFF]~CE SOUTHOLD, N. Y. CERTIFICATE OF' OCCUPANCY ~. 7B9 July 21 60 No ......................... Date ........................................................... , _~9 ...... . THIS CERTIFIES that the building located a~ Del~ot Lane, C~ttchogue , Street Map No..*~ ............. Block No ..................... Lot No conforms substsntially to the Application for Building Permit heretofore flied in this office July 11 $7 Z 43 dated ............................................... 19 ........ pursuant to which Building Permit No ......................... JUly 11 57 4ated ................................................ , 19 ......... was issued, and conforms to all of the requiccments ~, c n ' i certificate is issued is ............................................................ This certihcale is issued to .......................................................................................................................... (owner, lessee or tenant) of the aforesaid building. FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CL~'RK'S OFFICE SOUTHOLD, N. Y. BUiLDiNG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WiTH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: C II f:t,¢~zz..~.. ~ ~..o.~ ............................................... ........... .D~o.'b.. L,~t~.,, .....:..... .................................. ................... ~ u.t, olzo E.~.~lc~. ~......iL, X, ....................... t o ... ~u!l&..nmi. ~l ~::e t 1,f p~ ............................................................................................................. at premises located at ........~:/..~%A¢~..Z)OZ0.¢:L...Lg-~ ......................................................................... .............................................. .~.tt:g. al~,q~zte.,... Li ,.~ ~. .............................................................................. pursuant to application dated ..................................... Z~t~x.....~..th¢~,.....19.C~.~..., and approved by the Building Inspector. Fee $1.0.,.©,.0..... [9 ~ ~d FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined Approved ........................................ 19.....Z..Permit ................................. Disapproved a/c ............................................., .......................................... ............ ......... ........ ............... (Building Inspector) Application No... -~.~...~.'/...~ ........... 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 building~ 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 which is part of this location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. UDon approval of this application, the Building Inspector will issue o BuiJdin9 Permit to the apphcant. 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 I~een 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 buirdings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regula~tions. ~ig~ature of a~p]icant, or name, if a corporation) (AdEress of applicant~ State wh~/ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Name of owner of promises.~/~,...~.~./..~:,7..~'.6./. ~;...~.~..'.~.,.//. ~'..~......?..~...~'...~.S:./,?/.~.~/..//.~/..:...,..~...i..~::./~./.. Z/..C..:,.'5.. .... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1, Locotonof andonwhchoroposedwor<w bedone MapNo ¢~ .~ Boc< ...... /, .............. ,~, ................................................................... ~.C~=_~,....-r~... ........... ,: ............. 2. State existing use and occupancy of premieses and intended use and occupancy of prOposed construction: a. Existing use and 'occupancy ............ b. Intended use ond occupancy...~,~..~..~..~;%:2~%~.~ ........................................................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ..................... Repair .................... Removal .................... Demolition. ................... Oth~,e~ Work (Describe) .................... 4. Estimated Cost ....r~../..~vA.....~.'.~.~ ....................... Fee ..... ~./.....~..f...~ ............................................................. (to be paid on filing this application) FEES: 5. If dwelling, number of dwelling units ......... / .............. Number of dwelling units on each floor ............................ If garage, number of cars ............... ./.. ..................................................................................................................... 6. If business, commerical 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 structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ :.~..~..(.~....../.... Rear ............................ Depth .......~.'.-.;..~..i../. ........ Height ............................ Number of Stories ...... ./.. ................. 9. Size of lot: Front ........ ~.....?.....~. ..... Rear ......... ~....~.'~....~..... Depth ..... ..~....~....~?..../. ..... 10. Zone or use district in which premises are s!tuated ........ ..~..~/.....~...~...~.~../~.~ ...................................................... 1 1. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~.. ............................... ( 'z//:/-<' ,~'lf,/~/,/,~.~ /,, ..... O/,~/.~. 12. Nome of Owner of premises..~..~..g/.-: .~.~.//..~X4/;~'.~'./?..~.~'.JAddress/~..~g../.. ...... ~../..~./.~....~./..~...~..~./.(..Phone N .................... Nome of Architect...~..i.~.~.¢/b.~.~././..~.'.../../...//.~/.F./¢.~...Address ...'~...,,',(..,:!/./.;..,~../.~..~..4<~.. ....... Phone NO.F//~ .~.~-~..~. '~..,~.. Name of Address ........ Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner Iot:~, I I~ ~ ~>~ ~ql ~ ~ ..... ......~...~z....~...~ ,. ' ~ ~ ' / , "~/, ~./~ ~' ? J ~ - --- (N~me of indig~du~i signing appli~ofion) ~bove nome& He is ~he ............................. - ............................................................................................................................. (Contractor, agent, corporate officer, etc.) of sold owner or owners, ~nd ~s duly ~uthorized ~o perform or hove performed ~e s~id work ond to meke ~nd file ~his application; ~hot oil sto~ements con~oined in this application are ~rue to ~he best of his knowledge ~nd belief; and that ~he work will be performed in the manner set forth in the oppli~otion filed therewith. Sworn to before me this / ~...-./~ ~'-. ~~,r~ .................. ..... .... ~J ................ day of ........ ~ (Singature of applicant) Notary Public,...~...~.~ .......... .County y ;LOISE iIOWDEN Public, State of New york Oommission Expires M~rch ;)O, 1~'~.~