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HomeMy WebLinkAbout77-zFORI~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...... Z.. 92 ......... Date ....................... ~a~..-'l. ...................... 19.~... THIS CERTIFIES that the building located at .P~.J~.....~&tJ~oh'l.....P~oa~l, ................ Street Map No. ~...~.o...Gr.a.~w~JL~. Block No ..................................... , X~L'~K-~...~ew..~.l~'.~.o~.....~J,X'o conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................... ~,~lg~t~....~,~ .......... 19..~?..., pursuant to which Building Permit No ....~...~.~. .............. dated ........................ ~EI, g~i~:13...]-.l~. .......... 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 ............ .............................................. Pi~I.~.A~.....D~ELLIN~ ......................................................................... This certificate is issued to ..1~il,~:J,~.....]~CJ'~,r~ ........ (...o:~r~e~.) ............................................. (owner, lessee or tenant) of the aforesaid building. NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES AP, P. ROVE ~ ~ ~ I,~ ~ UNTIL COMPLETION WO K Date .................... AL~lz~tt~..... ii../t. .............. 19. ,~... Permission is hereby granted to: ~e~e~.I~em~:~zt..~.~:F.~/~.~:~'~..i~:~.~ac~ to ......... ~...nc~.~.~.. ~,~ ~ 7..~.~:~ ....................................................................................................... at premises located at ~E~,~'"'[~' ,.~'¢~,}~J~",*~r ................................................... ..................................................... ~4~ ~.¢~.z eE~4'v' ~"* ~ ' ............................................................... pursuant to application dated ~'~,~,-~ , ~ 19 f';~ and approved by the Building Inspector. Fee $....I~D,,~ ~O ......... Building Inspector FOI~/I NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTNOLD, N. Y. Approved ........................................ 1 9 ........ Permit No ................................ Application No..~.Z iZ ....... 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 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 part for any purpose whatever until o 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 lows, ordinances and regulations. ...... ................. (Signature of applicant, or name, if a corporation) ......................... ~' ~(Address of applicant) v ' State ~hether applicant is owner, lessee~ af)ent, architect, engineer, general contractor, electricon, plumber or builder. ..... ..... ................................................................................................ Name of owner of prem ses ...~.~,Z~ ..~..~-- _ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed wqrk will be done. Map No ................................... Block .................................. Street and Number ....................................................................................................... ¢~/. ................................ State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy .......................... ~ .............................................................................. b. Intended use and occupancy ~.~. ~~ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estirnated Cost ......~.,.3...~.'~...?..:...~..'~.. ......................... Fee ,~. ,o?.~ (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 cers ........... ..~.~ ................................................................................................... If basiness, commerical or mixed occupancy, specify nature and extent of each type of use ................................ . Dimensions of existing structures, if ony: Fron .t=;..':l:T~:~,i' ......,~¢....-~.. ............ L)ept~ ................. Height ............................ Number of Stories ....... ~-. ...................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ · Dimensions of entire new construction: Front ........ .~T......~/. ......... Rear ....'.~....~ .......... Depth ....~T.....~.. ................. Height ............................ Number of Stories ....~.~;~... 9. Size of lot: Front ....J../....~. ............. Rear ....... ~.'....¢. ............. Depth ..... ./.~.'~...¢)... .......... 10. Zone or use district in which premises are situated ...... A........~..'. ...... ~ .......................................... 11. Does proposed constructio~ violate any zoning law, ordinance or regulation? .......... ..~.....'..'~.. ............................... 12. Nome of Owner of premises...~....~-...r.~...~-CCddres~...~.~..~......~..'..~..Phone NO ..................... Nome of Architect,~,o.,_.~ .......... "~t~'~,~ ................ Address~ ........................................... Phone 0 .................... Name of Contract~c~<,~_~c...'r~rz,=~..~..Address ""~"~~C ......... Phone ~ 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 show street names and indicate whether interior or corner lot. STATE OF NF~V YORK, ,, COUNW ....... ' .............. ~;_~;~..~..6 ....... ~,..,~..': ...... ~.&%'.~d~....being duly sworn, deposes end says that he is the applicent (No~e'~f individue[ signing opplicetion) above nome& He is the .......................................................................................................................................................... (Contractor, agent, cat, rate officer, etc.) of said owner or owners, ond is duly euthorized to perform or hove performed the said work ~nd fo make and file this application; that ~11 statements contained in this ~pplicotion ore true to the best o~ his knowledge ond belief; and that the work will be performed in the monner set forth in the opplicetion fi[ed therewith, Sworn to before me this ........ /'"'~" ....... -'~ ' _ t"~ ~. ,day ~f ...... ~...: ....... Notary Public,.~.. ~. 4::7~ ............. Codnty .7'(Singature of opplicant) ry Public State of H.~ York My Commission £'l~:res ¥~llr~h 30, 19 ]~01~,~ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 5OUTHOLD, N. Y. Exam ned ...... '..C~W..':z..~'.~,.../..~Z ....... 19 ~;. ~ Approved ......................... ~.~. ............. t9 ........ Permit ~o.....Z .......................... Disapproved o/c ~' ~'~ ~ ....... (BuiJding Inspector) Application No ........ ~..?....~ .... APPLICATION FOR BUILDING PERMIT Dote ................. 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 adioining 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. 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 p.urpose 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 and regulations. ~--..2 (Signotur~Ont'°rname, if o corporation) .............................. i~t'~lri~ss of applicant) State whether applicant is owner, lessee, agent, architect, engineer general contractor,, electricen, plumber or bu der. ........ ..................................................................................................... Nome of owner of premises ........... ..~...~...o~~_~. ......... J~D~k/~.~.~.cw~.....~..~ ........................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer). Location of land on whlch~oroposed work will be done.~ Map No ...................................Block .................................. Street andNumber ..~.q/2~. ~~ .~...~.~ ..... State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. xisting use and occupancy ' .......................................................... b. ntended use and occupancy 3. Nature of work (check which a ,plicable): New Buddh*ig .................... Addition .................... Alteration .................... I Demolition ................ ....Other Work (Describe) .................... Repair .................... Removal ................ : .... 4. Estimated Cost .................................................... -- (to be paid on filing this application) FEES: 5. If d~eIling, number of dwellin~ units ........ I.~ ................. 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 .............................. I-lelght .............................. ix~mber of Stories ................................ r 8. Dimensions of entire new construction: Front....~.....~. .............. Rear ..... ~...~'_ .............. Depth .....2'z.....~.~.. .............. Height ............................ Number of Stories ..... / ..................... 9. Size oF lot: Front ....... LZ..~ ........... Rear ......... ~.~ ............ Depth ...... (h~.~? ........... 10. Zone or use district in which premises are s.tuated.....~.~. ...... z...: .................. 6j. ................................................... 1 1. Does proposed constructio~ violat~ any zoning law, ordinance or regulation? ............. ~ ........................... 12. Name of Owner of premises...~X~~ress .~~....~....Phone NO ..................... Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Controctor. A~~..~~ddress~. ~ . . . ~ ...... Phone~' NO L~ ~ZO 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 show street names and indicate whether interior or corner lot. Sworn to be~Core me this ....... /...cC.. .......... day of ..... ....... : ............... Notar)~ Pub I ~c,..'fE~C,~L~..~.*J .............. County d* ~.~MJc, Si,~ o~ ~ew /(Singature of applicant) STATE OF NEV~ YORK, ~ )¢ . I cou w OF /; ..... , ~ ' .. ~L '~ ' ...i.............. .~ ................ berng duly sworn, deposes and says that he is the appllcanf ~ame of individual signing qpplication) above named. He is the ..................................... ~ ................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly ~uthorized to perform or have 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 that the work will be performed in the manner set forth in the application filed therewith.