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HomeMy WebLinkAbout78-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ....... 2..4 ........... Date ........................ A.~S%...J.Tw .......... 19... ~. THIS CERTIFIES that the building located of ~j/~../t.~b~,,~c,.~O:,?.~z~ ....................... Street Map No ........ ~.~. ..................... Block No..~J.~ .......................... , Jj~t,~J~. ~.~.~.~......~. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................. ~t~..tJ~.t......J~l,t 19..~..~., pursuant to which Building Permit No ..~...'~'~ ................ , dated ........................ J~).b~.Zl~..J..~ .......... 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 ............ ......................... ~.~.vat ~..d.w~ll&~ ................................................................................................ This certificate is issued to ...~3.¢.hO~_~,,.~w~er~, ;;~,;,~,,~,~,~.~;?ni~} ........................................ of the aforesaid building. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES V~lli:~ Ai~P~~~i~,~~UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No ...... ~'" '7'~' .......... Date ...................... AU&n~t......1 ~ ........... 19. b'?.. Permission is hereby granted to: P~ cbt er ~c~e...~v~n~t.....~.C..~t~or~....~or~ z ~ ............. 0,~en~o~,.....~,X ............................. to .. ~ske" ~,t% e~a%4' on.. %.o...e~/: s%.}.~.. ~wet. t .$ t~'~. .................................................................. at premises located at ...N/S.-...A].. ~o~:rC~,o~,..L~'~e .......(...~/m...F~Ltee...Dis:t,.,,) ............................ ................................................ (~e~n.l~.,.. ·.. ~ ,X o .......................................................................... pursuant to application dated ......................... A~z_a~,~,t-.-...~ ............... 19...b-"'/'., and approved by the Building Inspector. Fee $...~/30 ............. FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No.......?.~..% -~...~... APPLICATION FOR BUILDING PERMIT are ~ ¥ 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 Jot 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 port of this location. c. The work covered by thb application may not be commenced before issuance of Building Permit. d. Upon approval o~ 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'occup'ied or used in whole or in part 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 o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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,~ ,~ (Signature of ap~[Jcan¢, or n~me, if ~ corporation) ....................... ................... (Addre~ of appiicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eJectrican, plumber or builder. Nome of owner of prem,ses...A ................. ~; ......... 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. Mop No. '~ Block ....~..~ ........................... Street and Number .(,.Y ,~.,~.....~T...~.h...!,~:Z.b:.Y'~r..~..,.~....~.v(/t..~..,~..~,.~ ....... Z ......::.~..~.r.:.,j.?.~,r:/-,~_..~.~.~,.y.., , , 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: o, Existing use and p y ....................................................... 'J ......................................................................... b. Intended use and occupancy ...................................................................................................... 3. Nature of work (check which ap.plicable). New Building .................... Addition ....................Alteration..,...~'.... .......... Repair ....................Removal .................... Demolition .................... Other Work (Describe) ....... ~ ............ 4. Estimated Cost ~'~- '~' O ~ , 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 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 Height ............................Number of Stories ..... :' ...................... 9. Size of tot: Front ~c'~ ~ ~ ~ ............................ Rear ............................ Depth ............................ 10. Zone or use district in which premises are situated ................................................................................................ 1 I. Does proposed constructi~ violate any zoning law, ordinance or regulation? .................................................... 12. Name of Owner of premises.~X~fit.~z¥.~]~)~.~.-A~ddress ............................................ Phone NO ..................... Name of Architect...; ........ ~ ......... ~ ........... k~_ ............... Address ............................................ Phone NO ..................... . . ................... Name of Controctor~,..: ....... :.L.-~¢..m..~l...:z.:~!.Address ............................................ Phone ~0. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or pro~sed, 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 NEWIYORK, ,, ) '- ,' b, ..... .~,~;.~..~.J~[/.....,~/...~[. ~/.~¢. .~'/,.~.C,.~ ........................... e'ng duly sworn, deposes and soys that he is the applicant (Nome of individual signing application) oboye named. He is ne .......................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application ore 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. Sworn to before me this ........ ......... doyof .......... .............. (Singoture of applicant) FOEiV[ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam ned ~f~"~'£ ! '~/ O '~ ") Approved ........................................ 19 ........ Permit 1'4o ................................. Application No.......'7. .................. Date ................................~. ........................1 ~ ............ 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. Up.on approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pe, rmff shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall bb 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. 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 agreesto comply with all applicable laws, ordinances//~ ~;and regulation§.~,/~. ///~ _,~ ) ,~ / ,~,~.~ ......... ................. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. · ' e f o nor of rem ses "~' ixlam o w p ..................... :: ...... 'l ........................ .~j,..~j ........................................................................... 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. Mop No ......... ...-~. ..................... Block .....-~.. ........................... Street and Number ........................................................................................................ ~ ......... .p ............. ~ ................ State existing use and occupancy of premieses.and intended use and occupancy of proposed conatruction a Ex st ng use and occupancy ~..~,.~.,~.~,~"*~ ~ .... t~ b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration.....~,,,~.... ...... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... A F ..-.... 4. Estimated Cost .......~..,~...~., ...................................... ee (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 ................................ 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 .../...~.. .......... Height ............................ Number of Stories ..... ../. .................... 9.Size of lot: Front ..... ..~..~..~ear ............................ Depth ............................ 10. Zone or use district in which premises are situated ................................................................................................ 1 1. Does proposed constructio~ violate any zoning law, ordinance or regulation? .................................................... Owner of premises.~'~.~.~zsc',~.~,~4~ddress ............................................ Phone NO ..................... 12. Name of Name of Architect .................................................... ~'~./.~' / ~,) t Address ............................................ Phone NO ..................... Name of Contractor/..~;.~.~.f.q/~,~, k~,~.~.~., 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 show street names and indicate whether interior or corner lot. STATE OF NEW, YORK, ,~ ) COUNTY . ~,,...,!.',..,.i./.., ,LK, ,~ - · .~,~,~i. i:~ ~: .'C ~ .~..'f:'i', ........................... being duly sworn, deposes and says that he is the applicant ~ Pub{ic State of NOW YaF~t Residing in Su folk County (Singoture of applicant) Sworn to before me this ........ ,~...~.... ...... day of ........ ~.: .............. 19...~..7. (Name of individual signing application) above named. He is rne .......................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized 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.