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HomeMy WebLinkAbout87-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ........ '~'"" 26 ..... Date ........ Oe-~ol~er.....9 .......................... 19..~.. THIS CERTIFIES that the building located at '"(~O~'W'l'rl'"&'"~h"f~'[' .......................... Street Map No .............. ']{4X:~ ............... Block No ............ ;XX~;X ............... , conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................... .ktlg~.fO..,..~l+ ...... 19...~7., pursuant to which Building Permit No ...... Z'""~ .......... , dated ..................... ,/["~lgt~S'~,--'"2'"~ ........... 19D'.~...., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issue¢ is ............ ............................... ~OfC~E-"t31~]~ t:,t)t N~."-' ( 'm~si~e s's ) ....................................... :-¥~ .................. This certificate is issued to ':~lgl;'"'/?~:'"[~:['l"]:~. l~c~v~r,'' { ............. lessee("'O]~t'l'eor tena~l~) ''') .................... of the aforesaid bt~ilding. Budding Insgec¢or / / / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES ~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No ~ ~'~ Date ..19..)./ pursuant to application dated ................... ~;~ ........... .-~......'~*. ......... ]9...*~.,~, and approved by the Building Inspector. Fee $/0 ~'~ . FO~ NO. 1 TOWN OF SOUTHOLD I~UILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Perm t No .................. Application No...-.Z... Z...~. ......... APPLICATION FOR BUILDING PERMIT Date ............ .(..~...~.. ~. ~., ~,, .T'. .......... ..~...~. ......... 19....~.....~... INSTRUCTIONS a. This application ~ust 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 Fommenced 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 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 ail applicable laws, ordinances and regulations. (Address of opplicar~) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or, builder. ............. ....... ......................................................................................................................... Name of owner bf premises ............ .~...Z ........ : ............ ,.~.S....~ .......................................................................................... If applicant is a corporate, signature of duly authorized officer. ........ ......... (Jxk:lme and title of corporate officer) 1. Location of land on which proposed wojrk will be done. Map No ................................... Block .................................. Street and Number ..... ...~..¢~.~..t,k~&.......~.~.T ................. ~...'T. ....... ~......~.'....~.~.~k',........~..~ ............................ State existing use and occupancy of premieses and intended use and occupancy of proposed construction: o. Existing use and occbponcy .............. .~..~..~.~ ....... m....~ ........................................................................................ b. Intended use and occupancy ....... .~..`.~f~..&.c~...~.~f~.....~h..ug.~.ku~.s.~...~..~g.~D.?..~.~d.:T~..~.~ ................... 3. Nature of work (check which a[~plicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition. ................... Other Work (Describe) .................... 4 Est mated Cost .?..o.~..c? .. Fee ...L.~.. .......................................................... (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..~.'~.c~.A.6.?~ ........... 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 ........ .~..t.~.'.z.~.:~ .... Rear ....... t..t...o.~.'..o....~ ....... Depth .....~....~.'.n.Q..". ......... Height .!g.....~.~....t.% ......... Number of Stories .........t ................... 9. Size of lot: Front ~,7-o' ~" +- Rear ....... t,.~.....T.o....-.... Depth ....I...~.?......~ ............ 10. Zone or use district in which premises are situated ......... t.5. ............. .(..c?..,.~.~.~,.~.,~ ................................................. 11. Does proposed construction violate any zoning law, ordinance or reguJation? .................. : ................................. 12. Name of Owner of premises...V~....~.....~.'.......~...,.~.~....~.:Address ..~'J~..t~z....~.~.¥~..~..~.~.o.~t..~:.~hone NO ..................... Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor..~:.~.:.C..~.0.~.'~...Cu~s,..1.~.c..:....Address .~..(.~...~.~..~X::..~i~.R~.o. lIDhone NO.'"JZ..O.O..L.'~ .... 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 Iot. ¢. (S~ applicant) ~ Sworn to before me this ...... ~....~ .......... day of .......... ~4~.., ............. 19;,~..Z... ~ Notary Public,.~..~.~ ....... y -- L. I,, ~,O.,~S' STATE OF NE~/ YORK, -- ) COUNTY 0~.....) S S.' ..~.....~..-.~.,...~xC.: ................................. being duly sworn, deposes and says that he is the applicant (Nlome of individual sig'~g application) above named. He is the ............................. ...~¢...~..~4..-c.~.e.~...'~.....~.. ....................................................................................... (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. FOR~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... J.'..~,'~ ... 19. ~ Approved ........................................ 19 ........ Perm t No..x ......... Disapproved o/c ............ ;.~,~.~.:~.'~..,..,;;;: ............... .~::>,.~,.~:::.'. ............. .,,.;::~,~,.,. ,~/~,~ ...... ....... .2P..!5....'. (.. %'.; ( .......................... (Building Inspector) Application No........~......?. ............ APPLICATION FOR BUILDING PERMIT Date ............. ~.~.V..s..~ .......... ~ ....... ~ ~.5~..~ ..... 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 o 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 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 lows, ordinances and regulations. ..... ................................ (Signclture of aDpli,~,ant, or name, if a corporation) [Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gbneral contractor, electrican, plumber or builder. ............. ~.~..u.~..~,.~,.~ ......... C~.~,:~.~.~.~.~.~ ............................................................................................................. ~ ' Nome of owner of premises .......... ~...].....Z;.....~.t.~.&.....C.¢.: ................................................................................. If applicant is a corporate, signature of duly authorized officer. [Name and title of corporate officer) 1. Location of land on which proposed wor.~ will be done Map No ............... El ack ...... Street and Number .... ~.~..~.6L......~.~.,~..: ........ ~ ,,~ ...... .,., ...~.~?..qfi.,.,~.. ~ ~ .r.. . ............................ State existing use and occupancy of premieses end intended use and occupancy of proposed constract'ion: o. Existing use and occupancy ......... ...... .Lo..% ..................................................................................... <, . / b. Intended use and occupancy ............. F.~.:.~.~.~.~, ......... ~f~....A. bd,~.~.~f;..a.~.g..~.o.?...q..r~,...~.T,~., ................. 3. Nature of work (check which applicable): New Building ...... ~ ......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition, ................... Other Work (Describe) .................... 4. Estimated Cost .................~..,.?.~..o......~.. ...................... Fee ................. ~.,~,,.....-~. ................... (to be paid on filing this application) FEES: 5m If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................................................................ 6. If business, commerico[ 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.....t..~..o..'.Z.9..". ......... Rear ...... J,J,.c~..z.o .......... Depth ............................ Height ...t.~....z~.....~.~ ....... Number of Stories .........) .................. 9. Size of lot: Front ..... !~Qi:.O.~'...~ ....... Rear ...... L~,~.,.'.C~ .......... Depth . . . 1~ ~ *i~'...~ ..... 10. Zone or use district in which premises are situated ................... .o..,s...t..~..~.~..s .............................................. 1 1. Does proposed construction violate any zoning law, ordinance or regulation? ......... !.~.,~.: ................................... 12. Nome of Owner of premises..~..-;...~..:....~:..q~.k..~... ....... Address .~.~.tD.,.Z:...C~.~.~-~.~T~.~'..~hone NO ..................... Name of Architect ...... i .................... ~ ......................... Address ............................................ Phone NO ..................... Name of Contractor.~...~.:.~.sfl.e-.~,..~,.....~...~...~....\..~..c..:.....Address ~,k4~,.~.~fl,.'04..~.~..,~..~..lI-..t..%e~h~Phone NO..~..:..°..°..L.~. ...... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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 YOF COUNTY ..... being duly sworn, deposes and soys that he is the app)icant (Name 4 s~gning above named. He is .,,e ......................................................... (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 thio 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, ...... .......... ...... ............... . -- ~ , ~ ~ ~,~ ~ , , ~ (SJngature of applicant) Notary Public~~.~ ...... County