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HomeMy WebLinkAbout97-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLER~('$ OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ..... Z.....90 ....... Date ................. Ap~.ll....3.2.. .................. 19..~.f~.. THIS CERTIFIES that the building located at ...O~t:Leto.....A~.~ ..................................... Street Map No. La~g.t. iin.§..~/a.t, er.s. Block No ..................................... , Lot No..~..~.i......S~uthold~.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....................... ~c!~.~t, ....... .~. ............. 19...~'.~., pursuant to which Building Permit No ..... .~...~.~. ............. , dated .................. ~e[Dt~embG~...~ ...........19...~.~.., was issued, gnd conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ............ ..................................................... Pt~ I.V.A.~5~.. ~)W~.L~[~-~ ..................................................................... This certificate is issued to ..~T:t~DhQ~I~.-~O~O~V.¢$G~....~. ........................................................... '(owner, lessee or tenant) of the aforesaid building. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES V~Fdtc~j~eS~',~ .~f~f~gt[~'R/4'I~'~A~L~~,~b~t~UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No...~..~' ............. Date .......... Permission is hereby granted to: A. Reiley ~;...5.O~ ........ ~/.q.....~:f~.f~.o.l.~..:l.~?.O~O..~.~.~y.~....Z. nc. ..... ~a¢.tl.tu~k,,,.....~ · ~,~, ................................. at premises located at ....,'fE/.,,~.....O.~,t~.~,~....J~:~.~,. ............................................................................... ....................................................... 5..o.~.t.,.~.~.o..~,~.~......~b..~.: ...................................................................... pursuant to application dated ..................... J~'~t,-.....'~. ....................... 19...~..., and ap.proved by the Building Inspec~r. Fee Building Inspector FORI~ NO, 1 TOWN OF SOUTHOLD BUILDIHG DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, iq. Y. Examined ............ z.'.~ .~i?..~.~........ ~.~....... 19....~...~ Approved ............................ ' ............ 19 ........ Permit No.~...../....Z.. ............. Disapproved a/c ~~ -~J (Building Inspector) .?..7 Application No ..................... APPLICATION FOR BUILDING PERMIT Date ............. ~..~/.'.~.. ~ · .~.. ........ :,~.,. ............ 19f.~..~...?.., 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 buflding 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 laws, ordinances and regulations. (Signature of a[~p[icaf~t, or name, if a corporatfon) (Address of applicant) State whether applican~!~s owner,/)less~a/'chitect, engineer, general contractor, electrican, plumber or builder. .................................... ~:~.:-~¥~-.~.:.-.(f.:,~.:.~=~ ....................................................................................................... Name of owner of p em'se ..... If applicant is a corporate~ signature of duly authorized officer. (Name and title of corporate officer) ~j~ ~.~.6 '-~+ ........... ~.3. ............. Location of ,and on wh,ch proposed work w" be done. ~ap No%<..~..~:q.~..... ~ ~.~...... d Street and INumDer ..:~...~....v .................................................................................... State existing use and occupancy of premieses and intended use and occupancy of proposed construction: c. Exist ng use and occupancy ..... '.~ b. Intended use and occupancy ................ ~r~! .~...~..~..~: .('t '!~.~.. >..~ :l .................... 3. Nature of work (check which applicable): New Building ........ ddition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ...... ,,(..,..~.:~.::~. ....................................... Fee .~/..¢L..: ............................................................................... (to be paid on filing this application) FEES: 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 ......... .,~/...~-r.. ......... Rear ..... ~'¢ ..~... ............. Depth .....Jm.....O.. ............... Height ............................ Number of Stories ....~..,:~fl,.~. ......... 9. Size of lot: Front ..... ..'7~..._.'~. ............ Rear ...... ..~....~.). ............. Depth .~....../....,~...~ .... 10. Zone or use district in which premises are situated ......... ~ ..................................................................... .~..~ I1. Does proposed construction violate any zoning law, ordinance er regulatian?......~..~'~......6? ................................... 12. Name of Owner of premises~..~..~,~L.l~r;.~iZ.,,?.*,~...Addross,, Phone NO Name of Architect ...................................................... Address ............................................ Phone NO ..................... Contractor...A..../~..~ '~,.~..{~ .~,~ ................ ....:~,~..,..~..~.~,A~,,.~..~/4 ........ Phone NO ..................... Name of PLOT DIAGRAM Locate clearly and distinctly oil 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. .................... ~...7;~...~ ........................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .............................................. ~~4..~,.,,Z~'~.~: ............................................................ (~r, 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 hls knowledge and belief; and that the work will be performed in the manner set forth in the appllcation filed therewith. Sworn to before me this ...... ..... day ..... Notary Public, Stata of ~aw York Residing in Suffolk County No. 52-0367800 My Commission Expires March 30, /~"'~S i~ret/o f~a ' plic a n t) FORi~I NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. AppJication No ........../....../. ........... 77 Approved ........................................ 19 ........ Permit No ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT -ate ~'1~ ~ u ..................... .g .................................... 19 ............ 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 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 a,n.d regulatior~s. , (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applican~ owne~rchitect, engineer, general contractor, electrican, plumber or builder. Name of owner of p .......................................................... U.~ .......... j,~ ...................................................................... If applicant is a corporate, signature of duly authorized officer. ......................... .t. ...................................... (Nome a' nd title of corp'orate officer) 1. Location of land on which proposed work will be done. Map P~o ......... ~ ....... d ............... bqS-~]< .................................. Street and Number 2. 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. Estimated Cost ....?.:..?...~..~.?. ........................................Fee ...~..~...~ ........................................................................ (to be paid on filing this application) FEES: 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 ~-, O Height ............................ Number of Stories ....~.~..~'~.. ......... 9. Size of lot: Front ..... ~....~. ............ Rear ...... ...~....~.. ............. De, nth ..~..~..~..~....'~ 10. Zone or use d~stnct ~n which premises are s~tuated ......... ~..~... .............................................................................. 11. Doos proposed construction vlolote ony zonino Iow, ord~nonce or re~ulotion? .................................................. 12. ~ome o{ Owner of premisos . ..Address ............................................ ~hono ~O ..................... ~me of Architect ........................ ~ ............................. Address ............................................ Phone NO ..................... Name of Contractor...A ~ ........ ~..' ............. 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 OF~..). S S.' ......................f~7/~'~] ~ )~:.fJ!:~ ......................................... being duly sworn, deposes and says that he is the applicant (Name ~f individual sig'ning application) above named. He is (Cantractor, 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. Sworn to before me this ELOISE BOWDEN Natal7 Public, State of New York Residing in Suffolk County Ne. 52-0367800 My CordmJss o:1 [ ~:~cs F,:,~rch 30, 19 iSbg :ture of appi ce t)