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HomeMy WebLinkAbout138-zFOR1V~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ........ ..~....~.0. ....... Date ........... Oetc~ber'":'20 .................... 19~?.... THIS CERTIFIES that the building located at .j~,~O~.~..~$~,O~t~ .................................... Street Map No. L~,~*~n~...~/~s. Block No ..................................... , Lst~. SO~}tO'~'"]~'~'~'~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................... ~.~..~..e.~b..e~...~..(}. ....... 19.~.~...., pursuant to which Building Permit No ....~...~,~.~. ............ , dated .............. .0.~..~.O.~.~,L..~.0 .................. 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 ............ .................................. PP, ~TJ~.. ~D~L LZ~G. ....................................................................................... This certificate is issued to ....~l~.,...~.'~.}t~.,r.~.~ ....([~F~,e:F..) .......... : ................................................. Lowner,~essee or tenant} of the aforesaid building. Building Inspector FOl~l~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES ~W~bT~,~r.S~-.G~ ,~~D*,~1~£~3~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .. ~.o...u..n_~.L ..Y.~.e...w....A._v..~.~ .......................................... ....... ~.~h.o?.~.d.,...~.,g., ........................................ to ......... ~Ailc~..an...a~Ld ~,.~ion...t o...exis.tlng...d.~e 1.1 ~Lng ................................... : .................... ot premises iocated at .Eak~mis..JRo.ad......(...l~ughing..wa~e~s.) .............................................. ........................................................... S.outho.ld.~ ..._ ~l.,.Y., .................................................................. pursuant to application dated ..................... 8ept~.....].O~...19.~'~. ......... 19 ........ , and approved by the Building Inspector. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. Examined ...... .~. ;r....:~ ........................ ] 9 ........ Disapproved a/c .... "' ....... ?-p ............................................................ .f. ................... (Building Inspector) / Application No [ ''~) APPLICATION FOR BUILDING PERMIT .......... ....... ............ INSTRUCTIONS o. 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 publlc 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 a~terotions, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ........ . ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, e~ectrican, plumber or builder. Name of owner of premises ...... ~r.~ ....... ..~ff.~~..~..'.~ ....................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wdl be dg,~e. Map ............ Block .................................. Street and Number ...... ~...~,~-~'~°~..~,'.7.~,.4~./."~.q...~.~...~ .................................................................................... State existing use and occupancy of,~.p~emieses~ and intended use and occupancy of proposed construction: a. Existing use a n d occ up anc y...~~.~Z~...~'~...~'~..... ,~.~..~..:~,.~, .~...., .~/,f'. ~ .~..... ,~!~.. ~, ,..~, .':~:{~<~ b. Intended use end occupancy ............................................................... ~. ............................................................. J~ ~* 3. Nature of work (check which applicable): New Building .................... Addition ..~ ......... Alteration .................... Repair ....................Re~:~val ....................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, commericaJ or mixed occupancy, specify nature and extent of each type of use ................................ 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..../...~....f .............. Rear ...... ../....~.. .............. Depth ..../....~. ................... Height ........ ~.. ............... Number of Stories .......... /'. ............... 10. Zone or use district in which premises are situated ........... .~. ......./.~..: ................. ,///_"',~ .................................... 1 1. Does proposed constructiot~ violate any zoning law, ordinance or regulation.~....~.r .................................... Name of Architect .................................................... Address ...... , .............. ~..~../.~... Name of Contractor...f~~l~Address .~.~-~..~.~.¢~. ....-- 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 whetl~er interior or corner lot. STATE OF NEWIYORK, ) (Name of individual sig~-m~' application) above named. He is the...~ ............................................................................................................. (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 oil statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed Jn the manner set forth in the application filed therewith. Sworn to before me this .7... ...... & .......... day of ..................................... 19...~... Notary Pub I lc,..~.~ .~.-~.x~-,,~,~,u ....... ~ [LOISE BOWDEN J,/ot~J PubJic, State of New York No, 52-036/800 ~'? (Singoture of applicant) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S' OFFICE SOUTHOLD, N. Y. Exom,ned ....... ................ Approved ........................................ 1 9 ....... !Permit No.......: ......................... Disopprove~t o/c ................. /.... ,~.~.~;i.~ ............................................ ~ ....... :: (Building Inspector) APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. ~Fhis~ application must be ce'npletely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. ' b. Plot ~lan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas~ end gi~ing a detailed description of layout of property must be drawn on the diagram which is port 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 wilJ issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout,:rhe progress of th~ 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. APPLICAIION IS HEREBY MADE to the Building Deportment 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 reg61ations. (Srignature of applicant, or name, if a corporation) , (Xd ~[';;'~ }' o'~/~ ~ ~ i i~:'~'~'~i ............ -~ ....... ~:.. State whe,,t, her applicant is owner, lessee, agent, architect, engineer, general contractor, <~lectrican, plumber or builder. .......... .................................................................. Name of owner of premises ...... z,.~..~......~...~....~ ................................. L~.f~.~..,~ ...................... ; ................. : ...... ; ................ ........ If applicant is o corporate, signature of duly authorized officer· · (Name and title of corporate officer) ~z~ Location of land on which p. rop'osed wo.rk willie done. Map N~J..~0e:{',~..'~.,~../.~.':~E~'i~bk .................................. Street and Number ..'~..~ ................................................................................................ State existing use and occupancy of p~remieses and intended use and occupancy of proposed construction: a. Existing~ use and occuponcy.....~..,.~.....e....~..,.~ .................... b. Intended u~e and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition ........... Alt arian ............ Repair ....................Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ..,~....~..~..~,~ ...................................... Fee (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 ................................ J~ 7. Dimensions of existing structures, if any: Front ....... ~.:...~...~....:... Rear ....2~....~.....~....: ..... Depth ..... ~...~..~....., m ..........r'/~..., ............ Number of Stories ...... /.. ............................................... ~ '~_'~'~/'; ............................................... ~ Height Dimensions of same structure with alterations or additions: Front .......... .~.....'ffT..~...7...:... Rear ................................ Depth ..............................Height .............................. Number of Stories ..../ .......................... 8. i~li~i~t~ions of entire new~S~re~C~ifO~io~n.t...iiiii~.!..~.....~......'... Rear ........ ./..~..~:. Depth ..... ../..~.~ ....... 9. Size oflot:Fron, ...... /...'.~...~..~'.Rear .... ../...~.~)..~.....' Depth.J~ v~. 10. Zone or use district in which premises ore situated ........... /~...J~ ........................ .~ ......................................... Name of Architect ...... ~:.~:.....~Z..~,/~..:.~....j/.~ ........ Address ...~,..;~/:.~.~....,~....~j....Phor~e NO..~,,~,..~ Name of Contractor...~...~ .......... Address .~2¢F~....~...~....~....:.~..'.~:....Phone NO ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-bock dimensions fram 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 ~fORK, ) ,,,,'.,I,~.~,_ ,~ .......... ~~.~...~....~. ..................... being duly sworn, deposes and says that he is the applicant (Name of individual s~ni~gapplication) above named. He is the ................. ~~ .................................................................................... (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. Sworn to before me this ....... ~}.....C? ........ day of ............. : ............ Notary Public,. ...... B.{3, ISE BOWD£~I ~IOt~y Public, State of New Yorl{ R~siding in Suffolk County No. 52-0367800 I~ly Commiss,on Expires March 30, (Singature of applicant)