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HomeMy WebLinkAbout141-zFOE3~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, iq. Y. CERTIFICATE OF OCCUPANCY No....,~...~.9. .......... Date ........................ ~t~h.....~) ............19..~.. THIS CERTIFIES that the building located at ..~/~...~.a~rld, el:~..~.a.t~ ....................... Street Map No. Fol~d~.s...F,~t~te/~lo~ ............... ~.....&..8~}., Lot No...~ott.~h~.d.t......~.~.~, conforms substantially to the Application for Building- Permit heretofore filed in this office doted ...................... .0D.t~ohez'...]'l ! ....... 19..~..., pursuant to which Building Permit No ....~l~] ............... dated ................... .0..¢'..~.~.1~.f~...~.,~. ............ 19.~..., was issued, and conforms to ell of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ............ ............................................... ......................................................................... This certificate is issued ta ..~o.b~.t..&..~l%ez....]~e~T;~e.tt; .......... (owt~e:~) ................................ (owner, lessee or tenant) of the aforesaid building. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, bi. Y. BUILDinG PERMtT (THIS PERMIT MUST BE KEPT ON THE PREMISES .~P~~!~.~4~*S~&&~V,,~I~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No.. Z.. 11.~1 .......... Date ................. OO ~;.ob~:~...ll ................. 19. %~... Permission is hereby ,granted to: ~to .b. ~..~.. ~...~;,e..~.e..t..~ ................................................... ............ ~.o~tt,~c)ld~.....~.,.,Y. ................................. to ....~ilc]..ne.~'..d.e~.lZ~,t. ng. ....................................................................................... ..................... at premises located at .~-,/.~,..F~l,~c-]e.~..,Pa.%h. .................................................................................. .................... ~'~.~. ~.~]C$...~.$.:ta .?,.e.~ .......... ~o.u.tho. ld.~ ........ '~.~' ......................................................... pursuant to application dated .................. .Q~.~.Q~.e.~...~I,]_ ...................... 1~[~......, and app'roved by the Building Inspector. Fee Building Inspector FOP~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ............................................... iiiii17¢ i ................ (Building Inspector) Application No ...... I ..................... APPLICATION FOR BUILDING PERMIT Date ............... 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 and regulations. / (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. 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 ...... ...--Z'..; ...................... Street and Number .........../.~.o...~.....~.....~/....~....-~....:~j ............ /....//'_C....~ ............ ~.~Jc.~..~ ...... ~,~.( ............. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: ................. ..................................................................................... b. ntended use and occupancy ......... ~~~ ' ' 3. Nature of work (check which applicable): New Building .................... Addi ion .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ..... .~...../..*~.)..~...~.. ..~....,.-. ....................... Fee .... J..O.. ............................................................................... (to be paid on filing this application) FEES: 5. If dwelling, number of dwelling units......~....~...*.m.~. ............ 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 ..... .~....A/...~.~. ............ 103' ...... I75 9. Size of lot: Front ....... .~...~.. .............. Rear ...................... Depth ............................ i0, Zone or use district in which premises are situated ........ ..~.'..~. ........................ ~...'! ................................................... 11. Does proposed construction violate any zoning law, ordinance or regulation? ............ )....~...~ .............................. 12. Name of Owner of prem~ses.~;.~ .............................Address ................................. L ........ Phone NO ..................... Name of Architect ......................... ;,._,,~,:L~ .............. Address ......................... ~) .................. Phone NO ..................... Name of Contractor..~..:...~.....~.~:.~....~..~...Address ........... ~.-.~.,~...¢...../Y..~.::.) .......... 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 whetl~er interior or corner lot, STATE OF NEW~ YORK, ,, ) S S,' COUNTY, OF ,,~~.) ~-,,., ..... .~......~l.~...~,::"~/......(,../..,~T~.~.Z.~rzz,.r,,.~/~./.. ...................... being duly sworn, deposes and soys that he is the applicant (N~e of'individual signing application) .. above named. He ~s the ................................. .~w7....:%:= ......................................................................................................... (Contractor, agent, corporate officer, etc.) of sold owner or owners, and is duly authorized to perform or have performed the said work and to make ~nd file this application; that oil statements contained in this oppllcotion ~re true to tho best of and that the work will bo performed in the m~nnor sot forth in the oppHcotlon filed therewith. Sworn to before me this ....... /l. ............ of ............ ......... : .............. ......... ./. Notary EL01SE BOWDEN fJ0taP/ Public, State of Ne~ York Residing in Suffolk County No. 52.0367800 My Oomm~ss.en E,.p~r~.s March 30, (Singature of applicant) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL~:RK'S OFFICE SOUTHOLD, N. Y. Examined ...... :~: ..................... 19 ........ Approved ....................... i..! .............. 19 ........ Permit No.....~:...~.../..: ..... Disapproved a/c ............................................... t:?...~ ................................................................... ....... /. . . 7. . . ....... : ....... .......... (Building Inspector) Application No // ~-l ~ 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 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 ~f a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and ~)ther 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. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder. ................................... ........................................................................................................................................ Name of owner of premises .................~..~..~.,~..~.... ,..~.......~...~,,.,~.....~.....~..~~....,'.~...?.-~./.~."..~,.../~....~....~.,.t~....~r.../~ applicant is a corporate, signature of duly authorized officer. ..... (Name and title of corporate officer) ..... ~:.C~. 1. Location of land on which proposed work will be done. Map No ..... ~?',~.....~....?...~., ........ Block .,:.."~..i .......................... Street and Number ...... ,.~.,~,. ...~..~.$ ............................ ~.,{. ....................... 2, State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy ................ p~ ............................................................. ,, , , menaea use ana occupancy .............. ~,,m ....... ,~ .......................... I' ........................................................................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... ~ ~...~.. OI .~J~ Fee 4. Estimated Cost ..../..~./. ....................................................... (to be paid on filing this application) FEES: 5. tf dwelling, number of dwelling units......~../~/..~.. ......... Number of dwelling units on each floor ........................... If garage, number of cars .............. .0.~.F--~.. .............................................................................................................. 6. If business, commerica[ 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 ............................................................................................. t ................ Dimensions of same structure with alterations or additions: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front.......~-.~....t. ............. Rear ....... ~'..'~....I ........... Depth ....... ...~...~...I. ........... Height ............................ Number of Stories ..... ..O...~..~ ........... 9. Size of lot: Front ..... ~...-~..~ ............... Rear ...... ~...~....~..~ ........... Depth ...../..~..?...(. ........... 10. Zone or use district in which premises are situated ..... ' ........ ~ ................................................. 11. Does proposed construction violate any zoning law, ordinance or regulation?....~..L~ ...................................... 12. Name of Owner of premises ..... ~ddress ................... Phone NO .................... Name of Architect ..................................................... Address ............................................ Phone NO. Name of Contractor.~.~.~..~.. .................. Address '' i'.i iiiii'.i'.'.iiiiiii ............................................ Phone NO. PLOT DIAGRAM bocate dearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensiOinrS fr~O~e property lines. Give street and block numbers or descr ption according to deed, and show street names and 'ndica whether interior or corner lat. ~'/'t/~e '¢'/o ~ J4 o ~ STA'I"E OF NEW YORK, ) ,,~.,'"~' '~- ~,~"'~ ~<'"~' :~ .,, ~z<' ~'~ be n~ .......... ~.:~c~l~ :~:,.,.,....., ...... ./..~.,,z,z..-.,. ........................... ~ sworn, ' (H~e of i~ividu~l sig~ing ~pplic~tion) duly deposes ~nd s~ys fh~t he is the opplJc~nf ~bova n~med. He is the ............................. ~ ............................................................................................... (Co~tr~ctor, ~ge~t, corporme officer, etc.) o~ s~id owner or owners, ~nd is du~y ~uthorized to perform or h~ve performed the sQid wor~ ~nd to m~ke ~nd file this application; that ~11 statements contained i~ this ~pplic~tio~ ~re true to the best o¢ his knowledge ~d ~eHef; ~nd that the work will be performed in the ~onner set ~orth in the ~ppHc~tion filed tharewith. Sworn to before me this /' ...... ,~.. J. ............. day of ..:-x, · N'ota~y Public, State of New Residin~ i~ Soffe/~ No. 52-0361800 ~y Commission Expires March (Sicrggture of ~pplicant)