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HomeMy WebLinkAbout142-zFOI~i~I NO. 4 TOWN OF SOUTHOLD BUILD[bIG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located atS/.~.....lYR~l~.~O~.d .................................. Street Map No ..................................... Block No ..................................... , conforms substantially to the Application for Building Permit heretofore filed in this office dated ................... 0.(l.t,.Q~P,l;:....."l.~. .......... 19...~'~., pursuant to which Building Permit No ...~,..JL~2, ............ , dated ................ ~tC.t,o'~.~.r....~L~ ................ 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 ............ .................................... PRT.V.A~.....;DMF,.L],Z.~¢G ................................................................................... This certificate is issued to .....,I~I.~OYI~..~kl4'~a .................... (...f3-~¢11~.) ........................................... (owner, lessee or tenant) of the aforesaid building. ........ !......¥ ........ ......................... '::.. ... 2. . .. ......... Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILD]lNG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES OF THE WOR~<.AUTHORIZED) No Permission is hereb~ granted to: ¢~lester. ~0~,t~¢~t~.i.....~ -~.~...~u~ .~o~e..~ek~a ............... ,. .......... ~.~o~g~e~......~:~. ....... , ...................... to .-B~t~..a. gd...o~i-~.,~>B...~o...O~5~4~,l rog.. d~o.~ 5.~ ............................ ~ ............................... ................................................................................................. ~ ............................ ~..fi .............................. ot premises locoted ot ")~8~8'""~l~l"I~Da~' ........................ ~,~ ........................... '~';."~ ............................. ..................................... ~} .................................... Peeonle ~......~.7~ .................... r'"~ ............................ , , , ,[ Building Inspector. r FOI~M ~0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ................... ~.I .................. 19 ........ Permit N o....'..~....../....~. (......'¢~'--.; .... Disapproved a/c ............... :, .... :Z:'~' ~ .: ........ ::~T.~;~.....~:.~ . .................. ~ .......... (Building Inspector) Application No...../...~...~ .......... APPLICATION FOR BUILDING PERMIT D o t e. ~:i:.. ~?! ~7 .~.':~i'~.. ~..~.~ ............................... 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 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 Oc~upa'nc~z 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 applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. ...... ~:<~'..~..¢~,,,~,~,~,, ~., ~%... ~.~...~ ~z K.,&~ ....................................................................................................................... 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. Map No ................................... Block .................................. Street and Number ....lqzs. X~-r~.....~/..~...~'r~......~...... ¥.,".,f~..c..~.-~,,~.~-~ ..................................................................... 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Ex st ng use and occupancy ......... -..,~.~ .............................................................................................. b. Intended use and occupancy......~.~.~.~ ...... .~ ........................................................... ~ ..... 3. Nature of work (check which applicable): New Building .................... Addition ...... :'.~. .......... Alteration .................... Repair .................... Removal .................... Demolition ............... h...Othez~ Work (Describe) .................... 4. Estimated Cost ...... ~...~...L..~...-~ .................................. 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 ................................ 7. Dimensions of existing structures, if any: Front ......... .~..?./ ........... Rear ..... .L../...~ .......... Depth ......~....(; ............... Height .....~. ................ Number of Stories ........ ./.....~ ............................................................................................. Dimensions of same structure with alterations or additions: Front ......... .~,s'-2. ................. Rear ................................ Depth Height .............................. Number of Stories -'/~ 8. Dimensions of entire new construction: Front .......... ~ .............. Rear ........... '.?.. ............ Depth Height ............................ Number of Stories ...... 9. Size of lot: Front ..~..P_,c~m~cx.. .~ea~ .................................... I0. Zone or use district in which premises are situated ....... (.'1.. ...... {/~~....~.. ............................................... I 1. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~ ...................................... 12. Name of Owner of premises....~...:....~....~~ess ..~~..~. ........ ~/....Phone NO ..................... Name of Architect ....................,~ ............................. Address ............................................ Phone NO ..................... Name of Contracto~..~~ ........ Addres ~,~.~..i..'..~..'..?~...Phone NO~..~....~/.72.,~.1_ 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. ST^T OF ¥OR , . COUNW SS.' (Nome of individual signing 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 in the manner set forth in the application filed therewith. Sworn to before me this E£OISF. BOWOE~ ~'ota~, Public, State at New Yolk Resi~in~ In Saffolk County No. 52-03678,00 My C0mrnJsslon £xp~res t~arcJt 30, J. 9 (Singoture of applicant) FO~ NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................ Approved ........................................ 19 ........ Permit No ...... i .......................... Disapproved a/c ........ ~ ,~.'?..~.~.-:.. ................. >.~c ............ ,~,., ,: :. L... :~.~,~?~ ......... (Building Inspector) APPklCATION FOR BUILDING PERMIT °ate.....-. ..................... 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 b~ 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. r e. NO building shall be occupied or used in whole or in part for any p~Jrpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLIC,~,TIoN IS'HEREBY MADE to the Building Department for the i~suance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and 5ther 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 applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Nome of owner of premises ...... : .............. .c...~...~......~... ............................................................. If applicant is a corporate, signgture of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No ................................... Block .................................. Street and Number~ c',.~ !~'~. ~'me~, (z~Z/*. ~..~..~¢¢,~ .... . State existing use and occupancy of pretzci.eses and intended use and occupancy of proposed construction: o. [:x~stln~ use ond occuponcy .......... : ....................................................................................................................... b. Intended use and occuponcy~,:k~~ ~'~ ~ 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: 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 ext~nt of each type of use ................................ 7. Dimensions of existing structures, if any: Front.......t,;;.....( ........... Rear ....¥.~...."~. ............. Depth ........~.....~. .............. Height ....... ~ ............... Number of Stories ....... 1......'L-,~... .............. ': ............................................................................ Dimensions of same .structure with alterations or additions: Front ...... :..~?, ................... Rear ................................ Depth .................. He ght .............................. Number of Stories~.~ ....... ¢ ..... 8. Dimensions of entire new construction: Front ............ ?.. ............ Rear ......~. .................... Depth He ght ............... Number .of Stories, ..... 9. Size of lot: Front .................. ,~ ......... ,~r ~. .............. ~ ............ epth ............................ 10. Zone or use distr(~t in which premises are situated...../~. ........ ~ .............................................. 1 I, Does proposed construction violate any zoning law, ordinance or regulation? ............ ~ ................................ ' 12. Name of Owner of premise .~..¥..~ ...... ~.?Address..~.:.~..~..~...~ / .~...Phone' ' ' NO ..................... Name of Architect ..................................................... Address ........................................... Phone NO ..................... Name of Contracto~:~:;-,~'.~.~,~.~L~.* ....... Addres .~..C~¢t~..,,/...)~/....:.~......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 NEV~ YORK, ) S S.' COUNTY OF ~...) (Nome of indi¥idual signing application) obove homed. He is the ............................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 flied therewith. Sworn to before me this ....... /.../'" .~. .......... day of ......... ~ ..................... 19..~..~.? .... Notary Public, ... ELOISE BOWDEN Notary Public, State of New York Residing in Suffolk County No. 52-0367800 My Commiss.on E,,plros t~rch 30, 1~ ..~ ~ (Singature of applicant) . ">.