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HomeMy WebLinkAbout147-zFO,RM N~O. 4 TOWN OF SOUTHOLD I~UILDING DEPARTMENT TOWI~ CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ........... ~. _ ,7.~..~.. Date ................................. .~.~...2,.~ ......... 19..~.0. THIS CERTIFIES that the building located al .~n~liata .~le~...l~...t~eeo~;l~J ..... Street -Map No...~. .............. Block No ....... ~.®_....Lot No .... ~..~. .................................................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... , ........ .~?.~.o._b.~.~....l.~..._., 19~..7.... pursuant to which Building Permit No ....... ~...~.4..7. ..... 'tared 0e~ober ~.~ 19.~I.~.., 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 ................................................................. ~PR. iritA~ 0~.~ F~.I~¥. t;~l~:tIqO This eertiflcale is issued to ............. !ta~e,J,..IillteJ,.,.os~alr. ................................................................ (owner, lessee or tenant) of the aforesaid building. Building Inspector FOP~M NO. 2 TOWN OF $OUTHOLD BUll. DING 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) Permission is hereby granted to: Geo. ~. Smith"&"Son~ .......~/O'""I~z~l"~ng .................. H"~:n" 'Roach" 'gouJ;ho'td¥ · ' 'P~ ;' ~,~' ....................... ,/ to ..... l~tt ~[ ~Zd ' ' 'I~ ' ' l~O':t l:t'ng ................................................................................ "\' ...................... at premises located at ..... ~[n(:]~L,~rr,.l~(~]~,,.~.~. .......................................................... i~ ...................... ............................................................ 'Pe~nia'i' '"'N'~'~Z~ ......................................... :'!' ...................... pursuant to applicotion dated ...................... Ol~.l~bOl~ ......... ~ ........... 19~?..., and, o~¢roved by the Building Inspector. Fee $ .-'~ O ~ OO,.... ~!~:~(::] " FORH NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOI. D, N. Y. Approved ........................................ 19 ........ Permit No ................................ Disapproved a/c .................. ~. .................................................. .~r;;'.. ................ ........................................ .................... ............. ............. ....... (Building Inspector) Application No. / ~/ (~ APPLICATION 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 area, s, 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. Up,on 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 cf 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. ..................... ....... ................................................................................................... Name of owner of prem ses ....................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Location of land on which proposed work will be done. Map No: .......... B ac< ................ Street and Number '~ ' ~ ~,'~-r,c-~b~ ~. ~~ '~"~ ....... State existing use and occupancy of premieses and intended use and occupancy of proposed construction: b. Intended use and occupancy .......... ~..¢~..~.,~..~ .......................................................... 3. Nature of work (check which applicable): New Building ..... ~'~ .......... Addition .................... Alteration .................... Repair .................... Rems! .................... Demolition .................... Other Work (Describe) .................... Eshmated Cost ...... .~.. 7/. .................................. Fee ................ (to be paid on filing this application) FEES: 5. If dwelling, number of dwelling units.....~J..~...~ ........... Number of dwelling units on each floor ............................ if garage, number of cars ......... ?../~.%~-. ................................................................................................................... 6. If business, commericoI 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 wi~h alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... .~."....~.. ............ Rear .....~....~. .............. Depth ..~..~.. ................. Height ...... ~...~.. .............. Number of Stories ....~:~./~...¢,,. ........... 9. Size of lot: Front .....~....~.. .............. Rear ..... ~...~.. ............... Depth ..~....~....~.. ............... i0. Zone or use district in which premises are situated... K . .'. ....................................................... 1 1. Does proposed constructio~ violate any zoning law, ordinance or regulation? ...... ..~...~ ..................................... 12. Name of Owner of premises...~...~..Z..~....~........~...~..~..,~..,..Address ..¢.~..~...~-:...?~..~..9....~.~.......~...~..,..Phone NO.~.....~..~.~.~...'~..~ Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor.~.....~../,~../~t~t..'~..~......~.~.~4~.~. ........ Address ,,~,a...*~.....Y"~.~../r.~.......~.:.~..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 · 3o whether interior or corner lot. STATE OF NEW,YORK, ) S COUNTY OF .~/~..) (Nome of individual signing application),~ above named. He is the ....................................... ~.~..'~..i ................................ . ..... (Contractor, agent, corporate officer, etc.) o~ said owner o~ 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 ore true to the best of bls 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 .... / .~.... day of .......... ~.: ............... 19. ~.~. ~/,. Notary Public,..~...~' ...... County EL0[$£ BOWDEN N~tsry Public, State of New York Residing m Suffolk County ~o, 52.0367800 (Slngature of applicant) NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. ,, . Approved ........................................ 19 ........ Permn No ................................ 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 adjoinin§ premises or public streets or areas, and giving o 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. Up.on 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 o 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 oil applicaNe lows, ordinances and regulations. (Si~e of o~,ont, pD~am~o~) ....... ................................... (Address of opplicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. ...¢..:..~..¢: :.::.<.,. ~: ........ Ck .:c.'.r../~ ..,...¢..~.~ Name of owner of premises ........ ........... ,..,..,../.¢...~. .................................................................................. If applicant is a corporate, signature of duly authorized officer. '" '7: (Name and title of corporate o:fficer) 1. Location of land on which proposed work will be done. Map No ................................... Block .................................. ..>z..~ Street and Number .~ .~..~,~z~¢~ ..... '.~.: · ....... .* ...... ~..~2-.~..~..~ .....~.¢. ............. 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: o. Existing use and occupancy ..~.:.~.';'~....~ ,.~. ~.~.4:~ ........................................................... b. Intended use and occupancy ......... ./..~:~.~'~..~,~,...¢~,~ ......................................................................................... 3. Nature of work (check which applicable): New Building ............... Addition .................... Alteration.' ........ Repair .................... Remo~ .................... Demolition .................... Other Work (Describe) .................... 4. I=stimated Cost ............................................................ ee ............................................................... (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, commerlcal 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 .....~..../~....~t,. ............ 9. Size of lot: Front Rear .... .................................................... Depth ............................ 10. Zone or use district in which premises are stuated 11. Does proposed constructicm violate any zoning law, ordinance or regulation ..................................................... 12. Name of Owner of premises...~...~ ..................... ;...~.'...Addross ....~..S'..~'..~..../~..~.5..~.......~...~...:..Phono NO~'~'~'~''~'~¢''~¢'. ..............:..~..- Name of Architect ................... : ................................ Address ............................................ Phone NO ..................... Con t r ac to r .~..- ~/-..~t~ )m'// ¢..( ~i ~/,~ Name of ;/ .............................................................................................. PLOT DIAGRAM Locate clearly and distinctly 811 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. Cg]UNTYiii~Z~/_~,..~i,,/j~.~F ~.'3 ~" · ,, , ....~.~....~.~......~.~..:....~..~'~.....~ng duly sworn, deposes and says that he is the applicant (Name' of individual signing opplication, L ~_ above named. He ~s the ..............~ ........................ .'~.....'c........×..... ........................................................................................... ' ' (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 ali 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 , ......... l.& ...... of ............. ................. Notary Public,....~q~Cc~,ff_~r~....y_~.....Coun~ty N'Ot~y PM~ic, State of New York Residing in SuffotN County No. 52-0367800 ~,~ (Singature of applicant)