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HomeMy WebLinkAbout152-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located Mop No ......................... Block No ......................... Lot No ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................ ~.q.~g.~,.~..~, 19.~.., pursuant to which Building Permit No. dated .......................... g~.~g.~...~L..., 19.~.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy forwhich this certificate is issued is .............. This certificate is issued to ...... .~.~.~...~.~...~.t...[~ ......................................................... (owner, lessee or tenant) of the aforesaid building. Howard M. ~rry FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUiLDiNG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES ~,~ld,(~,~EtE~E,l,~F .~J~9~V4[~,Dk~I~,,~J~qf'~[Gt~i,G~-~I~N~S~UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No ....... .;~......],.~p... Date ................. Oe.~o]~el,...~t~ ................ 19. ~'.. Permission is hereby granted to: Bol~lemlth Bros.~ .....A./¢~.-... ~l~s.,... ~mes...T~i.~ ........................ .~a.i.n...Read .......................................................... ......... ~ou~ho.ld ,, -... · ~,, ~ ,. .................................. to..l~love..e.~i~.t i.~g-..bu~.~g...to...new..-lee ~t~n.. &. ~l.ter... ~e.. ~peo .~ $.~ ea.~.ier~z, ot premises I~,cated at ..N/$.....l~erth.-~ea6 .......... (~ea.r...Bo.i. ssea~.-~ve.) ............................... ..................... · . ......................... Dou. thotd. ~......N.~.~.,~. .................. - .......................................................... pursuant to application doted .......................... O~tOb~]?-..~.~ .............. ]9.~.., and approved by the Building Inspector· Fee $."10.,00 ............ Building Inspector FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. xa m ea.......~<...., m_..: .................... ! ~ ........ ,, , No... '"7 ./..c"..~-..---~ ~...-¢...].... Approved ........................................ 1 9 ........ Perm t Disapproved o/c .................... =':~ ................. ...... ...... .......... .................. (Building inspector) ~ APPLICATION FOR BUILDING PERMIT Dote ........ 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 apDlicafion 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 at*~y 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 applicant, or name, if a corporation) ........ .......... (Address of appl?Cant) ~ ...................... State w~ether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Name of owner of premlses,....~/~</~. ................................... ~-~ ....................................................... ] ............................. ~,.' 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 ...~.Z¢~...&....4)c~cc...~:h..~'~...,~¢__,~., ....... ~..~.*.~....C..~.~,~.~.~...../.~...4~..~..~ 2. State existing use and o~cuponcy of premieses and intended use and occ~ncy of proposed construction: o. Ex~stmg use and occupancy .................................. ~ ............................................................................................... b. Intended use and occupancy .......... ~~.~..~: ............................ 3. Nature of work (check which applicable): New Building .................... Addition ....................Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work ~uescrioe~.~j......a.~...:-4z~t,co ~'zx",,~,J~ 4. Estimated Cost .......... ~ ~5'0'0~'"~ Fee /4), ~ (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 ........................................................................................................................................ If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................ Dimensions of existing structures .f any: Front ...... ~.~ ........... Rear ..../~.. ................ Depth ..,,1~,~..-..~.~. ........... Height ......... ~.:6 ............... 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 ............................ · ' ....... ' ............. ..... ' ................. -¢' Depth 9. S.ze of let. Front /.~'?~ Rear ~.~ ...,/..~....~.~ ' e t r Z? ' 10. Zone or us dis r'ct in wh'ch p emlses are s'tuated.....~¢~ ............................................................... 11. Does proposed construction violate any zoni?~ law, ordinance or regulation?~...'~.....,/~.,~..~.4..~~ 12. Name of Owner of premises,~.~ ................... ~1'..-d~Address ............................................ Phone NO ..................... Name of Architect ........ ~¥~_/- ..,~' .,,~ ............................................. Address ............................................ -,~ ~ ,~ ,, Phone NO ..................... Contractor....t~./22~..?_.Yt....~'~.. ...... Address ....c.~O~....~..c~....,~...~:7....Phone NO. Name of PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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. duly sworn, deposes and says that he is the applicant (Singature of applicant) Sworn to before me this ...... .~...~. ......... day of ......... ~.: ................ 19...~.~...~... Notary Public, .. .. ~OISE ~o~l~ Public, State of New ~'ork Res[ding in Suffolk County No. 52.03~800 Commmsmn Expires March 30, My ~' (Name of individual signing application) above named. He is the ......... ~~...k.... .............................................................................................................. (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. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. F- 7 Examined ........................................ ]9 ........ Approved ........................................ ]9 ........ Perm t No ................................. Disapproved aYc .................................................................................... ............. ................ (Building Inspector) Application No..../.....~..,~ ...... APPLICATION FOR BUILDING PERMIT 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 port for any purpose whatever until o 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 applicant, or name, if a corporation) ............ ....... ...... ............... (Add~ess of applicator') ~,~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Nome of owner of premises.~%' ............................... ~ .......................................................................................... :.. If opplicont is e corporote~ signoture of duly authorized officer. ......... ......... (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No ................................... Block .................................. 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 .................... Addit;o ..................... ^lterati ...................... Repair ....................Removal .................... Demolition .................... Other Work (Describe).~.~.ig....~ 4. Eshmated 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 ........................................................................................................................................ If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................ ~ ~ .... ~.~...3...'...c~..~ .......... Depth ...~.~.'....~....~. ......... Dimensions of existing structures, if any: Front......~.......~ ............. Rear 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 ............................ 9. Size of lot: Front ....... /.~.2) ............. Rear ...... ~..~....~ ............. Depth ..../.~.~.. ............... 10. Zone or use district in which premises are situated ....... ~ ............................................................... 11. Does proposed construction violate any zoning law, ordinance or regulation?...~..:.'~...;/~. 19. Nome of Owner of premises .................. ~....Address ............................................ Phone NO ..................... Nome af Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor....~JS~r'.?.~....,~..~2....:....Address ..~'~.~?...~.. .................... Phone NO~.~. '6~-~Y'73 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 NE~/ YORK, ~ ) S COUNTY OF~...) S .' "~'~""('~'~'~"~~'~"~ii~'~'i ............... being duly sworn, deposes and says that he is the apphcant above named. He., 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 therewffh. Sworn to before me this ........ f.~.....r~.. ...... day of ~ 19..~.~.. ,7.,, Notary Pubric, Sta&o of New York My Commission Expires ~Viarcll 30, 19 ~C:~ (Singature of applicant)