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HomeMy WebLinkAbout394-zFORM TOWN OF SOUTHOLD BUIL, DING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at.~//~.....V~,].3,~4~..~e .......................... Stree~t Map No,,~C~ ................Block No....~,~¢ ......... ,~,,~....J~.,~.e~J.~...,.~[[*.~.* .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................... ,.T:~].~. ......... ~' ............. 19..~.~..., pursuant to which Building Permit No, .?,..~.~.~. ............. doted ...................... ~U~ .......~.~ .......... , 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 .............. ................................. ][~R.][.¥~.F~ · .D~t~.L~f.,.]E.~G ......................................................................................... This certificate is issued to ...l?~,~.~..~,~,~l;~,e...][~][,,...L~,~[r;~......~4O~'~e~...~ .......................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING 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) N? 394' Z Date ................... ~%t~.~,.,...2~ ................... 1 g5',8 .... Permission is hereby granted to: Mis ~ · .A.u. nl~.. ~'~.....La.them ........................................... ............... .V. il?~ ~ e...L~. ........................................ ............................... 0~ie~t~.r.----l~ Y. ~ ................... to ........... b'~ild..em...addi.~on..oJa..mP~..exla~ing...d:~.e,~l$~g ............................................... at premises located at .W/g.....l/l:t, lag~..~ ........................................................................................ ......................................................................... 0.~ien.t ~......~,.g-o ......................................................... pursuant to application dated .................. ~1t].~.....2.~ ........................... 19~.~..., and approved by the Building Inspector Fee $.. ~.,.Og, ............ Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOL~ N.Y. Examined ....... :~..r~:..~. .............. 19/. ...... Approved ........................................ 79 ........ Permit No ............................... ............... .... .... ................. (Building Inspector) Application No ............................. APPLICATION FOR BUILDING PERMIT Date ............................. ./. ....... 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 punic 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 coYered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Buildinfl Inspector will issue a Building Permft to the applicant. Such permit shall be l~ept 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 issuanae of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southdd, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or nome, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ ~.L.~J..../~.A~'./~'..I.~.,...:~/-~,....~hZ.//-~./~. ...... : ................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of [and on which ~,oposed york ~ill be done. Map No: ................... ~ .................... Lo~ No: ....5 ......... Street and Number . Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................. ~.-/~..~...&/~.~...~ ...................................................................................... b. Intended use and occupancy .............. ~..b~...~.E..~../.././~..(~ ....................................................................................... 3. Nature of work (check which applicable): New Building .................... Addition ...... ...~.... ...... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... Cost .~..., P60,o b 4. Estimoted ......................................................... Fee .......................................................................................... (to be paid on filing this application) .5. If dwelling, number of dwelling units ............. I. ................. Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify,nature and extent of each type of use .............................. 7. Dimensions of existing structures, Jf any: Front ........ ,-/.~.~.'.~,.'.~ ....... Rear ......... .~.~ .............. Depth ...~.~..'.-.~.~ ........... Height .....;Z~.'. ................ Number of Stories ........ ..~.. ................................................................................................. Dimensions of same structure with alterations or additions: Front ............ /..~.iz./*.~ ....... Rear ...... L~..'.-.~.'~ ............. Depth ........ ~..7..~ ............... Height .......... ~.q~ ............. Number of Stories .......... .~.. .................. 8. Dimensions of entire new construction: Front ......... ~.~.'.';'./a[: ....... Rear ....... /.~1.*..-..~.~: ........ Depth ....J..~.~ ................. Height ....... /.P.j ............... Number of Stories .......... J. ................ 9. Size of lot: Front ........ .'~..~.J ............ Rear ........ ]..5.:L ............ Depth ..LS..~..O..~ ................ 10. Dote of Purchose ..... ~./f~..~./. ....... L~.~.O .................... Name of Former Owner ........................................................ ! 1. Zone or use district in which premises ore situated ........ /~..4~.~.l..~..~,e/....~'././t./,. ..................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ....... ~ ....................................... 13. Name of Owner of premises..~/k'.W.l,CZ..~.~.WlZ~.Address ..(,.,r~'~:n~.'.~...,.Z~.,..~. ........ Phone NO. ]',lame of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor ........ .'..."~.~..~..Z~.~/~/(.~,,F../,/.....Address ...... ..C)...~./..~'.,~.~.~.'.Z~',. ....... Phone NO, O.~..~.-.../..Z..7..o. 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 occording to deed, and show street names and indicote whethe~interior,~ or corner lot. J)l ~'~/~ vC ~ -~ ,~ ,V~. ~" A ' ' ......... I- STATE OF NEW~,.OI~,, ~,. ) S S ~'~-"~ COUNTY OF "~'~'"'~'"~"~'"~'"')~j/~/]~/-~Z--/~.~' / '~ ~ ~~'~ , s r ........................................... ~A].~...I~.~.~.: .................... be'rig duly wo n, deposes and soys that he is the opplicant (Name of lndlvi~ual signing 8p~icatlon) above named. He ~s 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 moke and file this opplication; thor 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 ma~s~rt~.in the application filed therewith. Swor~to before me this (~ ~ 'L,~/,li~l'~L&~~[~tN ~ ~ i / ~ ///~ ...... ....... FORM HO. ! TOWN OF SOUTHOLD BUILDING DEPAR'~MENT TOWN CLERK'S OF~=ICE souT.o,D,, ,. E×am ned ....... Approved...~~ ............... ~.~. .............. 19 ........ Permit No ............................... Disapproved a/c ......... ..................................... ...................... ~;'i'l~;~' 'J~;¢;~';; ~) ................................ APPLICATION FOR B~JILDING PERMIT 19...~..~. Dote 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 drown 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 c Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe 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 Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all appliaable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of opplic<~nt) ~ State wheth.er opplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... ~..'.-q'~'.....~.~/..~../.~Z......~.,....~'/J:..~-/~/.'¢/'.~:~ ...................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work willie done. Map N~o: ..................... ~ .......~ ....... Lot No: .................... Street and Number ...... ~.. .......... ~:-.;:~. ............. &. ........... ~..:..;1..~.. ....... .~.~.:.~;~,,z.~ ................................ Municipallty 2. State existing use add occapancy of pr, emlses and intended use and occupancy of proposed construction: a. Existing use and occuparlcy ..............,~..~¢~'..~'...&.~....~...~...;~f. .................................................................................... b. Intended use and occupancy ............ ~..~.z~"..4,,~,../..e.~.~. .................................................................................... 3. Nature of work (check which applicable): New Building .................... Addition ........ ..~.........Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... ~'~/6 06. ~o~ 4. Estimated Cost..~ ......................................................... Fee ..,~'... .................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. / ................. Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. ' " ~ Depth .....~...~...% ~. ....... 7. Dimensions of existing structures, if any: Front ........ /..~..-:./~ ......... Rear .......... .~ ................ '~'...'.'. .. Height ......... ..~..~...~ ............ Number oF Stories ......... ~,~ ................................................................................................. Dimensions of same structure with alterations or additions: Front .......... J.~...~..~ ........... Rear ...... /../~..T ................... Depth ........... ~7 ............. Height .......... 2,..~ .............. Number alc Stories ,, ...... .~.~. ..................... 8. Dimensions of entire new construction: Front ........ /.(~..z.~ .......... Rear .......... ~-/.~..-..(, ......... Depth Height ....... L~..f .............. Number of Stories ..... / ..................... , ~! 9. Size of lot: Front .......~. ................... Rear ......... -.~.~ ............... Depth ...... (...~'~..9..~. ............ ]0. Dote of Purchase ..........~.flt~..~.X.....(.~.]O. ................. Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ............. 4/~'.$./..~.~/~....~../~./,, ............................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... ~.~ ....................................... 13. Name of Owner of premlses..~.4(.4~..14L~.,./.4J:.f//~8.~..Address ..... .~./~./~'.4~..?7,...~./,..~,.'.....Phone of Architect ........................................................................... Name . Address ............................................ Phone NO. Name of Controctor.......Z..~.,8('.~...../~..~..~/~.4,.~4ff'.. ...... Address .......l~).,~..I.~/.?7~,.~./.,.Z.....Phone NO.C~.~./..'~..~..~..~ 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 wheth%r interior or corner lot. ~TATE OF COUNTY OF ~,~l..~..,) ', ............................................. ~..~;...[.~.~]~..~.~ ........... being duly sworn, deposes ,and says that he is the applicant (Name of individual~ing 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 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 m~r~o[th in the application filed therewith. .......... . · ........... ......