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HomeMy WebLinkAbout416-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...~//g-....,Pec~.a~.....Ave ..................... Street Map No...~ ...................... Block No ......[~r~C,~L,*~_Z ................ ~:~J~..~tt~.(~}~O.g~t ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ................... ~t~P..~t~.t.....~C~ ............ 19.~..., pursuant to which Building Permit No .~..~].~ ........... doted ........................ A~t,.....~,O ........ 19....~., was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ............ ...................... P~t I.WAT..~.....0 ~.. ~.~iI L~C.. iJW.~.~',L i,I ~, ....................................................................... This certificate is issued to ..... ~roht%..Dc~po.~ ................(...~w~.~e~?.) ............................................... (owner, lessee or tenant) of the aforesaid building. Building InspectOr TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUT.OL=, N. Y. Exam i n ed...(~.?.(~.......~...'...O.. ........... 19.?..~..7''~ Approved ........................................ ] ?...~..Perm No. Disapproved a/c .L......~ ............ ~ ............. ~ ................................................ ......................... ......... ......................... (Buildinfl 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 detai[ed 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc,e 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 applioable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) ................... ................... (Addre~/of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... ............................................................................................................................................... Name of owner of premises ........... ~I¢:.~.~. .......... ~.-~:. ................................................................................ , :er If applicant is a corporate, signa~re ~ duly authorized of 'c . (Nome and title of corporate officer) 1. Location of land on which proj?osed work will b~e done. MaR No: ............................................ Lot No: .................... Municipality ~' 2. State existing use and occupancy of pr, emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occuponcy .............. : ~'~ ............................................................................... V 3. Nature of work (check which applicable): New Building ...... ~ ......... Addition .................... Alteration .................... Repair .................... I~o~ql .................... Demolition .................... Other Work (Describe) .................... '7'/~,' (~), "~ 4. Estimated Cost ............ ./..:.:/ .......................................... Fee .L.~.. ................................................................................... (to be paid on filing this application) t 5. If dwelling, number of dwelling uni s ................................ 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, if any: Front ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions; Front ................................ Rear ................................ Depth .............................. Height .......................... .;,~d~'~ber of Stories ......7,.,.~,, ............... 8. Dimensions of, ept, ire. n~w construction: Front ....... ~.~ ................ Rear ......... .?.....¢. ........... Depth ~¢/~"~'~/"¢'~'~¢lumber of Stories Height ........ ~.. ............. ............................ 9. Size of lot' Front ] / ~ Rear 11. Zone or use district Jn which premises are situated ........... /~.L..~ .................................................................. 12. Does proposed construchon violate ~y zoni,/tg law, ordinance or/cregCt~on ..................................................... 13. Name of Owner of premises?'..].; .................................. Address ............................................ Phone NO Name of Architect ..........././V ''~''-''l''¢;'~'~j)i .............../'~/J"""'~-~'~ ......... Address .....___~'~ ....................... Phone NO. Name of Contractor ....... :..-.--.. ........ :.;7..~.'...Addres, ..... Z .................................... 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~L~YOP, J~ /.. ) S S COUNTY OF,-'q//~.~'~/~2'~"'(~'""')L ¢' ' ....................... ~....~-.:~. ...... ~./.:;.~:'..~...¢~..~......'~.. ....................... be n, duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .............. i .............................................................................................................................................. ,(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.enrj~ set forth in the application filed therewith. Sworn tc~before, me this ~ __ '~,~LI~'~_ S,gnotureofapp,,cant) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL RK'S OFFICE SOUT,O,D', ,. 'r. ....... Approved ........................................ 19 ........ Permit ............................... ...... .................................. (Building Inspector) Application No....,~,..?,..~.. ............. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completeJy filled in by typewriter or in }nk and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to ad}oining 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 nat be commer~ced 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 Builcflng Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, Ne~, 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. ..................... ¢f.,4. ............. L.~,'. ......... :.~ ...................................... (Signature of applicant, or name, if a corporation) ................... L . .< : '. . . . . . . ...... 1. .................. (Addre~jof applicant) ~ State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..........~"~r~Y~'~"~<~ ........... ................................................................................. If applicant is a corporate, sign~e of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which prop. osed work will b.e done. Map No: ............................................ Lot No: .................... Street and Number ...............~,¢'~ ................................. -~,...;~ .............. ~.,'...f ................................................ ~' MunicipoHty ~ 2. State existing use and occupancy of premises and intended use and occupancy o~ proposed construction: Existing use and occupancy .................................................. : .................................................................................. Intended use and occu anc~ . ...... ~../~.~:~..~;~.~. p y .... ~:..~. ,.:.- ~ ........................................................................... \! 3. Nature of work (check which applicable): New Building ...... ./~ ......... Addition .................... Alteration .................... Repair .................... (~,z~ ~R~e'~°val .................... Demolition ............. .~...Other Work (Describe) .................... 4. Estimated Cost .........Z/.~.~.'.~.:....~... ...................... 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, if any: Front ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of some structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Hefght .............................. Number of Stories 8. Dimensions of entire new construction: Front ...... ~...~. .............. Rear ........ ~.-...~.... ....... Depth ...¢~..~. ............... Height ....... - '-- "'-~ 0r~..~..-~..'~.¢~..~,~Number of Stories ......... / ................. 9. Size of lot: Front .......J../.~-- ............. Rear ........ .//../..~ .......... Depth .....~/.~...(~.......~.. , 10. [)ate of Purchase ............. (...~....~....t. ........................... Name of Former Owner ...,.~..~..~ ...................... 11. Zone or use district in which premises are situated ........... A.....~.: ................................................................ 12. Does proposed construction violate any zoning law, ordinance or reguJation? ....... ~.....,~ ..................... 13. Name of Owner of premise . ~ ....... Address ............................. Phone NO ..................... Name of Architect ........... , ............. ~ .............................. Address .... Phone NO ..................... Name of Contractor......~..: .............. ;../.,~.~,.¢~.....7.::....Address ...~ ......................... hone NO ..... ~.~.~.../.. PLOT DIAGRAM Locate dearly 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 NEWc~YOJ~,~ ) $ S COUNTY OF ..~¢...~-~.~...~;......) ' ~. ~-L .,~IP,,t.~.. be n duly deposes and says that he is the applicant ....................... ~......I.f~.....~..~z ....................................... g sworn, (Name 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 ail 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 s~ forth in the application filed therewith. Swordlike me this ..... ~.. day ? ......... ~.~...~.~~ (Signature of applicant) Notow Public, ..Z'~.~.~..~~o~¢¢