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HomeMy WebLinkAbout425-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at.~./,~.....~.P.~..~T1A~ke,~...~.e~o~'Cr~tr~]~, ste~line Map No.~:.... Block No ...................... L.Lot N . conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................... ~.~..2~ ............. , 19...~, pursuant to which Building Permit No ........ ~,..~ ......... dated ........................ ~.~.~...~..., 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 .............. ................................................. .............................................. This certificate is issued to ............. ~.~.~..~.. g.~g~.t...~ ..................................................... (owner, lessee or tenant) of the aforesaid building. -- Building Inspector HOWARD ~. ~ERRZ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. TEMPOBAB~' CERTIFICATE OF OCCUPANCY THIS CERTIFIES thor the building located at..~./.~.~.Q.~..~.~.~..~...~..~.?~.~...~..~.~.~..~.~.~.e~.~.~r~9~ ~t~l~n~ H~bo~ o~ ~O.H~S~e ...... 2~o=k ~o.....T~.~ ............. [o~ ~o....~ .............................................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................ ~,..~ ........... 19.~..., pursuant to which Building Permit No. ~...~.~ ................ doted ........................... ~.~...~ 19.~..., was issued, and conform; to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .............. ............................................... ................................................ This certificate is issued to .~..~._~.~9~...~ ................................................................. (owner, lessee or tenant) of the aforesaid building. Building Inspector HOWARD M, TEP~Y NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam ined.......C....~.....:~... ~...~.. ........ 19.~...~.. Approved ......~ ~..~,......19..~.'...~Permit No...~..~.....~....~..~ .......... .................. ............ (Building Inspector) 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 coYered by this application may not be commenced before issuance of Buildlng Permit. d. Upon approval of this application, the Building Inspector will issue o 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 Jn 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 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 applicable laws, ordinances and regulations. (Signature of applicant, or name, it a corporation) (Address of appl~ant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ......................................................................................................................................................................... Nome of owner of premises~....L~.//~.~.z2 .... ~ ..... .~ ........ ~ .................................... 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: ...... ~..~.~[~ .......... Lot No: ...~ ........... Street and Number ...... ~~.....~.~.....~~.~.~ ............................................. Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: o. Existing use and occupancy ....... ~.~ b. Intended use and occupancy...~Z.~.~ ...... ~~~ ............................................................ 3. Nature of work (check which applica'ble): New Building......~... ......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition ..................... Other Work (Describe) .................... 4. Estimated Cost....~.~..~..(J....~ ............................. 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......-T: ...................... 7. Dimensions of existing structures, if any: Front.../J('.~x~'.~. ...........Rear ....... 'z:..: ................. Depth ......-~. ..................... Height ......~ .................. Number of Stories .......... -~. .................................................................................................. Dimensions of same structure with alterations or additions: Front ....'~Z.. ......................... Rear .......--~ ........................ Depth .......... ~ ................... Height ....... ~ ................... Number of Stories .....-'7 .......................... 8. Dimensions of entire new construction: Front ....... .~./.. .............. Rear ......~./. ................ Depth ......~-~...~.. .......... Height .......... ~..../. ........... Number of Stories ....... ./., .................. 9. Size of Jot: Front ......~.~,,~...~ ........... Rear .,,..Z/~',.~..,~ ............ Depth ...z(,~.~.,. ............ 10. Date of Purchase ..... ~'~.Z..~.. ....... 9~..~x..../~...~...~..~... ....... Name of Former Owner~"~...(~.~.~..~......~.~.(~.~'~,~. ....... 11. Zone or use district in which premises are situated ......... L. : .... ~...~... ................................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation? 13. Name of Owner of premise .-"~.~,,'~,~z')...,~.'~,...~...~...Address~"~?'~...Z:~'.~'..~.~.'....~--~R',Z.t.....Phone NO.~.~,.~.-./.~..~../ Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor.~.~',~.~.~.~..~.,~.¢.4~.~.~...Address'~.~',s-~..~.'...(~/~.~, ....... 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. L STATE OF NEW ~RI~z~ ) S S COUNTY~F ~..~~.,) ' ~ ~~:-~' .~~ be ngdulysworn, deposes and says that he is the opplicant ........... - ............... 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 manner set forth in the applicon filed ther~)th~_ . Z Sworn t~fore me this ~ ~,, ~~ ~' ~ aay pt) ........ ~ ......... l.~...~ ...... :~ ............ ~,~'~'"~ ~',',~,, 6 ,;~(~t~re of apphcant) ..................... .... Notaw Public, .. aunty ' ~'~*'c~0 ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×ommed ..................... ~ ................ 19 ........ ......... 1,2 .Perm, No ¢ ,f APPLICATION FOR BUILDING PERMIT Date ......... ~. ~.. ~..~/,S.'...,~%......~.. ~. ............. 19 .~.~..... INSTRUCTIONS o. This opplicotion must be completely filled in by typewriter or in ink ond submitted in duplicote to the Building Inspector. b. Plot plon showing location of lot and of buildings on premises, relotionship to adjoining premises or public streets or areas, ond giving o detailed description of Ioyout of property must be drown on the diegram which ie port of this Iocotion. c. The work covered by this opplicotion moy not be commenced before issuonce of Building Permit. d. Upon opprovol of this opplicotion, the Building Inspector will issue a Building Permit to the opplicant. Such permit sholl 'be kept on the premises ovoilable for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in port for ony pui'pose whotever until o Certificot, e of Occuponcy sholl hove been gronted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuonoe of o Building Permit pursuont to the Building Zone Ordinonce of the Town of So~thold, Suffolk County, New York, ond other opplicoble Lows, Ordinances or Regulotions, for the construction of buildings, odditions or o Iterations, or for removal or demolition, as herein described. The epplicant ogrees to comply with oil opplicobte lows, ordinonces ond regulations. (Signature of applicant, or name., if a corporation) (A~dress of aplS]icant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ Name of owner of premises ....... ............................. 7'"' .... ........................................... If applicant is o 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: ....... ,:(-/.4~,¢4~.~s:./...~.~ ............ Lot No: ..~ ........... Street and Number ..........~..~5/'.,~ff.t~._,7~,g/.,,M¢.......~...~,¢,~;~...~ ....... ~"'..,~.,J~'.t/,~.~W.~,~/..~ ...................................... ~ ~ Municipa-lity 2. State existing use.and occupancy of pr~mises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... 4' ..~./J~..~'~ .............................................................................................................. b. Intended use and occupancy ......... ..~.../~?J..//,~.~.~ ...... ~..~..~-.,~¢,,¢//J/..~ ....................................................... 3. Nature of work (check which applico'ble): New Building.....~... .......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 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 ....... ~ .................... 7. Dimensions of existing structures, if any: Front.~/~....-; ........... Rear .......... .%;. ............... Depth ..... ..-7 .................... Height ........... ..% .............. Number of Stories .... ..-z.. ..................................................................................................... Dimensions of same structure with alterations or additions: Front .....~ ...................... Rear -- Depth ........ ..% ................... Height .............. %.. ............. Number of Stories -- 8. Dimensions of entire new construction: Front ......... ~'../..'. ........... Rear ...... ~../...~. ........... Depth .~...:.~....x~. ....... Height Number of Stories ....... ../.. ................. 9. Size of lot: Front .......~.~.~..: .......... Rear .....¢41..¢t~..: ........... Depth ..~'.,~2.~...~ ........... 10. Date of Purchase ..... ~...~...z.~.~../ ...... .~.../....../..?....¢-.~. ......... Name of Former Owner4(~""~"~'~'CC'Z"'~/'7/CxC~c~'/'~'"'2x ..... 11. Zone or use district in which premises are situated ......... ~.....~.~.' ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .......--%. ............................................ 13. Name of Owner of premisesC!.,'C~'/'C~,"~.c2.~4'.,..l~.~Address~r'~...~...¢~'.~..,~.Z.~.~,....C~'z~.~.-..Phone NO.~..~.:..~..-./.,~.~..! Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of ~ntr~ct~r`4~.~..~.~..~..~./~.~'~.~Address~5.~.~.~..~....Ph~ne 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 NEVC'/~ORK,,¢' -,'~ ) S S COUNTY OF,,~'~'..)¢/~---- ~//. t/o.* _ /. " ' ' /~ " ~~ beln (Name of individual signing application) duly sworn, deposes .and says that he is the applicant 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 manner set forth in the applicaf~gn filed there~/~h. Sworn tobefore me this __ , ~/,,//~¢¢?/,¢/~, ,/~.