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HomeMy WebLinkAbout437-zFO~M NO. 4 TOWF~I O1: $OUTHOLD BU~L. DING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, I~1. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located Map No ...... .*..*..~. ........... Block No ........ .~.~.* ......... Lot No ...... ~.~.~ ........................................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .................... ,~t;e~t~...g),/ ....... ~ 19..'~., pursuant to which Building f:~ermit No....'g~.~. ............... dated ................... J~;eL~e.~...~ ........ , 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 ..~.~..~,...Dt~l,~lrJ. t..~e~. .................................................................... (owner, lessee or tenant) of the aforesaid building. FOB, M NO. ~ 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.° 437 Z Permission is hereby granted to: pursuant to application dated ........................ .~..?.~.~..e..~....*~..?.......?. ........... 19...~..~..., and approved by the Building Inspe~or Fee $...~..e....(~.. ........... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Examined ......... . .~...~...4 ........... 19....~.. Approved ........................................ 19 ........ Permit No ............................... (Building Inspector) Application No ............................. APPLICATION FOR BUILDING PERMIT Date ............. ........ .............. 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 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 k. 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 issuanoe of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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, if a corporation) ...................... ......................................... (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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 ..... ..~... .... ~ ..... .Z. .......... ~.... L .............................. -~wunicipadty 2. State existing use and occupancy of pr, em/~s and i,,n~nded 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 .................... Addition J/ Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... i 0o 4. Estimated Cost......,~ ....................................................... Fee ~3 (to be paid on filing this application) §. 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 ......... ~..O....~-. ...... Rear ............................ Depth ~3. O .~- Height ............................ Number of Stories ..... ~ ........................................................................................ Dimensions of same structure with alterations or additions; Eront ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ./...~.. ...... ~ ....Rear ......... /....~......iT ...... Depth ........................... Height ............................ Number of Stories ....~ ......... 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ~.?....~.?.....~.....: ................. 11. Zone or use district in which premises are situated .......... ~....-T......~ .................................................... 12. Does proposed construction violate ag, y zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises...,~..'.~.:..~.~;x. .......... Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Controctor../.~.....!..~-- ~-- .....................Address ........ ~:.........~... ................. 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 NE¥~ ~C~_, ~ ) S S couNT, OE · Y~.~-t,/J'- ~'~'--,z-,,.,---'- ben du sworn de oses ~nd so s that he stheap cant ........................ ~.~'.~.;....:...:..,.: ........... :....::...~. ............... g Y , P Y P (Name o~ inalvlaual slgnmg~~ 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 appficat/on; that all statements contained in this application are true to the best of his knowledge and belief; andswornthatto beforethe workmeWdlth' sbe performed in the man~r~,s~rt h~ "~'o ~e;,0~,~:,in the application filed therewith. . . ,, , . . 9~ ............. ~.,, nf ~ 19 ~,~ u"'~ (Sgnature of app t) ....................... ~ot~ Public,. ......................................................... FOI~I~f NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned' ....... .~ ,, ,, . .............. Approved ........................................ 19 ........ Permit ......... APPLICATION FOR BUILDING P~:RMIT Date .............. :~'::'.'::~....~..~.. .......... L .............. 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 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 p art for any purpose whatever until .a Certificat, e 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 ar demolition, as herein described. The applicant agrees to comply with alt applicable laws, ordinances and regulations. / ,,, //! ~,,/ I ~', r ,:_.. (Signature of applicant, or name, if a corporation) (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of p ....................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) · ' t O I. Location of land on whl,c.h proposed work w~!l be done. Map No: ....................................... r'" Lo N : .................... Street and mummer ...~...~ ............................................. ;~..':: ..................... i .................................................................. ~unicipality , 2. State existing use and occupancy of premiss and intended use and occupancy of proposed construction: ~" )' ~).....:...4 ................................................................................... a. Existing use and occupancy .................. ':.~:..~...;.'".' b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.....l.~..l'..O.::)........~.. ................................... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling umts .........., ...................... 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 .......... ~4¢.~....~.: ...... Rear ............................ Depth Height ............................ Number of Stories Dimensions of some structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... /...(?. ............ ' Rear .................... /./.(o . ...... Depth .................. Height ............................ Number of Stories ..... (.D..~]::,~ ........ 9. Size of lot: Front .................... Rear . . Depth .......................... ,,.x 10. Date of Purchase ............................................. Name of Former Owner .(.~.Tiil..'....:,~.:~'.~,i'.:.:~...~J....;..: .................. 11. Zone or use district in which premises are situated ............ ........... 6:~"; ............................................................... 12. Does proposed construction violate a~(~ zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises....~.:../.'~.:..~¢¢.~4~..:.~'. ......... Address ............................................ Phone NO ..................... Name of Architect ............... ~ ...................................... Address ............................................ Phone NO ..................... Name of Contractor../.:z~ .............. ;.~ ............................ Address ............................................ 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. COUNTY 0 ............... ) ' / ~.-~ ...., ...... ,,., t~ /.. /,. ..... ...._.~- . ......................... ':/.:......:;]. ......................... ~.......%- , ~.t3g duly sworn, deposes .and says that he is the applicant (Name of in'Sividual signing 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 .rnanner ~L ,forth_in the application filed therewith. Sworn ~c) b~f,~re me this ~:-:' o ~ t/'~----'~"~--/~.,' t' ,-I,~,, of '~ ,,,.. 19'~,'/; '~ Sulfa I~ ~?~ ~'ott~ (Signature of app cagt) .......................... ~ .......... ~ ....................