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HomeMy WebLinkAbout454-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY Map ~o ......................... ~oc~ No ........................ Lot No ................................... ............. ................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................. ~..~. .............. , 19..~.~., pu~su,ant to which Building Permit No ...... ~..~.~. .......... doted ~ ~. ~8 .................................................... 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 ..... ~..~,.~...~.~...~ ............................................... ~ (owns, r, lessee or tenant) of the aforesaid buiJding. / Building Inspector FOR~f NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~ N. Y. E×am ned ........ ........... 19.. T ,, ,, . ............ Approved ........................................ 19 ........ Permit No. Disapproved a/c . . .~. ~ ..~. . . .~. . . .~. . :. : ~. . ~t. ~( . . . . . . .q~. . ~. . . . .~. " .~. . . . . . ?.t~. : .~. . . . .~. . . . ~ . . . .7. . ~. .~/~. Application No......J~...~'..~/.. ............. (Building Inspector) APPLICATION FOR I~UILDING PERMIT Date ............ i....::~ ............................. 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 part 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 ali applicable laws, ordinances and regulations. ........................ ture of applicant, or name, if a corporation) , .................. ~Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..........0 ~.~....~q,~ ...................................................................................................................................................................... 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. Mop No: ..j,..d...~.....~............................."~'~-~ Lot No: ..... ~ ..... Street and Number .~ ~J~ ..~...~...~ ~ ...~..fl....~¢J~_'c~..~..;.~.. ..~...C '" ..................................... ......................... ................ 2. State existing use and occupancy of premises and intended use and occupancy of proposed c6nstmction: o. Existing use and occupancy .................... 1~.....:..:...~......~ ............................................................ . .......................... b. Intended use and occupancy ...................... ................................................ '...: ....... 3. Nature of work (check which applicable): New Building ........ ...~..~.....Additlon .................... Alteration .................... Repair ............. ~....Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.....~.~...~ ....................................... Fee ....J...0...~. ......................................................................... (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 ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alter,arians or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Numbe~' of Stories ................................ Dimensions of entire new construction: FrOnt ....... .~..,.o.~..~...4..:... Rear ........ ..~...ff.....:...¢..:. Depth ...... ~...~.....:......; .... & o Z Height ....... ~.....~.' .~.;.... Number o~ Stories ....... ./..~.'..~r:.........,... 9. Size of lot: Front ........ /...~...¢?...'..~...~.- Rear .. /. ~ .~...~..' Depth Z~...~..o 10. Date of Purchase .~.i~..O.~.~.....~.~.t.~.~..~..L.i~i.~'~'~"~f Form21";;n21"i~i~?.'..~../'-~.~P..."O.......~?....'~....q~L....t"J..~...~-'~ 1]. Zeno or use district in which premises are situoted .............. f ................................................... ]2. Does proposed construction violate on,/ zoning Iow, o[dinon?~olr regulotion? ....... ~..~. ...................................... 13. Name of Owner of premises.~.~..~/¢~'..~.. ....................... Address .~..~....,~.....~./...~..~..~....~......~Phone NO..~..~.~.'~~' Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... 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. C'D ~J ~--~'/~ STATE OF NEW~¥C)R,K,¢ ) S S COUNTY OF ~ ..... ) ' .................................................................. be ng dul~ sworn, deposes and s~s thor ho is tho (~ame of individual slgning application) above named. He is the ............................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly autho~.perform or have performed the said work and to make and file this application; that all statements con~]~~2pplication are true to the best of his kno~dge and belief; and that the work will be performed in~¢4~(th in the application ,filed therewith. // ......... ¢ ....... t. ..... a~ or .,.4.~ ......... ' .............. ~a...% *B // (Signa u e o appl'cant) Notary Public, '~..~.:...~ ............... /ego ~ ,.°o ' FORM NO. 1 TOWN OF SOUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................. 19... II. . Approved ........................................ 19 ........ Permit No ............................... pp ................................. ~.....~ ...................................... ..... ........... ..................... (Buildin~ Inspector) [ Application No.....~......~..~?.. ............ APPLICATION FOR BUILDING PERMIT Date .......... ~../,f / ? ........ ~...c~ .......................... 19.......d~.... '~ 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 opplicetion, 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 pukpose whatever until ~ 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, es herein described. The applicant agrees to comply with ali applicable laws, ordinances and regulations. .................... ?C---7Agnature/of applicant, or name, if a corporation) ....... , ........................... (Address of applic~ant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............. "7' .............................................................................................................. 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 b~e,,,done. Map No: ..../'~'.....b...!~...~..~......~.....'~...~.. ...... Lot No: ..:..-~.. ............. St reet and Number ...~.....~...-x~.....~.....~..'dr........~'~.. ........ ...~.....Z~......~...~.....~..;::.....~.'...~..-~i~.~...: ........... i i]~.... Municipality / 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use aha occupancy ...................... ~. ............................................................................................................. b. Intended use and occupancy ............................... ~" ~-...0~....~ff..~;-..~ .................................................... " Addition 3. Nature of work (check which applicable): New Building ....................................... 1Alteration .................... Repair .............. ~...Removal,~ .................... Demolition .................... Other Work (Describe) "t ................. 4. Estimated Cost ...... ./.,...~ ........................................ Fee ...&.~. ............................................ : ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... O..~...~ ........... 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 .............................. Numb~;r of Stories ................. ~. ............ 8. Dimensions of entire ~,ew construction: Front ....... ~.~/_~.....~..~.., .... Rear ..... .'~...~.....~T....~.: ..... Depth ....~....~......~...~... ...... Height ......... ~'?......~..~.... Number of Stories ...... ./.~.2~. ............... 9. Size of lot: Front ....... /...~..~.. ........... Rear ........ ./.....~.. ........... Depth ~.~.,.-~........'~...~......'~'..A 10. Date of Purchase ......~.'...~....,~..~. ........ .~..~y./~ ~ ......./. ~.~.~...~..Name of Former Owner..~..~...~....~..~..~....~...~.C...~...~..Crg.:;~. 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 premises~..~.9~...~..'.~..~.~.~....Z...~.~dd~ .....~.~-f~....~.~..:.~'~i~"~T'~.~ Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... 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 d~scription according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWffY. p~,,_ ~ S S COUNTY,~F~.~.. ~ .~4 ......... ) ' (Name of indiv~dual signing adp ic~ above named. He is the ............................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners and is duly auth~e~4~?erform or have performed the said work and to make and file th s ar~Nication' that all statements contain~frl~/~J~'~appiication are true to the best of his know~dge and belief; and hat *he work wdl be performed ~ne~r~,~ ¢~oF~ n the app~cahon f~le~ therewith. ~ Sworntobe~e~meth~s ~ ~ij.~'Cl SOf~°f~, ~ ~ .... ~ ~ '--~ /~-~ 4 ¢ ~ ~ -~/u~,~ou~, or} - ~(Si-nature of applicant)~- ........................ aa~ o ...... ~.~..~ ................. '~.~,~ ~ ,~.u ~ , Notary Public, ~~.~,..~ ............... C o ~'~4u~ .