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HomeMy WebLinkAbout457-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING D£PARTMENT TOWN CLERIC'S OFFICE SOUTHOID, N. Y. CERTIFICAT[ OF OCCUPANCY THIS CERTIFIES that th~ building located atJ/~.~l.~..A.~.e~.t....~t,~;.~.t,t~O~.~...~,~.,... ~ Map NoZ~.~...T~Z],'e/g.O~lock No.....-..-...-. .............. Lot No..~..~..?..~. ....................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................. ~t~.~f~Ilt~,,~...~ .......... 19..~., pursuant to which Building Permit No ..... ...~..~..~. .............. dated ................... ~1.~).~,..~.~......, 19..~.~., was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .............. ............................................... .............................. , ................. This certificate is issued to ..~J~o~L~Y~::~I~}tJ;~][~L.I~...i~,~ ............................................................... (owner, lessee or tenant) of the aforesaid building. Buildin~ Inspector FORN~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUT.OLD, N. Examined......~......'~....'-t. ........ 19..C.~'. Approved ...................... :.). .............. 19 ........ Permit No. ~ ........... ./.. ........ Disapproved .............................. a/c .............. ff~...~,..~.~:,.~~..~'~N.....~ ..~-~x~..''m ....................... i~ ................................................... .......... .......... ................ I ................ Application No....~.'./....~..:Z ............. INSTRUCTIONS a. This application must be complel, ely 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 adioining 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 <2 Certificafe 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 Sou'thold, 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, if a corporation) (Address o'f appli~/a6t) 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:/..'.].~....?.~.....A....~_...~..%). .........Lot .................... Street and Number ....................................................................................................................................................... Municipality State existing use and occupancy of p~emises and intended use and accupanc~ of proposed construction: O Existing use and occupancy ~(~...6~-- ~,..-.~ ~o~ / b. Intended use and occupancy ....................... ~.J~ ..................................... ~ .................. ; .......... : ........................ 3. Nature of work (check wh]ch applicable): New Building ~ Addition .................... Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated ~ s ........................................................... Fee J.. ...................................................................................... (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 alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ~..,~ ............... Rear ........................... Depth ............................ / Height ....... ~..~ ............ Number of Stories__ ~,,=-~_ ~,~z~~"'~' ~ ~C 9. Size of lot: Front ...... Z...~ ........... Rear~.~..~Z...~.~p~h.''' ........................ 10. Date of Purchase ........................................................ Name_/i/~of Former Owner ........ ~.~...~ ........ Zone or use district in which premises are situated ........ /.~....~..~ ........ 11. 12.~uoes proposed construction violate any zoning law, ordinance or regulation?"'"".'~".'"'."".'.'.'.".'.'.'"'"".''''''''-' '""~'"'"' ' '"'"'"'"'" 13. Name of Owner of prem,ses../.~ ..................... ~.....Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone ~w~, ,, ~, ~ ~ Z, w 0 A- No ..... .a..~...f:.L o, .............................. .......... ............. ........ PkOT DIAGRAM kocote cleorly ~nd d~stinct¥ oll buildinos~ whether existin~ or proposed, end indicate oll set-bock dimensions from property lines. Give stree~ end block numbers or descrytion occordin~ to deod, end show street homes end whether inter,or or corner lot. .................................. /~.~.~......~ ........ being duly sworn, deposes end soys that he is the applicant . (Name of .?dividual signing application) above named He is me ............................................. ~ ...... ; ............................................................................. (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 afl statements contained in this application are true fo the best of his knowledge and 5elief; and that the work wil be performed in the manner set forth in the application filed therewith. Swor~,~ be~ore me this ,~~ M~,~-~t~ :'2 ....... L ..__:: .... ..... ............ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD', N. Y. Approved ........................................ 19 ........ Permit No. (Building Inspector) Application No ....... ......... APPLICATION FOR BUILDING PERMIT Date../_~.,....~.. ~' 194~-- Y INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su/~mitted 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 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 applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) ............................. ............................. State whether applicant s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises... .~.....~.....~.!..V. ............ ..~..~....~...,/~/'..~../..~. 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: /..Z~.~.....?..~.~.~./~/z"'.~.~. ........ Lot No: ~..~...7.(..~...~.. umber ......................................................... Street and /J Municipality 2. State existing use and occupancy~ of pr,em~ses,,~,..d' intended use an_d, occupaj~cy of proposed construction: a Existing use and occupancy .......... ~..~ ................... ,..~. · ' ...................................... t~ ~5 l/ ' b. Intended use an~ occupancy~...~...¢.].~..../.~..~) ......... .~.£.~....~....~.~.:......~.~f~.......~.. ~/.'..~./...d.:.~ ...................... · 3. Nature of work (check which applicable): New Building.......~?............Addition/ ...................Alteration .L Repair .................... Remova.I .................... Demolition .................... Other Wor~(Describe) .................... 4. Estimated Cost .......... ..~. ...... ~.~ .............................. Fee ../..~.'...~. ....................................................................... (to be paid on filing this application) · · l'a~ e 5. If dwelling, number of dwelhng un.ts ................................ Numb r 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 .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front....~..~ ................. Rear ~ 6 ~ Depth ~ ~ x 9. Size of lot: Front ....~.~..~ ............... Rear .~.~..Z ......... ~.... ~epth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zono or uso d~str[ct in which prem'ses ~ro s'tuoted ........... [ ................................................... ]2. Does proposed construction vio~t~, ong xonin~ bw, ord[nonce or ro0ul~t~on? .......... ~ ................................ 13. ~*mo of *wn*r o* pr*m,sos...l~...~~Xddross ............................................ ~hono ~O ..................... ~*me o{ Architect ........................................................ .. ~ ~Address ............................................ Phone NO. ~'i'~'2 ....... ~omo o* co~t~o~,o~r..q&.~.~r.F.~.~.~.~.~,.~n.~dd~o~.T~.~..~.~...[~~. .......... ~ho~ ~0 ..... &.~.~.(.... PLOT DIAGRAM Locate clearly and distinctly oil 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. (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 application filed therewith. Sworn to before me this ~'~t.~v r~LOI~;£ Bo t~ ............... ' ..... ' ................................ ~.'~ ,. ". 5} .~ -~ount ~ ..,'" .~ ."