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HomeMy WebLinkAbout463-zFO~M NOo ~ TOWN OF $OUTHOLD BUILDING DEPARTt~ENT TOWN C[.ERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CEP~TiFIE$ that the building located at~...~..~....~..e.?....~.~.~.~..~.~..~...~"~..~.~.?..~...~..~..~..~'..~k Ma~ No ......................... Block No ......................... Lot No ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................. .~.i,~.,~.,~,.~...~..~.~.~....'~,~?19,.~..~..., pursuant to which Building Permit No ...... ..~...!.ll..~.~ ........... dated ~e,~.~et~l~e~' ~ , 1 ~'~ o ..................................................... 9 ........ , w s issued, and conforms to a~l of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is .............. ................................. ............................................................. This certificate is issued to .....~.,.~..]..~,J.1.....~,~,~,~.~..t~.,.?.~...~. ................................................................ (owner, lessee or tenant) of the aforesaid building. Buildina Inspector FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S SOUTHOLD, N. Y. BUILDING PERMIT (THIS F~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 463 Z Date ............. Bep.t. embe~'.---.eS. ............. t9...~8. Permission is hereby granted to: · ,~al~h.... ~ussell. ............................................ .............. t~x...~6.3 ................................................. ................. ;Mat~titue~,..... ~t ,~6 ........................... to .... Bu~.]:d...new.-~me.~.~-~ng ............................................................................................................ ot premises located at B,!C.O~e~ R~., &.JWO.O~Q~I;~'~. D~ .......................... .................................................... ~f~t,.~i..t~e~- w ....~ ~-:~'.~ ....................................................................... pursuant to application dated .................... .~e. pCe~tbe:~...c).. ............... 19.~)~.., and approved by the Building Inspector Fee $..1(~,.00 ......... Building Inspector TOWN OF SOUTHOLD BUILDfNG DEPARTMENT TOWN CLERK'S OF~=ICE SOUTHOLD, N. Y. Approved ...................... ~ ................. 19...h...Permit No ............................... Disapproved a/c ....~ ............................................................................... (Building Inspector) Application No.....~....~..~ ............. APPLICATION FOR BUILDING ii~_~ 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 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 applicc~tion 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 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 Souchold, 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, ord inances/~nd~., regulations...~.....~'~~ (Sig~ture of c~plicant, or name, if a corporation) (Address of applicant) State wheth,er applic/9~ owner, le~,ee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner of premises 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~../~..~......~..~..~k)....~..~......~..,....~...~.......~....~....~.........~/_,~~~... 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 occupancy ........................................................................................... property lines. Give street and block numbers or description whether interior or corner lot. 3. Nature of work (check which applicable): New Building ....... ~¢C..........Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ........ ~.,.~...,~..~,.~..~.....~L ........................ Fee .~,0. ................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelllng units ......... Number of dwelling units on each floor ............................ If garage, number of cars ............~.....~..~ .............................................................................................................. 6. If business, cammerclal or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if on,/: Front ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories .................~t~D~...~',,-~... ...................................................................... Dimensions of some structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ ~.. ~,ff ,~' ? 8. Dimensions of entire new construction: F_r~ont...: ............. Rear ..... _........ .............. Depth .......................... Height ............................ Number of Stories ..../....,~r~...~.. 9. Size of lot: Front ..../..~.-~ ............. Rear .... .~.;~;~'~..: .~... ........ Depth ...~....~.........~.../...~ ~7 10. IDate of Purchase~,~....Z...~...4...~.. ................. Name of Former Owner ~..~.~ ....... 11. Zone or use d~ r~ct in which premises are situated ........... '~...~.~.! .................................................................... 12, Does proposed construc,t~On violate any zoning I~w, ordinance or regulation? ...~..~ ...................... 13. Name of Owner of pr~.k..~......~..~.?...../~..:~d~ress ...~..-,~..~.,.~..~. one NO7~...~../.¢t~...~ Name of Architect ........................................................ Address ~::~ ............. ,..! ...... .,~ ....... ,P, bone NO .... Name of Contracto~..........~...~...~...~...~. ........... Addres~......~...,.~......~one NO....~..~.'~............. ~'~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from according to deed, and show street names and indicate STATE OF NEW~O~z~K~c ) S S .............................. ~~ ....................................... (~~-. being duly sworn, deposes and says that he is the applicant (Nome of individuoYsignin~ application) above named. He is the ........................................................................... ~ ................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file th s application; that oil statements contained in this application ore true to~ best of his knowle~e and belief; and that the work will be performed in,the manner set f~cth in the opplicat~n f~led there~h. / ) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLDL N. Y. Examined ................ 19 .....~ Approved ........................................ 19 ........ Permit No. __/¥~'Z) Application No....~../..~.?..'. ............... 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 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 in part for any puFpose 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 o Building Permit pursuant to the Building Zone Ordinance of the Town bf 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, ordina,~ and regulations./~ (~i~natut'e bf 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. premises ..~-~;.. · ...... ~ .............................................................. Name of owner of ~.. ~M~*'"~ ~' / ~' If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) whichproposed work will be done. Map No: ............................................ Lot No: .................... Location of land on Street and Number ........... .O...~.q~.... ..... ~ ....... '/" Municipality State existing use and occupancy of pr,emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................... ..~(/J~L~ ...................................................................................................... occupancy ..~..~ ~ b. Intended use and ................................................. '~.~.r ....................................................................... f ~t~o 3. Nature of work (,check which applicable): New Building .................... Add' ' n .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost....~.Z~,,.~...¢'....~. .................................... Fee ........... .~..q~......~'~..~ ................................................................ (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 .........../~....~r~.............' : .................................................................................................... 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 ~'¢ ...... .~..: ................. Depth ................ 8. Dimensions of entire new construction: Front.....~.. ....................Rear Height ............................ Number of Stories ..... ~..~ ...... 9. Size of lot: Front .../.~..~.~. ........ Rear ...... ./....~.....~.'~.. ......... Depth ..~.~...~.. ........ /.,.-~..~ 10. Date of Purchase .~,~.~....~..~....5.,~. ............................. Name of Former Owner .~",2~M~,'~ 11. Zone or use distr~t in lwhich premises are situated ......... .~.~.....~.: ........................... 12. Does proposed construction,,,violate any zoning law, ordinance or regulation? ; ...... ~....~.. .......................... 13. Name of Owner of premiseL.~. ~,~....~J,~-~.~/ct,..~ddress ..~.,~,-~.i~..~,~.Phone NO~.~...~....~...~.....~ Name of Architect ........................................................ Address ....~.,. ........................... ~ ........ Phone NO ..................... Name of Contrc~ctor.~...~......~...~...~...~...~.. ................. Address~.~.....~.../~.:..Phone NO. PLOT DIAGRAM Locate clearly and distinctly all buildfngs, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or descr~n according to deed, end show street names and indicate whether interior or corner lot. STATE OF NE~ YJD~K, ~/ _.. ) S S COUNTY OF .~~.')..) ' ........................ ~~...~....~.......~~..~.....being duly sworn, deposes and says that he is the applicant (Name of individual s~n[ng 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 to~ tc~t~litc~:i~r~h;~,la~eS;:;;o~:~ ~¢~n~5~)is~cf~ ~ol~h;r;ptp~t)~e~:nt~i~e~e:[otfowi~owledge and belief;