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HomeMy WebLinkAbout477-zTOWi~ OF SOUTHOLD I~U~LDING D~PARTMENT TO'~,~N CLEI1K'S OFFICE SOUTHOLD, N, Y, CEHTIFliCATI~'- OF' OCCUPANCY THIS CERTIFIES that the building located al -Map No..~ .............. Block No ....... ~.~ ...... Lot R'~ ......................................................................... conforms substsntially to the Application for B~ilding Permit heretofore filed in this office dated ..............Q~...~ ......... , 19~... pursuant to which. Building Permit No ......... Z.,.~.~... ~ated ..........,..~.-.~ .......... 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 BU~ESS BUILDING This certiflca~e is issued to ~A~W~,..~0,~...~ ........................................... (owner, lessee or tenant) of the aforesaid building. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI4OLD, N. Y. Approved ........................................ 19 ........ Permt No ................ Disapproved a/c .........~ ................. ~ ............ ~ ...........~ ........... Z; ....... (Buildin~ Inspec*or) Application No ..... ../~..Z...~(~. ......... APPLICATION FOR BUILDING PERMIT Date ....... /: ~.. ~...,~¢.... ~.~.'... ~ ............................ 19...6...~... INSTRUCTIONS a. This opplic'~tion 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 issuanoe of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other appllcable Lows, 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 oil applicable laws, ordinances and regulations. .....'~(~ture"'~'"": ...... of :~'/~' :',pplic~, ..................................................... if, corporation) (Address of applicant) State whether applicant is own~ less~,~ent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises. ..~¥. ~ .......... '~'. .................. If ap, pJicgpt,is a c,~rporate, 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 premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.../.'.-t'~?..~]../..*c'4f./~Z'~-~'-,~m ................................................................................................... i , b. Intended use and occupancy .......................( ....................................................................................................... 3. Nature of work (check which applica'ble): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ............................. .ff'.~.z? ....................... 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 ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of For~er Owner ........................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises ........................................ Address ................................ ;. .......... Phone NO ..................... Name of Architect ........................................................ 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. /2' STATE OF NE~/-YO~[~, , O~-/ ) S S COUNTY OF .'~,~..'~...) ' ................................................................................................. being duly sworn, deposes and soys that he is the applicant (Nome of individual signing above named. He IS the .......................... ~ .............. ~...v~..~ .................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work ~nd to make and file this application; that oil statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the monnerE~f~E~ the application filed therewith. Sworn to before me this ~/~~:-' ~..P~bJ[c, State of ........... ~ ...... day °f,''''~~'"';'~~':~'~o~. (Signature of ap~an,) __ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exom,ned ......... ,, ,, . ~z__z/'7 7 Approved ........................................ 1c) ........ Permit No ............................... D sapproved o/c ........ t'"~ ........... ~ ............. ~'~'~ .......... '?~'"'""//"'"'/~- /,," ,/' ....%, ...-" L ....................................... .L .................. .~: ................ ~ ............... ' ...................... ~ (Building Inspector) / Application No.....~...~....7. ............. APPLICATION FOR BUILDING PERMIT Date, ......~....~.~... -~.. ...................................... 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 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 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 o[I applicable laws, oral inances and regulations. ................................... (,,/ /~gnature c¢~-~¢~licant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ...................................................... Name of owner of ~ If applic, a,~t,4is,¢ gorp,~?te, signature of duly authorized officer. ........ .............................................. (Name and title of corporate officer) .N~./ ......................................... Lot No: .................... 1. Location of [and on which propo,sed work will be done. Map i~ Street and Number ..../..~'...~...~..~...4~.~...' ............ ~Z"~/.~.-c?~.'~'.~'~"Z'*~.....~'.: ......................... 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 ................................................................................................................................ 3. Nature of work (check which applicable): New Buildlng .................... Addition .................... AIteratlon .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ................ ..~. ~..~...~: .......................... Fee ............... ./...~'... :i*..~.. ': .......................................................... (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..../..z.....2~..!.,''. ....... Rear ..../...~...~.,A.../..~..~ .... Depth ............................ Height ..~... ,~...,~...~..~...'.-T..... Number of Stories ............................ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Forme. r Owner ........................................................ 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 ........................................ Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor~..'/...'./..~~ d......Add ess )~.'"~'...'~.,~,;/-~.~one NO..~...:../.~...~..~7. 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 NEV~O~J~,~,/, ) S S COUNTY OF ,~L..~.....) ' ............................. :,' .............................................................. being duly sworn, deposes ,and says that he is the applicant (Nome of individual sign~ opplic~tion) 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 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 manqer s~t~e application filed therewith. Sworn to before me this ,ot~,Public, State 0f ~ ~ ..... ~... day of ....~..~ ,]~,,,,,,,.~y-0~szsoO g 7 (Signature of applicant)