Loading...
HomeMy WebLinkAbout494-zFOKM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at...lg/~...,t~.~.o~c~ .................................. Stree, t Map No...~ ............. Block No...~..:~:.. .............. Lot N~.......0..~.~.e..~..~.t......~..*~..e. .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................................... 0at,,..20...., 19.5~..., pursuant to which Building Permit No ....... 2L.4~)J~ ........... dated ....................... 0~.tg~'....;~.O. ........ , 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 .............. ................... Yr£v~te.. ~. f~i~...~lli~g ...................................................................................... This certificate is issued to ...... Stg~le~...~OSkosk~..,.T~., .........(.¢~Y/ri~r.) ............................................... (owner, lessee or tenont) of the aforesaid building. FO~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.o ~t94 z Permission is hereby granted to: .. II.tmg,e~...1)z~o~,..~Tr ... ........................... ............. I~m~t e.....l~,.J., ..................................... to ........ 1~..~...~1.~.~]..~.~,~ ......................................................................................................... et premises located at ....... ]~l.....~..~X'9*..~il~...{..~.~...~.). .............................................................. .......................................................... ~.t.,e.a.~.t......~..:.Z.. ......................................................................... pursuant to application dated ................... ..O..Q...~.?....J~.,~.......~...O. .................. 19...~...., and approved by the Building Inspector Fee $ ..]'...O..e...00. .......... Building Inspector FO~i~I NO. 1 TOWN O'F SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLDL N. Y. Exomined......~'~ .................. ~ 19 ........ Approved ........................................ 19 ........ Permit No ....................... Disapproved a/c ................ ~ ................ .~.~, ......................................................... ................................ , ............... :'i~. ................ ~. ................... ,,c.'................~........ -- (Building Inspector) / Application No....ZT/...~*:..~. ............. APPLICATION FOR BUILDING PERMIT ,o Date....~........~ ............................................................ INSTRUCTIONS o. This application must be completelv 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 dlogrom which is part of this location. c. The work coYered 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuonoe of o 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 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. premises ~,,~ ....... ~~,,d~,',,.~..... ' If applicant is a corporate, signature of duly authorized officer, (Name and title of forporate officer) I. Location of land on which proposed work will be done. M~ap No: ...... ,~: ................................... Lot No: ~.~..'~.~.-.~: Street ond Number ...t...~ ..~ ...~........:...~..*.....~..~....:...,......'~. ................................... ; ......................................... Municipality 2. State existing use and occupancy of pr, emises and intended use and occupancy of proposed construction: Existin use on'occu anc ~C...~.. ~'~'' , a. g a p y ............... ~.,....:__ _ ................................................................................... b. Intended use and occupancy ............ .v..~..~r..z...'n:..'~r..~i. .............................................................................. 3. Nature of work (check which opplicaNe): New Building Y Addition .................... Alteration Repair ............ ,~.....Removal .................... Demolition .................... Other Work (Describe) .................... · 0o0 i0 4. Esbmated Cost....~...',+r:.! .................................................. 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, Jf 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 ../.. ........ ~ ........... 9. Size of lot: Front ...../.....~....5.. ........... Rear ...... ../(.i~...G. ........... Depth .../....~....,.~?....../~ ....... 10. Date of Purchase ................................................... Name ~f F,o~rmer Owner ~[...~...~.: ........... 11. Zone or use district in which premises are situated ............ ~.'....¢~'..'.~........~...~m~Z..!. ...................................... 12. Does proposed construction violat~any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises..~..'~~.~' ~' --~.:.Address .~..: ................... Phone NO ..................... Name of ....................................... Address ............................................ Phone NO ..................... Architect...,..ji, )_...'...~-- ·_ ~.. (~ ..... Name of Contractor.~....(l...':¢~...~.; .............. 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 NEW,...~(OI~K,, ~7'~" ) S S COUNTY OF ..~"~M'~.Z2~..)~/~/~ ~ ~ ~ / C'~' ~ ' ........................... --v ..~~.c~.'....'4~.......being duly sworn, deposes and soys that he is the applicant (Name of individual mgning 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 this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work w be performed in the manner s¢,,forth in the application filed therewith· Sworn to before me th~s ~ ,:'- ~ ,,,,, ;~,, , Notary Public, .~.Z~~...~.:~.Count~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... ~.~.. ................ ~ 19 ........ ~'~ Approved ........................................ 19 ........ Permit No ................. Disapproved a/c ""~"""7~ ........... 7"~ .......... ~;~ ................................. ............. ............... (Building Inspector) Application No......~..(.~..c~ ............. APPLICATION FOR BUILDING PERMIT 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 o detailed description of layout of property must be drown 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 pukpose 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 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 applioable laws, ordinances and regulations. (Signature of applicant, or name, Jf o corporation)' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · . -.:, ......... :-- .4 ,-.~_,/: ,,~-../ ,.~ , N~m~ o~ ow~ o~ ~,~,~ ...... ~.~*,:::,:,'.,, ...... ~:~...~....".~.~'.:'.~.~.,~ ....................................................... ~. If ~pplic~nt is ~ corporate, signature of duly ~uthorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................Lot No: Street ond Number ,../~/..~ ....... L .~.[~?.~.¥::'x~..~r..;..~..(.- ............... ,..,,~ ~.~..<.~.~:~..~¢:~.~:~::.~...~. .............................................. Municiidality 2. State existing use and occupancy of pr~fi/i~s and intended use and occupancy of proposed construction: b. Intended use and occupancy ............ '~:~"~*;'~-'~":"~'"'~*'"i .............................................................................. 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair ............. w....Removal ......., ............ Demo[itlon .................... Other Work (Describe) .................... 4. Estimated Cost.....L.~':! ................................................. F e .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... : ..................... Number of dwelling dgits on each floor ............................ If garage, number of cars ....................... ~.....!~::'.~..-....'2~...~..'~.. ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, Jf 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 .......... :.'%..../.:: ....... Reeq ............. -?.,..).'~.:. .... Depth .......... .~ i ....... Height ............................ Number of Stories ...~ ...................... 9. Size of lot: Front ............................ Near ............................ uepm ............ '.......I:R ...... ' 10. Dote of Purchase ........................................................ Name of Forme, r Ownerr..?.~:.~;::'.:('~':L.%.:'L.../.£?.;~,.~;.::~.~ ............. 11. Zone or use district in which premises are situated ............. ./,..~.......~...,f~: ....... ~...'.5:..~';.? ......................................... 12. Does proposed construction violate,,any zoning law, ordinance or regulqtion? .................................................... 13. Name of Owner of premlses..v......~..~.., ...... ?,,~.: .............. ~., Address ..~=; ....................................... Phone NO ..................... Name of Architect ........f.h ............................................ Address ............................................ Phone NO ..................... Name of Contractor..~..k..~..°7.2~5...~..*;~'?..*,T~:::C..: ............. Address ..~.LJ.....~.~'J..: ....... ; ............... Phone NO ..................... PLOT DIAGRAM l.ocate clearly and distinctly ail buildings, whether existing or proposed, ond indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, ond show street names and indicate whether interior or corner lot. .... . ............... , - , ~o~ STATE OF NEW. YOJ~.,,K../,t,~. ) S S COUNTY OF ................................... )i..;t.:k.~:.?..~...,..~,.....i....:.....:..;....;..'......being duly sworn, deposes ond s~ys thor he is tho ~pplicont {N~me of individual s~onino oppHcot~n) above homed. He ~s tho ................................... ~ .................................................................................................................. (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 Jn tNs application are true to the best of his knowledge and belief; and that the work will be performed'in the manner~ set:~orth~o~:: ~Jn the application filed therewith. Sworn ~ before me th's '"~ ' ~ ~l~c' _~ 0~ Notary Pubhc, ...~~~ .................. cou