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HomeMy WebLinkAbout505-zFOl/~ ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY Mop No ~1'~ ~,,a:~O['i Block No ..... , ................... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office doted dated ..................... .~.¢..o..~..e...~..~...e.~.,..~. ......... 19...~.~.,was iss.ued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ................ Joseph This certificate is issued to ........... (owner, lessee or tenant) of the aforesaid building. ...... /~'/~ ' Building Inspector FOI~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 505, z Dote ................... ,l~o.~.e~be~..... J. ............ 19~8 .... Permission is hereby granted to: .~oseph Deerko~k~.... A~C.... Jo~eph..~r~wle~. .................. ........... N~l,t,.t.~- t.UCk t ..... N.,. Z. ............................... to ... JSu~.],d.. new..d.~e:L],:Ln~ ............................................................................................................. at premises located at [~/'.,~.... ~Vil~lG.]l.....~[~¥~ ................................................................ ............................................ C.u.tci~3~ue ~..... ~ .. ~ ............................................................................... pursuont to opplication doted .................. .~V~b~ ....... .'L ................. 19.~[~..., and approved by the Building Inspector Fee $].Q.,O~ ............ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~ N. Y. Exo mined.....~......./. ............. 19.....~..'. Approved ........................................ I9 ........ Permit No ............................... Disapproved o/c (Building Inspector) Application No. ~C~ ~' APPLICATION FOR BUILDING PERMIT Date ................... ~.... ~ .~....-77...~...:....../.' ........... l 9...~.7..~...~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the 13uilding 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 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 have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance 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 whether applicant is owne, D~lessee, a~lent, architect, engineer, general contractor, electrician, plumber or builder. premises ~***~-..~.* ..~ ......... A ....... ~2~>,,-~ ................................................................... ame of awne of If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land which proposed on 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use o a occup y ........................... ; .................................................................................................. b. Intended use and occupancy ........................~.?.7.~.~;.:.'~. ................................................................. 3. Nature of work (check which applicable): New Building ........ ~....Addition .................... Alteration .................... Repair .......... .~ ....... Removal .................... Demolition .................... Other Work (Describe) .................... (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 ............ /:~(..D. ...... Rear z--,~ O Depth ~....~. ................... Height ............................ Number of Stories ............................ 10. Date of Purchase ........ ./...~...~.-...~. .................................. Name of Former Owner ('~J' ..~...~ 1 1. Zone or use district in which premises are sltuated .............................................................................. 12. Does proposed construction viol~t~low,_~ ordinance or regulation? .................................................... 13. Nome of Owner of premlses.[~:: ......... ~..,~.,~..,~._._._.~ 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. STATE OF NE~,~YO~tz~)~.. ) S S COUNTY OF ~...':~.......) TZ .......................... ...~..~,~.~.....~.?.~..~...c~..' .......... being duly sworn, deposes and says that he is the applicant (Name of i~zl~vidual signing 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 oll statements contained in this applicatign are true to the best of his knowledge and belief; and that the work will' be performed in the manners0 se~(~l~['t h'p Sworn to before me this ~t~, ublic, TOWN OF SOUTHOLD BUILDING DEPARTMENT Town ¢,ER,'S OmCE SOUT.OLD N. ¥. Approved ........................................ 19 ........ Permit Disapproved a/c ............... ~.; .................... :~.~. ~ .................................................. Application No......~....?..~ ............ APPLICATION FOR BUILDING PERMIT Date ................... INSTRUCTIONS o. 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 Jn 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 oil applicable laws, ordinances and rregulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is bwne/~.lessee, a~.en~t,~a~r.c_.h~ect, engineer, general contractor, electrician, plumber or builder· ................................................... :..!. ............................................................................................ Name of owner of premises....~'~r~.-~,4'~ ......... I.X.:. ...... ~,~.~.~;,.L..rI ................................................................ tf applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) · . . Vd ' ~'~ i ,~;, .~...~.',~... Lot · I. Loc~fion of land an which proposed work will be done. Map No .......... L.u....,,~ ....................... No ..................... ~unicipality ' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................ ~ ....................... ~:.....~ ................................................................................... use and occupancy ........................ ~.~W:~:b~r.;::.....z..~;;~;_ ................................................................. b. Intended 3. Nature of work (check which applica'ble): New Building....................J Addition .................... Alteration .................... Repair ........... ~, ....... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost...!.~,~:)....O..?...(.~ ....................................... Fee .~..O...~ .......................................................................... (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 .... .Jrt. ~). Rear Height ............................ Number of Stories ............................ 9. Size of lot: Front ..... ~.. ................... Rear ....... ~....~: ............. Depth / i0. Date of urchase ........................................................ Name of For,met Owner ...................... .................................. 11. Zone or use district in which premises are situated ................................. ~ .............................................................. 12. Does proposed construction viglatg~any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises. Z~....,..kc~...:fk.?..~:~:..~:?:.~.......AddressLl I~' ", ............................................ Phone NO Name of Architect ......................................................... Address ............................................ Phone NO ..................... Name of Contractor..~:~.~?;f:~L!~......~':.'z/.../.'.';.?..~:~!S.4Address ............................................ 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 NE'N~YO, I~I~..._ ) S S COUNTY OF ~,/~.q~.~.,{: ........ ) ' .T..' , .............................. :.'.~.~.~...'~;-:./ ............ t: ................................. be.ng duly sworn, deposes and says that he is the applicant (Name o~ i~ividual signing appllcation),~ above n~med. He is the .............................................. ~t~.~T;...,..,............~ ~ ~ ~ .......~ ......................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform o~ hgve perfor~'the sgid w~rk,and to make and file this application; that all statements contained in this applica 'on~[~.,~e~]~th~ be~ of ~ knowledge and belief; and that the work will be performed'~n the manner set f~t~l~in,, th~'dfi~ti~K~f~' Sworn to before me this--~ n ~ ~ .... (~0~ ~ ......... / ........... day of .L.....Z~..~J.~.::.:~JZ... ..... ~~r~...,.,,.,,._ ~_, ~ '- ~00 (Signature of applicant) N ~ , · ................. ~ ............... Y ' n ~O &~