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HomeMy WebLinkAbout507-zTOW~ OF gOUT~OLD SOUT~OLD, N, C~-~T~FICAT~ OF OCC:UPANC¥ THIS CERTIFIES that the building located at w/.~,..~.~...'giew.. Dl:+o...t~latt:t~t .Map No. ~qel~tvJ, ew... Block No .......... ~.*~ ....... Lot No ...... ~t. ...................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............... ~.V.~.r...,.5.. ......... 19..5..~.... pursuant to which Building Permit No..~.....9.~ ........ dated ............. ~.O.~I.~4(/!~K..~. .......... 19..5...~,., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ....... ~..~....I..V,.'~'...~.'...Q...~.....~...~...~. . DW~[~.~,~I~I.0. ......................................................................... This eertlficate is issued to ..~?.~.~.P..h...~.f..~.~.~...~.~.r.. ........................................................ (owner, lessee or tenant) of the aforesaid building. ltuilding inspector ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEi~K'$ OFFICE SOUT,OLD', N. Examined ................................................ i, ......... Approved ........................................ 19 ........ Permit No. Disapproved a/c . . ,.,,. ................. ;, ................................................................. (Building Inspector) / Application No....~..~...(.)...Z ............. APPLICATION FOR BUILDING P£RMIT Da te ............................................................ ~ ~.....~ ..... 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 Certificafe 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 Sot~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. ...... ........... :: ................ ............. ~ignatur~ applicant, or name, if a corporation) (Address o~ applicont) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. ............................................................................................ Name of owner of premises .......... , .~'.'~.~ ........ ~'~..'i?...'.'.C.~..S,TM ................................................................................. If applicant is a corporate, duly authorized officer. (Name and title of corporate officer) ,~('.,,/,,, ,~,,. 1. Location of [and on which proposed work will be done. Map N~o: .. ../...~..~.¥J ........... Lot No: .~ ............... Street and Number ................ ~; ........... ~:~.E,-,~:,~ .............. Municipali~ 2. State existin~ use and occupancy of premises and intended use and ~cuponcy of pr~osed construction: o. Existing use aha occupancy ......................................... ~ .......................................................................................... b, Intended use and ccupa y ....................................................... ~,~. .................................................................. 3. Nature of work (check which applicable): New Building......~......Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.....~:..:.~......~ ..................................... 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 some structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction~ Fronf. i...~....~...'. Jf~) ....... Rear ............................ Depth .....'~.. ................... Height ............................ Number of Stories ............................ 9. Size of lot: Front .I..~.~,....~-.. .............. Rear ............................ Depth )' ''~ O 10. Date of Purchase .............. ../...?...~..~...,.,Z .................. Name of Former Owner ...... .~.~.....'..~.....~ ........................ 11. Zone or use district in which premises ore s~ruorea ................................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises ................ Address ............................................ Phone NO ..................... Name o{ Architect ........................................................ Address ............................................ Phone NO ..................... Name of Controctor......~'.,:. ......................... ~ ............... 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_~C,y~R,K,~.~ ) S S ........................... ~7.....~...~_~.......~...~..~....-......being duly sworn, deposes and says that he is the applicant (Name of il0d/vidual signing oppl~Lcation) above named. He is the........................,x~ ..... r'~..~ ........................................................................................ (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 applicotior¥ ore true to the best of his knowledge and belief; the a plication filed, therewith. and that the work will be performed Jn the manner set forth in ~e a~,~, .~ Sworn to be~ore me this ,/~ .............. .~..'..... day of ....... ~... 1,~..~.-..,~._... 6/ (Signature of applicant) Notary Public'[-~,~.~.; ....... FORI~ NO. 1 Tow oF BU..DI,G DEPARTMENT TOWN CLERK'S OFFICE SOUT.OLO, N. ........ .......... Approved ....................... ~.~. .............. ]9...~J...Perm[t ~o..~.~.~ ........... Disopproved o/c ......... ~ .............. }p,~m ............... ~ ......................................... ........................... .......... .............................................. (Buildi~lnspector) APPLICATION FOR BUILDING PERMIT 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 purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 oll applicable lows, ordinances and regulations. ...... ~i~;;~Tof';~iiL'L'L'i;'~;'~g;'i~'T~;~g;~i~i ......... ............... :.!..: .......................... (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (~ o~.~.~-_ ~.~., ~: ..... ............................... Name of owner of premises?~T._j,v.:;~:':.~..~!:.'.: .......... ............. :.~J...;~. .................................................................................... If applicant is a corporate, ~gnature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be d, one. Mop ~: ..~.. ....................... : ............... Lot No: .................... Street and Number ........ ~;.~' · ..... ~ ................ ~"'?'(:!'f:' ~::: ;:" .............. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ...... /,....7.';....;...;;.;;;..~ ........................................................................................ b. Intended use and occupancy ......................... s,. ................. : .............. ~ .................................................................. 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.....?.~ ................ ' .................................... Fee / /) ~ (to be paid on filing this application) 5. If dwelling, number of dwelllng um~s ................................ 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 .Z.~ ~ Height ................... .i..~.. ¢:.Number of Stories ............................ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ Former 10. Date of Purchase .............. .,/...~..~...~.._.~ ..................... Name,~,~ ~L~,Z~wner ...... ~,J...~..~...~.,~r~,,., ........................ ]1. Zone or use district in which premises are situated ................................................................................................ 12, Does proposed construction yiolate any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises .'.... .4~.t.~ ....... Address ............................................ Phone NO ..................... N.ome of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor ..... ~..~ ....... ~ ...................... 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 inter[ar ar corner lot. STATE OF NIEW~YORI~ ' ) ¢ c ~ . J~ j~ .......................... [../.~...,L~..~.....~U~??..~.~......~.~ ........... being duly sworn deposes and soys that he is the applicant (Name ~f yndividuol ~igning application)~ . above named. HeVis the ......................... ~...~..,.-,~~.. ............................................................................................. .... (Cbr~¥roc~Tor, 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 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 flied therewith. Sworn to before me this ......... ,.,~.'". ......... day of ..ydv. z~::, ..... :~,~¢~ ......... ,~'¢.k,~ ....... (Signature of applicant) ,otar .ublic,