Loading...
HomeMy WebLinkAbout533-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at.¥,/.,,~,..~.~qt,l~fl,~'LA.~.e~'t~O.e..~.~l,~,~,~e~tr~ Map No. *** Block No ......................... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................... ~.~...~ 19...~,, pursuant to which Building Permit No ..... ~..~.~ ............ dated ...................... ~q~...~....., 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 .............. ............................................ ................................................... This certificate is issued to ...~..~...~e~ ........................................................................... (owner, lessee or tenant) of the aforesaid building. TOWN OF SOUTHO~LD 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°. 533, Z Dete ............ ~] .O..~...e..~..b., ,e..~...,,. '.~.0. ................. ] 9.~..8' .... Permission is hereby gronted to: Build new dwelling .......................................................... et premises located at ~/S Pe~.u, ash Ave Cutcho g~te .t ,,..~:..~..: ................................................................ pursuant to application dated NoYem, ber. ~L6 ............ 1~~. .....and approved by the Building Inspector Fee $..,Z...O. :.9..0. .......... BuiJding Inspector TOWN OF $OUTHOLD Town CLERK'S OmCE SOUT.O'~, N. Examined ........ ~..~.. Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ......~2~,~ ............................................................................... ( ' '0 P Application No ..... ..?..~...~. ........... APPLICATION FOR BUILDING PERMIT Dote ............................... 19 ..... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and su~omitted in duplicote to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relotionshlp to odioining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is port of this location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this oppllcotion, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises ovoiloble for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or inport for any purpose whatever until o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuonoe 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 alterations, or for removot or demolition, os herein described. The applicont o§rees to comply with oil applicable lows, ordinances and regulotions. .... ........ ....................... (Signature of applicant, or name, if a corporation) ............... ~..~....~.,....L....6....0.....~....i.~ ..................................... (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ;o 5 ToO, o?;Z. ; ; ; ; :?. . ............................................................. (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 pr,ergises and intended use a~nd occupancy of proposed construction:. o. ,st,n useondoccuponcy ............. ....... ........................................................... b. Intended use and occupancy ........................... .~,/.~A.~..."~..~..~.....~.:(.. .............................................................. 3. Nature of work (check which applica'ble): New Building .................... AdditiOn .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ......... 7 ......... ' .................................... 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 .......... ~..'....Cc.. ........ Rear ......... ..~'.....~. ........... Depth ...~...O.. ................. Height ............................ Number of Stories ..... ~... 9. Size of lot: Front ......... J....O...~©. ....... Rear ........ J...~ .......... Depth ......./.....:~.....O.. ......... 10. Date of Purchase ............~..~..?.....~.. ........................... Name of Former Owner ....~..~.....~ ............ 1 1. Zone or use district in which premises ore 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 .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly end 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~/. Y~O~,I~ /), ) S S COUNTY OF '~[('~'"'")(J/J ~'~ ~-~ ,~' ............................. .V._.'..~......~.¥~...~ ........... being duly sworn, deposes and says that he is the applicant (Name of i~idual signing application above named. He is the ........................................... ~..~.¢~'...~ .............................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duty 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 manner set Notary PuN'c,. ................ ~. y ' , TOWN OF SOUTHOLD BUILDING D£PARTM£NT TOWN CLEP,~('S OFFICE SOUTHO/D, N. Y. Application No. ~ 3 3 Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c '""'"'"(_' ....... ~'~-"' -X-~'"''""-f"."'.'""'""'""'" ............... f_~f~7 .................. ................. ...................... 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, relatlonship to adjoining premises or public streets or areas, and giving o 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 k. ept 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 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with ail applicable laws, ordinances and regulations. ..... ,J. .........................o ................ ,,,:,. ,. ........................ (Signature of applicant, or name, if o corporation) ............... ~..~,~...r,~....L....6....~...~,...i~'~ ..................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 7 °arnp; IT, fa ~7 ~: ra° fc o~ r;j~ st:i ':'i';~~aT;:;;;'~; ;:::';;l~'' ~''''*~'~z~ ............................................................ (Name and title of corporate officer) 1. ' Location of land on which proposed work will be done. Map No: ............. .-7..::;.::: ..................... Lot No: ~ ............. Street and Number ...... ~./~ ........~....~..~.~,,,...~.,..Ct~,.~ ................. 8~.,~..~,~.~,.,~:~.~,,..../t/..,.~, .... ~ /j Municipality ~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use aha occupancy ............ ?.~.-;; ........................... w ............... ~ ............................................................. b. Intended use ond occupancy .......................... ~2pn.~,,r. ........... :~fZ ................................................................ ? 3. Nature of work (check which applica'ble): New Building ......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition ........ d. ......... Other Work (Describe) .................... 4. Estimeted Cost....L.~ ....... ~7 ..................................... Fee ..I.,(I...7.'?T ............................................................................. (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 ................. ~ ....... ..C~...f}~ ..................................................................................... 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 ....... ~....~,;:~i ......... Rear ....... ~'"t; ............. Depth Height ............................ Number of Stories ....~ .... 9. Size of lot: Front ........1..O..O. ........ Rear ........ :/..~.~ .......... Depth ";"'?"~"O ......... 10. Date of Purchase ............~..~....~'...~. ............................ Name of Former OwnerI"~C~'"'~')~'~ :'/4 ' ] I. Zone or use district in which premises are situated ........................ ...~.: ........................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... ]3. Name of Owner of premises ........................................ Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Nome 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 interior or corner lot STATE: OF NE,~'/..~'~.RII~,~), ) S S COUNT',' OF ....... ) ' .................................. .~..'..:~:; ..................... ~ ....... ' ............. b~i~ d~ly ~wo n, d~pa~es a~d ~ays that he is th~ ~p~li~ant (Name of i~idual signing applicatio~ ~ above named. He is the ......................................... .(~d..~:?..~:2....~..~ .......... ". ................................................................... (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 ali 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 ~gt~b ~ the application filed therewith. Sworn to before me th~s ~:~'l'q st:t~ ..... . ........ Nota~ ~ubllc, ~.4~Z ....................... County