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HomeMy WebLinkAbout544-zFORM NO. 4 TOWH O~ 5OUTP~OLD ~J~LDING D~PARTM~NT TOWh~ CL~R~('50~F~CE SOLIT~-tO.LD, N. Y. C~RTiFiCAT~ OF OCCUPANCY THIS CERTIFIES that the building located at.~./.~...M.~..~.~.....~...~..~..t....~..~..~. ~..?...O.~ ...... ~'l~u~ Map No ......................... Block No .........................Lot No ..................................................................... conforms substantially to the Application for Building Perrnit heretofore filed in this office dated ............................. '.D..G...??..~..~.~.~.....~.~., 19...~.~., pursuant to which Building Permit No...~...).~..~...~ .............. dated ........................... ~?..?.~..~..?..~...~, 19....~...~., was issued, and conforrns to all of the requirernents of the applicable provisions o~ the law. The occupancy for which this certificate is issued is .............. ............................................... ................................................................ This certificate is issued to .....~..~...3..".....~..O...~...~..~...~..G..~..L...O..~?..~. ............................................................ (owner, lessee or tenant) of the aforesaid building. FO~M NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S O~FFICE SOUTHOLD, ~'. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ..,/ ~reb~ H~:~s-.... ~ .~.C..-. ~.~ o-.. ~ ....E~t er. ...................... to .. BUT.~d...a~..~Id&~.io~...e.~.-en..e~.l.s.tt.n~...gue s.t..¢o:~taA, e~ ......................................... at premises located at ~ai~ ~ & $%~,~ ~1~ ................................... pursuant to application dated ............................. D.~-c:e.~lb~:[t...l.~. ........ 19..~'.~., and approved by the Building Inspector Fee $- ~'~'OO ............. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No........-.~....~,./.~/i ......... Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c .............................................................................................. .............................. L;<:~......x.:r:::2~........fi::'.:...'~'. .......... ~z:~~. .......... 7"~::.T2'i ......... ........ ...... ........................ (Building Inspector) / 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 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 issuance 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 applicable laws, ordinances and regulation.s. ...... ~.: ........ L/..6.~..~..~-:...~.. .......................................... (Signature of applicant, or name, if a corporation) ........ ..(...~.~:...!i.~..~:....!~...~...~..~....(.:.. ........... ~!~:~:.)~.: ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ ..C ....... o ~ ....... ~ .............. r.:~ c_ z- :~ ............................... ~ ..................................................................................... Name of owner of premises ....................... .~..~.~... .......................... ............................................................... If applicant is a corporate, 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 ........................................ ~ ..................... A .................... ' ......................... :.~..~. Municipality /./~' ~ :2, Stote existing use ond occupancy of p~emises and intended use and occupancy of proposed construction: a. ~xisting use and occupancy ................ ~..~. .......... ~~ ......................................................... b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... AddJtlon .................... Alteration Repair ........... j~.....Removal .................... Demolition .................... Other Work (Describe) .................... 4. ~sTima~ea ~osT..,.,~ ......................................................... ~ee .......................................................................................... (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 ............................ uepTn ............................ Height ............................ Number of Stories ......... ..O~...~.~ ................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front....../.~.~ .................Rear ........ ./.....-~.. ............ Depth .X....(.~ ............. Height ............................ Number of Stories 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name'~J-*°'f F~rT~r~Ow~ner~ ........................................................ 11. Zone or use district in which premises are situated ............ ~...\ ....... ~"'""~ .............................. ,,¢ .............................. Does proposed construction violate a y zonin law, ordinance or regulationP 12. Owner ' .%..^'~ ~ ~'"A~: Ad'res~ ..~...'.~..""~ '~"'~'~?~'Z'~':. ............................. NO 13. Name of or premises ....... ~ .................... .......... a .......... : ............. .~-/..//.=. ....... ..................... Name 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 inte or or corner lot. STATE OF NE'vy~YgI~I(~: ) S S COUNTY OF ..~.~/~t~:........"~-~T..} :' (Name(,~,,Yndividual' ' ia~L~sign'nD ap?~ca ' above named. He is the ............................. ~.'-~.i~.-~.~.~.'~'.T .................................................................................... (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 I be performed in they .~r~B'e~'L~et, forth in the ol~,lication filed t, hqrewith. Sworn to before me this ~ ........ ~...~... day of .....~..~.?.~!,~,.~:.'~?~.,~..,,~..~rlf fi,' ~(Sl~]natu're of applicant} FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK*S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Perm t No ............................... Disapproved a/c .............................................................................................. ......... ' .............. ....... ...................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and sub)mitred 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 shell 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 p art 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 a Building Permit pursuant to the Building Zone Ordinance of the Town of Sou'thold, 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. ...... ..... ' i. .2. .................... (Signature of applicant, or name, if a corporation) C I "-' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................. %~...~...:.~.%..". ....... ~ .................. ~.......~ ................ .¢....,....~ ............................. Name of owner of premises ....................... R.....n ...................................................................................................................... If applicant i~ a corporate, si~ct~re of d~ly c~thorized officar. (Name and title of corporate officer) 1. Location of land on whi_ch proposed work will be done. Map No: ......................~.~...~.~[..-i-~ .......... Lot No: ....:~.~.:~' ....... Mumc~pohty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................(,.,;:.'~.~..~[Z::?.: .......... ,;.c.!. ?.~.~..~..~. ......................................................... b. intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): N~ Building...~.'. .............. Addition .................... Repair ........... ~r~.....Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.~,,~...t~? ............................................. Fee ..~.~ ....................................................................... (toibe paid on filing this application) 5. If dwelling, number of dwelling umts ............................ ....Number of dwelling units on each floor ............................ If garage, number of cars .............. ..':Z~...~.. ....................................................................................................................... 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.....?..~, ................ Rear Height ............................ Number of Stories 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ................................................... Name o.f Fo~rm,qr Owner ........................................................ 11. Zone or use district in which premises are situated ........... /..~....?.~.~.'..:.:; ........................ ~z~'"~.'~'z'~~ ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation?~........~...~...~.. ............................ 13. marne at uwner or premlses....~. ....................... % ......... ,~aar ~ .......................... ;?..~,..~. ............................... Name of Architect ........................................................ f ,('I Address .................. r'~ P:~'"'""',~ ............... Phone NO ..................... Name of Contractor...~..,'.....~.~.?.'i>?..~......:.~ ..................... Address 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 YORK,,- f, ) S S COUNTY OF ..~J.~.~'¢t),kq./i~-.-.) ' above named. H~the ............................. ~.c~,~..,.~,~.~-.. ................................................................................. ~n{ra~tor, agent, cg~porate 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 contain~,~ in ~is application are, true to the best of his knowledge and belief; and t~at the work will be performed in the ~q~'E S~t f~rth in the ~p[ication filed it~erewith. Sworn to before me this .............. of ....... Y, of