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HomeMy WebLinkAbout267-zFORM NO. 4, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the budding located at ~[O!CI~i~J...~.V~ &..l~c~ood..l~,d ........ Street Map No ..... ~C~¢, .............. Block No ............ XXX ............... , conforms substantially to the Application for Building Permit heretofore flied in th~s office dated ............................ ~t),~,l..~/. .......... 19~'~ .... pursuant to which Budding Permit No '"~"~7' ............ , dated ................... AI~J.~[. ]-~. ....... 19...~., was issued, and conforms to all of the requirements of the apphcable provisions of the law The occupancy for which this certificate ,s issued is ............ ...................................... Pm.i.v.a.te.....d.~ellin8; .............................................................. Th~s certificate ~s issued to ~Q~aS.. ~]./~e~. ....... .(...Oh'fl~,,,Tt..) ................................................. (owner, lessee or tenant) of the aforesaid budding FORM NO. 2 TOWN OF SOUT~OL~ 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) No. 267 Z , ~ote .............. ~,~.r~.;L....~,[I. ................ ~..8..... Permission is hereby granted to: ~!~t. Broo~r .~.~..~.e.r.e......~..q....T~.~...P~..~-.~. ................ i ............... ill.t, ~. ~'A ............................................ I ............. l~t,. t~naf** .... ~:Z~ .......................... at premises located at ..IK~Ld~:tO~..Bd .& ~u~l~_~.~,~ .............................................................. ............ i ........................................... ~/~t,e.~oga~ t .... ~.Z. ................................................................ pursuan~t to application doted ................ A,~l~.i~..~ ........................... 19.~ .... and approved by the Buddinq Inspector Fee $... ,~)....*.~.....]~..,~ ~ ~udd,ng Inspector FOI~ NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL Fde No . .Z....=0..6.2 ................................ Date .................. .A.~.~.i...]-..7 ....................... 19..~..~... To ..... N.t, .B~..o.ok...Builder. s...a/.a. Zho. a..Delaney · .M.~..~i~ni.~...~Y., · ....................... PLEASE TAKE NOTICE that your appl,cation dated ........................... ..A.?..r..i..1....Z ...... 19..~.~... for permit to construct .~ .. ~.W. .~. .1. .1. ], .r}. F~ ................. at the premises located at Hql..d..e...n....K...v.?..~.....&. ...... ....... [~.[.i ~ ?,.q. .o. 9.d. . . . . ~ .o. .a. . .d. . ~. . . .C. .u. . .t. .c. ?.n. 9.g .~t. ~ .~ . . .N. . ,S~Yme t Map .................................... Block ............................................ Lot ........................................... is returned herewith and d,sapproved on the following grounds ....-q.'.h...e.?...e....J.:.s....~.o...t....l...0...0....f...t.:. ......... ........ £~oza~ge...ozz Holdez~. A¥~ ............................................................................. /s/ Howard M, Terry Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ....... ....... .................. (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 puFpose 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 regulations. (Signature of applicant, or name, if a corporation) ......... ........ .............................. State whether applicant is owner, lessee, agent, ar.~itect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.../..~..~...~../~.~.....~....~. '.;)....~...~..~./~...~J....~..-.X)...~....~..~/. ............................................................... If applicant is ~ corporate~.~duly authorized of fleer. .... ................... 1. Location of land on which proposed work will be done. Map No: .~..~. J~.~.l..~...~..~....~'...... Lot No: .................... Street and Number/~J~/-AJ.~.~-~......~.~.,..~..~..../-.~.~...../Vu~)r~;~.~p..c~ii-..ty-'..~..~./..~.~..~..~.~ ....... .../~'..:..~.- ...................... i ...... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................... ,,~.....~.....?.. i:J::::.~.~ ....................................................................... b. Intended use and occupancy.......~...~.....~...~..~...~.....~..~....../'~....f ................................................................... 3. Nature of work (check which applicable): New Building ......... ~..........Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ......... ..~......~.~.~ .................................. Fee ..{..0.......°~.... .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... J. ...................... 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: ~:ront ............................ 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 3 *3 ' Depth ............................ Height ........ ~r'r~ .~...! .......... Number of Stories ...J...~.(~ ........... /~]O Rear ./~3 Depth /..~..~.. .............. 10. Date of Purchase ............................................. f Form ] l. Zone or use district in which premises ore situated ........ : ..... ~....O'xCr~ ................................................... 12. Does ro osed construction violate on,/ zoning law, ordinan, ee or regulation? ..~...~....0. .................... 13. Name of Owner of premise~..~.~...~..~..k..~.-~..~.~. ............ Address .~w../.ZL~x~..~.....v'z.+~..~.~'.%.~.~.Phone NO ...... .?..~...f...')~ Name of Architect///~'" ~/"~ ....................................... Address ..~; ..................................... Phone Ng.~/~.;~w.w~..)~F . NO...~: ~....~... ~.(. Name of C~nt~act~./.A..~..~.~..~..~`...~...~.~;/~t~Addres~r~..¢.~..~.~.r..../~....~..~..~'''~'''~''' ....... Phone / ~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, end indicate ali 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-YO~ ~.. ) S S cou NTY OF, · ~;..% .~.==...= ............... being duly sworn, deposes and says that he is the applicant ................ iNa~'g¥ indiVidual/signing ap~~ above named. He is the ...........................//'~~~~.ii .................................................................................. (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 app 'cation' ....... that a statements contained in this application are true to the best of his.,>~k~wledge_, and belief; and that the work will be performed ,n the manner I~_ f~d~ ,n_the appl,cati~'~er, ew~'C~ Sworn to before me this .~ ~/,~/~ ~01~0~'~/ ~--~~- )-- ', . .- 2 '~. day of.~,-.pA-..-..~ I~//~ $.~ ¢ i,~J~natur~apph'~ant .................... . ,< ^ .... :" .... Notary PuNic, ,....~.~.~...:."C~'~y ,r~ ~o,~ ~?