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HomeMy WebLinkAbout640-zFORM NO. 4~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ......................... Date .......................................................... , THIS CERTIFIES that the building located at,.,~..*.,O..~..~.~..~./..~....~.?:.~...~ .............................. Street Map No ........ .x...x~.. ........... Block No ......................... Lot No ................................................................. conforms substantially to the ,~pplication for Building Permit heretofore filed in this office dated ....... A]?~I 1~ 19,~ pursuant to which Building Permit No. ~J 6/~0 dated Ap~'.fl-] ~17 19.?.?...., wes issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy forwhich this certificate is issued is .............. Private orie family dwel~iing This certificate is issued to ....~.z.?~[..~!}.~!~?..~. .......... .0...~...~ ................................. [ .............................. (owner, lessee or tenant) of the aforesaid building. ......... ,"T ¢) ............................................... ~ ......... Building Inspector FOIP~I~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPL£T~ON OF THE WORK AUTHORIZED) N? 640 Z Permission is hereby granted to: pursuant to application dated A~rIL ~} 1~ ~9 .......................................................................... , and approved by t~e Building Inspector Fee $..~.Ca ............... Building Inspector .... k" ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined Approved ........................................ 1c) ........ Permit No ..... ~ .................... Application No. ' (~ 'f ~ APPLICATION FOR BUILDING PERMIT Date ........ /~..~../~.../....L~. ........... /.. '.:~ .............. 19.,~... .... 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 issugnce 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 avqilable for !nspection through~qut th9 prego'ess of the work. e. No building shall be occupied'or used in whale or in part for any pui'p~s'e whatever Until .a Certificdt, e 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 'YorE, and'0th~'r applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or a Iterations, or for r~mo~91 o~ demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances ~nd 'regulatigns. (Signature of applicant, or name, i a corpora ' ) · (Address of applicant) State whether applicant is owner, lessee, agent, architect, enginee( general contractor, electrician, plumber or builder. if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) -I, Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable)i: New B6ilding .................... Addition ....~ .........Alteration ..~ ........ Repair .................... Removal ..............:....,Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ....... ..~..J....~..,.~. ....................................... Fee .......... ~..5~.!.~..(-,-) ............................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ~..~..~ ......... Number o~ dwelling units on each floor......O,~.~ .......... 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 ....... ]~.l ................ Rear ....... ~..~ ............... Depth ...... ~.~ .............. Height .......~.~. ........... Number of Sto6es ......... ~.~..~ ....................................................................................... Dimensions of same structure with alterations or additions: Front ......... ~.~.~. ............. Rear ...... ~ ~ Depth ........ ~.~.~ ............ Height ........ ~.~ ............ Number of Stories ..~.~.~ ................... 8. Dimensions of entire new construction: Front ......... .~ ............. Rear ......... ~.~ ............. Depth ~ I Height ........... .~. ............. Number of Stories ...~ .............. 9. si~e of io~: Fron~ ....I.O.~d.~ ......... Re~ ..... L~..~.~ ...... Depm ...L~.~ ................. 10. Date of Purchase ...................... ~.~.~.~. .................. Name of Former Owner ......... ~.~.~.¥ ...................... ~ 1 1. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ~.~. ................................... 13. Name of Owner of premises.~..~..~Address ............................................ Phone NO ..................... Name o~ ~.~...~...~... ~ .......... Address ~.~~hone NO.~.~7~ Name of Contractor..~...~.,..~.~J.~ ............ Address ~.~.~..~Z~hone NO..,.~/~.~ ...... PLOT DIAGRAM , Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr lines. Give street and block numbers or description according to deed, and show street names and interior or corner lot. STATE OF NEW YORK, ) S S. COUNTY OF ..~...W.~.~..~...X:~'......) (Name of individual signing application) above named. He is the ................ ./~...,~.....~...~....~./...~..,~/...Z}....~ ........... ..~..../~....~..../../..~..~.'~....~'.,~ .................................................. (Contractor, agent, corporate officer, etc.) of sakJ 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 will be performed in the manner set forth ~n the appl~cation flied therewith. · ,, FRANK E. SQ~INSKI Sworn to bee re me this }e~r ~AgY PUBLIC,StaI~ of N,w~A ~ ~/. //~/ .......... ........ of ....... ............ <~. ~ ~ Commission .................... ............... TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~" L.(] ! '( 19 '~. Approved .................. L! ................... 19.~.....Permit No .... ~ ~.?~,~ ......... ...... ............... ......................... (Buildin~ Inspector) Application No ........(¢... f:!...O. ........... 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 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 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) ....... (Address of 6pplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................................... Name of owner of premises .............. .~...'.~..~...~...~..~.......~.'.....,.~..u..~...O.-L....~,''~' ...................................................................... If appliCant.is a corporate, signature of duly authorized officer. (N6me and title of corporate officer) "1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... ' Street and Number ............ O.~....5..~D..~.~.~. ................ I..L.LI.~.~.~.) ..................... Municipality 2. State existing use and occupancy of pr, emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................. ~.~.l~.~.~-~...~......~-O...T'...'~...~-.~..]~,. ................................................................ b. Intended use and occupancy ............. ..~.~..~L~..~..~..~....~',.O.~.~..'J~.~..C~.~T.~. ................................................................ 3. Nature of work (check which applicable): New Building .................... Addition ....~. ...... Alteration ..~ ......... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost......~..l..~::~..Q ........................................ Fee .................. ~....,,~'.~..q.~...~... .................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ~;t..~....----~.. .......... 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 .............. ~;:~..t~ ................................................................................... Dimensions of same structure with alterations or additions: Front ........ ..~'....~... ............... Rear ...... ..'~'...~ .................. Depth .....~,.~,.~ ............... Height .....2..Q. ................ Number oF Stories ...... C2...~..?h,-. ............. 8. Dimensions of entire new construction: Front ........ J..,~..! ............ Rear .......... ~ ............... Depth ....~..~. ................. Height ....... ?....Q.t. ............ Number of Stories ..... O...~..,~, ........... 9. Size of lot: Front .l.C;~r....I..7. ............ Rear ..1.~..~.:..~...~. .......... Depth ............................ 10. Date of Purchase ................. /...~..~....~.. ....................... Name of Former Owner ....../~..~.~...~./~.,~...~. .......................... 1 1. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~..Q ...................................... 13. Name of Owner of premises../~..~...D.~.I4J..~).../~.a.~..4./9~Address ............................................ Phone NO ..................... Norm°et'of ~.~..~.(:~QF,,J;~....~,..~/~.H.%~i~ ....... Address lY/~lg~.~.kh~.fi,~..,/.&~ .~.ff~.T. Phone NO.J.~r..~.~;~,7.. Name of Contractor .~.~...W ..~,~, ~ J~L.T..7~-.. ............... Address ...i~'E~.V~.$.~...~.t~.'D'kT.q~M~.Phone NO..~..J.J..~ ...... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back lines. Give street and block numbers or description according to deed, and show street names and interior or corner lot. fr STATE OF NEW YORK, ) COUNTY OF ...,~./Z,..,~. ,'~.~...~...~......) SS. ........ I(~ .~. ~ [~' ~' ' '~[~l~ . '~ '''~ ............. being duly sworn, deposes and says that he is the applicant -- (Name of individual signing application) (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 will be performed in the rj0ar,~e~ set ~o,r,t~ in the//application filed therewith. Sworn to befgre me this '~~ Nota~ Public, .................. ~.~.4~(~.~.~.~...~m~h. fc~ ~,