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HomeMy WebLinkAbout635-zFORM NO. 4 TOWN OF SOUTNOLD BUI£DING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. CERTIFICATE OF OGCUPANCY No. ........... rate ......................... ................. THIS CERTIFIES that the building located 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...~..~L~. ............. dated ........................... .J~..~..~.~......~.~....., 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 .............. ......................................................... P~ ~V.A,TE...~ ~i~Z,...FA~ILX. D~'ELLIKG ...................................... This certificate is issued to ...~.~,.b..e..~,,t,,,.T.~,,,,~.~,,'~],,~.~k%y.~..p.~la~. .................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector HOWARD M, ~E~y FOR,M NO, ;~ TOWN OF SOUTHOLD 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? 635 Z Date ..................... ~px~il....~ .................. 19.59... Permission is hereby granted to: D. Jehu..~o %endorse...-A/¢.... Ro-be,r¢...I~l-ti.~.a.y ............... .......... 5q5' '"~a're"l~r} ............................................. ................. ~k~lea~.....I~ o~r.o ...................................... to ..BuS. id.. ~e~-. ~r~e..x~a.~i. ly. 4t~ell;~n~ ............................................................................................... ct premises located at $/.g....~es%..V~e~..Dm~ve .................................................................................... ............................................................. ~a%%.:[~;uek-~.....M ~.~f., ................................................................... pursuant to application dated ..................... Ap~l.l..~-~ ........................... 19..~.9..., and approved by the Building Inspector Fee $.. iD.e.Q~ ............ uildmg Inspector TOWN O~: SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFF,ICE SOUTHOLD, N. Y. Exomin d ........... .:.. Approved .............. Disapproved a/c ....... I .................... ./. ........... .~z'.~ .................... .~C......I ................. ~'~rC.~- ~' Application No ............................. 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 So~rthold, Suffolk County, New York, and other applicoble,,Laws, Ordinances or Regulations, for the construction of buildings, additions or a Iterations, or fo.r removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ~ (Sig~fure of applicant, or name, if a corporatiom (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. premises ~'~ Z~ -,'~,(~ ~ 7-- ~...'~/-~/-'/"¢) '"'¢~. ~./... ~' Name of owner of .. .-. ...................................................... ~---- ..................................................... 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: .................... ' '" ' Municipa?ty ~ ~/~ C ~ ~ 2. State existing use and occupancy of p~emises and intended use~ an~ ~ccupancy of proposed construction: a. Existing use and occupancy ............~ ...................................................................................................... b, Intended use and occupancy ...... ~.~ ...... ~.~......~.~....~.~.....~.~.~......~.C.~.~.~ 3. Nature of work (check which applicable): New Building.....l.4'..............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 ......... i:'....~ .............. 7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................ Height ............................ Number af 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 ...,.~,.,~f,.." ............. Height .......... ./..~...~--' ....... Number oF Stories ...... ..~.. .................. 9. Size of lot: Front ../...~....~.. .............. Rear ...... ./...O..."~..~...-. .......... Depth ....... ./...~..?....~'~...~....~...~P,'~ 10. Date of Purchase .............~~....f....~....'~.,G(..Name of Former Owner .................. ~ ............................... 11. Zone or use district in which premises are s~tuated' .................. C~... ........ ~. ................................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation? .... z~..O....; ................................. · al,,;.,,,, Z/-,/,¢ 'il& 7/? ,.r't- ' ]3. Name of Owner of premlses.,~.~. ....................... ~ ...... ~dress .f..~....'.~...~-.~. ........................ Name of Architect ................ :.;...;.....7; .......................... Address ............................................ Phone NO ..................... Name of C~ntract~r~``~:~'.`./....~.../.~....~.~....~../~..~/~..~...~..''~''~.'.''6....Address .~..-,?d~...~...."~...'~....&'......'~.,O.. ......... Phone NO. ,?..~...-..'~.....--.... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed,X~ indicate all set-back dimensions from property lines. Give street and block numbers or description according to ,¢~]'; and show street names and indicate whether interior or corner lot. STATE OF NEW_YORK, ) S S COUNTY OF ,~...~.~...~.~'~.....) ~ ' . . ~ ~ ~ . ~z~ b~, depo,~, a~d ~y, th~ h~ ~ ~h~ ............................. r. ........................... ~ ..........................g duly sworn, (Name of individual signing application) above named. He is the ...................... ~.~.~.~.~ .......................................................................................... (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 th s application; that ail statements contained in ~¢~cation are true to the best of his know]edge and belief; and that the work will be performed in the m,a~'~att~.~,¢~Dlicat~on filed therewith. Sworn to before me this , / Suffolk ~.Suffolk (,aunty . /~dav of ,~/ ~. ~~'[[p~;~¢~Si` (Signature of applicant) ................ ~ ~.::~fr.~.-~.,Z%Z. "~~ -.~0.,9~ ~. Notory Pub~~.~.~i.~:~ ......... Coun~ ~ ~ FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (Building Inspector) /~,~- APPLICATION FOR BUILDING PERMIT Do,e ................... ........ ........ .... INSTRUCTIONS o. 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 premis~?;~relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must ~Jrawn 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 pm-pose 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 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, i~a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..,.ex/... Nome of owner of premises ......... ~.-.~.~..:..7~.. ................ ~g..~...5 ......................................................... 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. Mop No: ............................................ Lot No: ....-~: .............. 2. State existing use and occupancy of pr~mises and intended use and occupancy of proposed construction: b. Intended use and ~cupancy.....~.~.~. ...... ~......~.~.~.....~.~....~.~.~.~(~ ....... 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 same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construct!on: Front ........ ~.~../~.....' ...... Rear ........ ........... Depth ................ Height .......... .~..~ ......... Number of Stories / .... 9. Size of lot: Front ...~:~ ............... Rear ...... ~:~Z .......... Depth ......[~.~.¢. 10. Date of Purchase ~~ /~ Name of Former Owner 11. 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.~.~:~r:~..~.t~'~A~dress .4.~;f~..,.g. ff.;',K....?~.2.. ........ Phone NO ..................... Name of Architect ................. 'Z..~;.q....% .......................... Address ............................................ Phone NO ..................... Name of Contractor.~...';(~¢'~r.~...f~.~'~(F~7..Address %~.~....~ ......... Phone NO. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed,~d indicate all set-back dimensions from property lines. Give street and block numbers or description according to d~, and show street names and indicate whether interior or corner lot. ~ ....... /.~11,,~t ,,'~r~'4 ........... STATE OF NEW_YORK, $ $. COUNTY OF ~.~.~..~*~.....) .......................... ~.f.....;;.~...~...~'.'~'.........~....(.~.~.~.~...~I/....~...~..~..~..~.being duly sworn, deposes .and soys tha~ he is the applicant (Nome of individual signing application). abave named. He is the ...................... .~..~.~q~.~.~.~.~ .......................................................................................... (C6ntractor, agent, carparate officer, arc.) of said owner ar awners, and is duly authorized to perform or hove performed the said wark and to make and file ~his aFp cation; that all statements contained in this application are true to lh~ bes~ of his knowledge and belief; and that ~he work will b~ performed in the m.onner~forth in ~he application filed ~herewith.