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HomeMy WebLinkAbout636-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY ~, 650 June 15 60 No ......................... Dote ........................................................ , 19 ........ THIS CERTIFIES tha,t the, building located at ..~S..~e..a~...~..~...~..~.~...c.~...e..~..t~.~.e~a..'~.~..~...~'~..~.~.t!.~ 5~Pe~hole1' 14~eawooa Acre%l~.,. *** .1,.4, Map ................................ No ......................... hot No ................................................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................... A.~.~.~...~. .............. , 19. . . .5. ?. ., pursu.a'nt to which Building Permit No. S 636 dated ................. ..~.?.?..~...~.4. ................. 19..~..~..,wa.s 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 Geor~..e,..J.; & Satlt~z'a Lo Ber~.'y~ owners (owne, r, lessee or tenant) of the aforesaid building. Building Inspector 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? 636 Z Date ...................... .,~.~....~ ................. ~9~.9. .... Permission is hereby granted to: ~ e ~:r~_~e...& ~%z,..~z'e., ,B.e~.r~. ...................................... ............... 2.~c~ni~ ~....N.~... .................................... ~ o. B.~ild..a~'~...g. tl~...tt.~.~.~.~....d.~.Z.~i.~.~g. ................................................. ~ ............................................. at premises located at ....t,t~..~f..]J,.~....e,~.~,e,.~.o.o, ct..A~,~te~ ........................................................................ ................................................ ~z...v..t.~.-. ........ ~?;~.%?!..o..z.~.,.....?....~.: .......................................................... pursuant to application dated ...................... .~.,P.?.~.~.,...~ ....................... 19.~.~...., and approved by the Building Inspector Fee $~.0..._ .0~,. .............. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~ N. Y. Examined ....... Approved ......... ~........z/...~....19~Permit No...~--~.~..~.. ........... Disapproved a/c .......~/:'-"-~'~ ..~....~.....;;Zz.z;~~ ....... Application No ......~....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 thro'ughout 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and ~e~g~ulations. ............ ................ (S'ignature of applicant, or name, if a cod~ra~on) .............. ............... (Address 6f applicant) State whether applican~ is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem~ses..,¢ .............. ~-....:~ ........................................................... ~.....~ .............................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Locat,on' of land on which' proposed work will' be done. Map No.' .;~¢.~<,Z/'C~.~.'c~...c.f-cCc'C~.C;.~t· · ~ No' ..... · .~../?.......... Street and Number. ~,k,~.c~'~...~.;.?q<J~,*¢--~. ¢-~.~.'.~,~.'~..~'/...%:¢~..~..~. ...~.~.f..~ , ·. Municipality State existing use and occupancy of pr. emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ~..-d'r.< ~: :-,~ .~./. · ·.. · .¢~..'.~..'¢./. · · ................................................................................... b. Intended use and occupancy ....... ~~'~.T¢:~~. ...................................................... 3. Nature of work (check which applicable): New Building / Addition .................... Alteration Repair .............. .,i~..Removal .................... Demolition ....................Other Work (Describe) .................... (to be paid on filin~ this application) 5. If dwelling, number of dwelling units ............. ~..Number of dwelling units on e~ch floor ............................ If g~rafle, 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 ............ ~.~ ....... Rear ........ ~'~ ........... Depth ...~.~. .............. Height ............................ Number of Stories ............. 9, S~ze of lot: Front ............................ Rear ............................D p ................ .../=..... 12. Does proposed construction violate an~ zoning law,e, ordinance or regulation? .................................................... Pk~DIAGRAM kocate clearly and distinctl~ ~H buildin0s~ whether existin~ or proposed~ ond indicote oll sea-bock dimensions from property lines. Give street ond block numbers or description occordin0 to deed, ond show street homes ond indicate whether interior or corner lot. STATE OF NEW Y~K~ ,~./)~ S S ...... ~,.~a,~rr~.(:.~.~.~-~.~.x~,~.,~(,~/.. .................. being duly sworn, deposes and says that he is the applicant ~ (Name of individual_signing appl~]~d'tion) above name~JfHe s the-- ...... ~..~;.6.:'.'~..¢ f.~. · ........................................ :~ ............................................................................... " (Contractor, ogen}, corporate officer, etc.) of sa d owner or owners and is duly autho.ri~d to perform or have performed the said work and to make and file this application; that al statements contoi.n~id in this application are: true to the best of his knowledge and belief; and that the work will be performed in thb mannerW~,f,,ii~./~ ir~.t, be application filed therewith. Sworn to b/efgre me this ./. ~..~...~ da" of ,.---~4~, , ~/ ~ll~l~lij~,~. ~Z-~ ~I'~1 (Sigfmture of applicant) FO11M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am ned ............. Approved ....... ~../...'~'~....... 19 .~.~... P e r mit No ...... ..%~.....~....~-...~.. ....... Disapproved a/c ..~...... . ........................................ ~:....~ 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 Southold, 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. (~?~gnature of applicant, or name, if a cor~"rati'on) .............. .............. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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 [~roposed work will be done. Map No: ...~~~Y-,z~No: ..... ../..~........ Street and Number Municipality - 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy .............. ~ ................................................. 3. Nature of work (check which applicable): New Building ........ ,.~..........Addition .................... Alteration .................... Repair ............... ~.~..Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost...i'.../..~.~..~)....'~..~'" ................................. 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 sarne structure with alterations or additions: Front ................................Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ............ ~.. ....... Rear ....... .v.~....~'.. ........... Depth ......~.....~.. .............. Height ................... ~ ........Number of Stories .../....~.~ .......... 9. Size of lot: Front ........'~.../~..~.. ............ Rear ........ ../'../...~.....'~.. ..... Depth ......... ../.....~.../~..../.~'~-~') 10. Date of Purchase ...~~~...~..~......~..~'..Name of Former Owne~~ 11. Zone or use district in which premises are situatea ................ ,~.~ ......... ~~-~-.=...: ....................... 12. Does proposed construction violate any zoning law~,/ordinance or regulation? ..: ................................................ 13. Name of Owner of premise,,~.~..'~.~..~"~:f~',~s'~/~' ~-"~" ....... ~~...:z..,Phone NO ..................... ame of Architect '/~,~~..-~.~,dZ~dress 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 interior or corner lot. //,,~'~' STATE OF NEW YO,,I~. ,,, ,~ ,4,~' S S COU NT~,OF ..~' . ..... ~~ ................. being duly sworn, deposes and says that he is the applicant (Name of individual ~igning appli~ion) above name~e 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 this application; that all statements contained in this application are true to the best of his knowledge and belief; dnd that the work will be performed in the manner set ~h~hff application filed therewith. /~ 4 ~f ~ 19 ~,N~. s2.~LRlk e0~gnature of applicant) ........... , ........... 5a o- .................... Notaw Public, ..~..~..~'