Loading...
HomeMy WebLinkAbout639-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTJ~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z , UZ r 6 THIS CERTIFIES that the building located at.~../..B....~.O...O..~..~.~.~...~.~.....~...~..~..~...~.~.~.%..~..~..O..~.. Street Map No...~.e.?.~.e...~..... Block No ......................... Lot No ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ApZ~L~L ],6 19...~..?.., pursuant to which Building ~rmit No ....... ~ .............. dated ............................... ~...~..., 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 .............. PRIVATE ONE FAMILY DWE~ING This certificate is issued to ...~.~.~...~.....~.~...~E .......................................................... (owner, lessee or tenant) of the aforesaid building. FOI~M 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 COMPLETION OF THE WORK AUTHORIZED) N? 639 Z Date ..................... ~]p~. ~......~.~. ................ 19~9 .... Permission is hereby granted to: ~ursuant to application dated ........................ .~?~?.~....~..6. ......................]9~.~...., amd aDproved by the Building Inspecfor Fee $, ~.0..: .0..0. ............. Bui/ding Inspector FORM NO. 1 TOW~ OF $OUT8OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ ] 0..i'.....Perm~t No Disapproved a/c ...,N ........ '"-?"="x ............................................ :~'~ ........... ............. .... ~:../.L.: .M.'::.:j .......................................... (Building Insl~ector) INSTRUCTIONS o. 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 pubiic 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 o 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 issuanc.e 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. ..... c ..................... ......................................................... ,v: r' , o (Signature of applicant, or name, if a corporation) ..~..'....: ............................................... : .......... :. ........... /.... Z: .... (Address of applicant) State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of .... '*"* ~'*-./~'.-r.'~,E_.~.~-, ,-'>. ~.~z:'l.-O~'~'/{-"J . . ...................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. /ocotion of lend on which proposed work will be done. Mop No: ............ ~':; ........... ?:;~ ......... Lot No: .................. ........ ................. Street and Number ...................................... )r.~7 .... ~unicipality 2. State existing use and occupancy of pr. emises and intended use and occupancy of proposed construction: a. Existing ~se and occt, pancy .........1~..~:5:):.~..::~..:. ....... ..~/';:~:;.L.~..; ....................................................................... b. Intended use and occupancy ..~,.-b~ ¢ ::'~:~-'~' ~:z~91 ~t~>~- :? ()~'~ "- 1 ' 3. Nature of work (check which applicable): New Building ........ X~ ....... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost_..!...~..>l..~.~.0..0.....~ ........................... Fee / O. ~ .................... (to be paid on filing this application) . 5. If dwelling, number of dwelling un,ts ................................ 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 existinfl 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 ...... ~C.......'~.. .......... Rear ........... Depth Height ............................ Number of Stories ....f~...-'x~....k'~,. ........... 9. Size of lot: Front .....L..c?Z~ .............. Rear ...... ./..?.~ .............. 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...' ............... :~:.~ ............ Address ............................................ Phone NO ..................... Name of Architect......~.:.~..~.:f~.)....~..'~.~ .................. Address ............................................ Phone NO ..................... Name of Contractor...J.~..~.~...~...~x/...~.'. .......... Address ............................................ Phone NO ..................... PLOT D~AGRAM 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,~/'O~,~,~(~,, ) S S COUNTY OF .... .'~¢e.. ~.....) ,' It ~--~' ./...~...'..~.. ~i( ~.~.~..being~.a.(~i~.~..... duly sworn, deposes and says that he is the applicant (Name of individual sign[nfl app' ' above named. He ~s me .......................... ~ .............................................................................................................. (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 this application are true to the best of his knowledge and belief; and that the work will. be performed in the manner set forth in the~application/x filedm. ,~thercwith' Sworn to before me th~s t~_~ ~ ~1' .................. .... _ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ,, . ....... Approved ........................................ 19 ........ Permit No. Disapproved a/c 'i ..................... i'~'~i'lg i~g Insp~c ) Application No ........ ~..7.(...: .......... APPLICATION FOR BUILDING PERMIT Date .................. /I"~ ......... l,~ ............ (_'~ ......... 19.~.../. .... INSTRUCTIONS o. 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 Deportment 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 Paws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................... ............................. .... ............................. Name of owner of ~ .............................. ~z .......................................................... 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 ..b.~./.~. ...... ~.).O:~;~r.,O.~(~..'..~.~.~.7~i..-,~.. ................. ;.~..~J.O~.,~$'~.~.C,~.. ......... ~:~.~.~., ...................... / ~? Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ........ .~..Z~....f~..c~'.~..~.~M.~..~ ....... ?:~..~.~. ............................................................................ b. Intended use and occupancy ............... ~).~M~. ........ -~ ;% ........................................... 3. Nature of work (check which applicable): New Building ........ ~ ....... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost..:....,.j..~..:.,,.0...: ........................... Fee ..................................... (to be paid on filing this application) 5. If dwelling, number of dwelling umts ................................ Number of dwelling units on each floor ............................ If garage, number of 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 .....~......G. ................. Height ............................ Number of Stories .._~:~ ........... 9. Size of lot: Front ..... /...C~ .............. Rear ...... (..'.:~'~ .............. Depth .~...~.~ ............... 10. Dote of Purchase ...... / ............ K .................................. Nome 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. Nome of Owner of pram sas ........................................ Address ............................................ Phone NO ..................... Nome o~ .................. Address ............................................ Phon~ NO .................... Nome o* Contractor .................................................... ~ooress ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly oli 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 ¥ORIG ~ ) S S COUNTY OF ...... ~'~.,~.~,)~,...) ' ''--[ I ~ L~ ~,~,~be ng duly sworn, deposes and says that he is the applicant (Nome of individual signing oppl~otion) above named. He ~s the .................. k:.:,~.~..~.~,.~... ....................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du~y authorized to perform or hove performed the said work and to make and file this application; that a statements contained in this application ore true to the best of his knowledae and belief; h ark w'l be erformed in the manner set forth in the application flied therewith ~ ~ - and that tew . P rn to efore me this , ..... , / .................................................. Nota~ Public, · k./ --'