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HomeMy WebLinkAbout670-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at..~.lJ;J~..~.O.a,~..J~.OLt~;J%Q~.¢],l..~.~'~... ~ Map No ........ .?.?.?. ......... Block No ........ .?..*.?.. ......... Lot No ........ .?.?.?.. ..................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............................. .~..~..~.....]:..1. ............ 19...~...~.., pursuant to which Building Permit No ....... ~,..~.1~. ......... dated ............................. ~L~...~, ........... , 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 .............. ........................................................ J~Z~',C~L~ .. 0]~.. F.A~ILZ.. D. Ialg Tff. =l~iO. ....................................... This certificate is issued to ...~...e..a...~..~..~...O..e.....~...O.~-g_~..~..~..t....~...%~[~.~. ........................................................... (owner, lessee or tenant) of the aforesaid building. ....................... ....: ................ ,~r...~ .,~;..' ........ ~.,~. BulJdln~l Inspector ~ HOWARD M. TERRY 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.° 670, z Date .............................. I~...... 1'1 ........... 19.,,~... Permission is hereby granted to: 0,,,~- o~.t~,o~ ..~.c....~??.t.?.?.....~ ................................. ............... ..O.~ .,.~...a. ,....~:.l'..,. ................................. to ..... .c..,.~.,....~..~ ~.~.t.~..~..~..~:..~.~.,..t...~z .~.,..,.~..~..~ ............................................................... at premises located at ....~./.~.....~.~:i.~.~..~lt~ .......................................................................................... ........................................................... .s..o. ~.h..o..~....~:.~.,. ....................................................................... pursuant to application dated ................................. ll~r..l'l ................... 1S5~....., and approved by the Building Inspector Fee ~.. ?...0~.. ................ Building Inspector FOP~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, lq. Y. Examined ........... ..~..~...~.~.....~...(.L... 19.....~-~...~ App oved ........................................ 1 9 ....... Perm~ ................................ (Building Inspector) Application No ......6..'Z..©. .......... 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 o detailed description of layout of property must be drown on the diagram which is port 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 Lows, 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. ...... L ..................................... (Signature of applicant, or name, if a corporation) ............. ........................ ,,/(Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Name of owner of prem.ses ........... ~,~.',~.-~.~.~.<..~.'=..~.~....,-:.~.r. 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 ................................... Block .................................. Street and Number .~.~...~.:...~;:~~.....~...~. .................................................... State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... "~-~ ,~~'"' ;/.~.~..~cf,~.. ............................................. Intended u~e and occupancy ........ 3~ Nature of work (check which applicable): New Building .................... Addition .................... Alteration......~ .... Repair .................... Removal .................... Demolition . ................... Other Work (Describe) .................... 4. Estimated Cost ......... ../~.../.¢.~/:~/.J..~?. ........................... Fee .~..~...~..'~... .................................................... (to be paid on filing this application) FEES: if dwelling, number of dwelling units ............ ./.~ ............. Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................................................................ 6. If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front ....... ~'.~....~ ............ Rear ....... .~..~..../. ........... Depth ...... ?.../z~..~ ............. Height ......... ~ ................ Number of Stories ................... ~ ........................................................................................ Dimensions of same structure with alterations or additions: Front ......... ~.(. .............. Rear ......... ~ ............. Depth ......... 2.~ ............... Height ........... 2.4 .............. Number of Stories ....... ~ ...................... . 8. Dimensions of entire new construction: Front ........ ~ ........... ~e~r ....... ~ ............... Depth ............................ Height ....... ~.~{, ............ Number of Stories ..........~ ................ 9. Size of lot: Front ....... Z~ .............. Rear ...... ~.~..~. ........... Depth ....Z~: ................ 10. Zone or use district in which premises are situated ...................... .~ ..................................................................... 11. Does proposed constructi~ violate any zoning law, ordinance or regulation? ........ ~ ..................................... 12. Name of Owner of premises~44:~.~.¢. ~~ ~..Phone NO. ... Address ..................... Name of Architect ................................... ~...., ........ Address ............................................. Phone NO ..................... Name of Controctor~.~.~2;~ ...... Address .... ~.,,~. ~hon* ~O.~.~ PkOT DIAGRAM kocate clo~rly ond distinctly oll buildinos, whethor existin~ or proposqd,..ond indico~e oH set-bock dimensions from property lines. Give street ond block numbers or descri>tion occordin~ to ~e}d, ond show street nome~ ond indicote whether interior or corner lot, STATE OF NEW YORK, ) SS.' COUNT,,.Y~r~i /¢ ,.~ ,,~,/OF ....~.; ................ F~) .,, . (Name of individual signing application)/~, above named. He is the ......................................... .C..-;/.Z~..~,q.~.~:~,:..~.~'"' .................................................................................. (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 c~pplication; 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 in the application filed therewith. Sworn to before me this "~d ././.,.::'... ay of .................... ~... 19...~,.. .... // Notary Pu .. (Singature of applicant) JIJDITFI T. BOKEN A~btazy Pt~M~c, State of I~4ew YorA' TOWN OF SOUTHOLD BUILDING D£?AETMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No......~, ..~-~..~ .......... APPLICATION FOR BUILDING PERMIT 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 o detailed description of layout of property must be drawn on the diagram which is port 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 p,urpose whatever until o Certificate of Occupancy shoi[ have been 9ro~ted 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. ........ ~,,, ~/~ ~,~.. ~. ~.... ~ .~.~'::. ~. ~.; .~ .~. ;...~ ..................................... (Signature of applicant, or name, if a corporation) ........................... ................... (AddreSs oF applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. ......................................................... ......................................................................................... Name of owne of premise ............ ~:~¢~.;; .............. ¢¢..:...~¢r.... ............................................................................................. 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 b~e done. Map No ............... ., ................... Bloc < .......................... Street and Number .* · E(-.~. .... ;;' . ................... State existing use and occupancy of premieses and intended use and occupancy of proposed constructiOn: a. Exist ng use and occupancy (,~ '/' ~., ........................................................... b. ntended use and occupancy Alt t' 3. Nature of work (check which applicable): New Building .................... Addition .................... era ~on .................... Repair .................... Removal ........ i ........... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .......... ..~.~.~.~..~.-,...."~... .......................... Fee ..l..~....'~..i ............................................................................ (to be paid on filing this application) FEES: / If dwelling, number of dwelling units ............................ Number of dwelling units, on each floor ......................... If garage, number of cars ........................................................................................................................................ 6. If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front ....... ~.'..~'./. ............. Rear ...~7...'.~...~ ............... Depth ....~..~..../. ............. Height ....... ,-~7~....r. ............ Number of Stories ............. ./. ............................................................................................... Dimensions of same structure with alterations or additions: Front ........... Y..~'.....( ........... Rear ..... .'~...;:'~..../. ................ Depth ....... ,~.'..(. ............. Height ........ ~-~....l. ............ Number of Stories ........... ('. .................. 8. Dimensions, of entire new construction: Front ........ .~'.~.. .............. Rear .?..~'~../. ................. Depth ~..,..~. ..................... Height ....r,~ .................. Number of Stones ...... Z .................. 9. Size of lot: Front ....... ./.~.~...~ ........... Rear ...,(',~.~../. ................ Depth ....,,~.,.~;f..:..z. ........... 10. Zone or use distr'ict in which premises are situated ...................... ~ .................................................................... 11. Does proposed constructio~q violate any zoning law, ordinance or r~gulation? .................................................... Name of Architect....~.~ ........... ,~ ............... ~ ..............Address ......... .~ .............................. Phone NO~. ................... Cant ractor~;~.~¢ Name of ......... Address , ..... Phone N__~__.~.K2 PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propose~, grid indicate all set-back dimensions from property lines. Give street and block numbers or description according to Ue~d and show street names and indicate whether interior or corner lot. .......... ] .. . ........... :¢p ........... STATE OF NEW YORK, ) S S.' 'COUNTY ~ ............................ ) , .............. ~.~ ............................. being duly sworn, deposes ~nd so~s the~ he ~s the (Neme of ind{vidue~ signing ~plicetion) above named. He is the ................... C.~;~k ........................................................................................................... (Contractor, agent, corporate officer, etc.) of said awner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that ali statements cantained in this application are true to the best af his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to be[ore me this ............... Z4.~ day of .................... ~... 19.....~..~... (Si,got. re of o plicont) Notary Publi .*~./..: ' JUDITH ?, BOI(EN ~{~l~ Pubhc, State af New York ~JS. ~,~44983, Suffolk County