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HomeMy WebLinkAbout674-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OGCUPANCY 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..2...., pursuant to which Building Permit No......~...,.~,~.?.. ............ dated .......................... ¥',a~...,]-~ ............. , 19.,~.C),., 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 .............. .............................................. ~,tt~Z~.&~...Q ~.. ~,~I~. DWE ~[~G ................................................. This certificate is issued to ..~...~.~.~.~...~....0...~..~.~.. ........................................................................... (owner, lessee or tenant) of the aforesaid building. FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OPFICE SOUTHOLD, N. Y. BUILDING PERMIT THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N,o 674~ Z Dote Permission is hereby granted to: .0. ~!e...~.. ~.~.~,z.e.. ~/.~..~?...~ ~.o.~ ....................... .(~e.e~.~¢~.t,.,...Na~. I~k ......................................... buil~ addi%ioa aa existing dwelling at premises located at ....e..~.~,.~d..e...~..~.?.qD.~..e. .............................................................................. G~eenpert~ ~ew ~erk pursuant to application doted ............................. ~...3~. ....................... 19.~J~... and approved by the Building Inspector ~e $~gg ................ Building ~spector TOWN OF SOUTHOLD TOWN c,.~,~'s O.lC~ SOUT.OLD, N. ~. Examined ......... ~-..~../...~...... 19..~..~. Approved ........................................ 19 ........ Permit No .......... Disapproved o/c ................................................. ~ ................ .................................. ............. (Building Inspector) 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 co~ered 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 Jn whole or in part for any purpose whatever until a Certificate of Occupancy shaJl hove 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. ..................... ...................... (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. ,. ............................................................................................................ · - ' /c% Name of owner of prem,ses.x~...x~...t...../g....~7..,.~ ........... .~. .......................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and titJe of corporate officer) Location of land .o_o,n,which proposed work will be done. Map No: ................. J~ ............... .. Lot No: ......~... ........... Street and Nu ~n~r .~....~/;/~'J.~'.../-~...d.~..f?..~..~---~ .~...~!~...~ ® '.7..,~... c,,~ z.'~/?.~.'. ~..¥~,..~.., ~./. -- ">" MunicipoiiYg'"'7"' ................... 7' ............................... State existing use and occupancy of,pr,emises and intended use and occupancy of proposed construction: o. Existing useandoccuponcy ......... ::.b..~..(Z//.,:?.~..~. .............................................................................................. b. Intended use and ~ccupancy.....~..~..~.//(.~.~...../~.~..~:~.~..`~`...``.``~..`~..c./.~./~..~.~..~..[~w ................................. / 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.D~mensions of entire new construction: Front....~-~n~-.~ .......... Rear ....... ~.~. ......... Depth .......... Height ........ ..~..~..... ........ Number of Stories ...~ ...... · ' ........... ./...~...~.'..~..~ Depth ....... ./.~...'~. ........ 9. Size of lot: Front ..... ./,.~.,~- ..-~... ...... Rear 10. Date of Purchase ........................................................ Name of Former Owner :i. ..................................................... 11. Zone or use district in which premises are situated.....~.. ........ ./...~...~ :......................................... 12. Does proposed construction__ / ,/,violate any zoning law, ordinance or regul,atign? .................................................... 13. Name of Owner of prem.seS~(~.-.f."'"/~...~..'~..~,..O.,~....,Address ...~.~..-.~...~6]/~, ........ ..~¢,~..~..~p ' =" ' ._,~... hone NO Name of Architect .................................. Address ........................................ Phone NO ..................... Name of Contrac . .. .~..?./. .......Address ...... Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly oil 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~,~,_ ~w~;_c./¢'~Z ) S S that he co ,NT ......................................................... ~ ............................ 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 this application that a statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed Jn the manner set forth in the application find therewith. Sworn to bef~ me this ~'/~- /Z¢ ~ _z 7~ 19~ -- , (Signature of applicant) ........... z~ ....... aay u, ;...~..~.....~-.~.. .~.~-~ J~orrff i, BO~J.~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No ............................. Application No ....... .~......;~'....~.... .... Disapproved a/c ........ ~ ....... >..-,~ ............. /.~ .............. . .,~..'~. .............. .,~ ................ ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled Jn by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plat 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 co~ered 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 ail applicable laws, ordinances and regulations. .-?/ ,. :, ..................... "' ' ' ...................... (Signature of applicant, or name, if a corporation) .................... ': .................... Z .......... ' ........ ~.~.,<..:.../...: ................. (Address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................. :?. f:...:: :, :.. ........................................................................................................... Name of owner of prem ~o..:..~: ............ ~.,...~ ............ :~-. ................................................................. If applicant is a corporate, signature of duly author/zed officer. (Name and title of corporate officer) 1. Location of lando~2.nwhlch proposed work will be done. Map No: ....................................... ,..... Lot No: .................... Street and Num/b'~r:,..¥.~:.~/Xx:~.~:....../.2;/g,f('.:.z.;.!~k~,'.. ~.,..c~?..~:~': ....... :...../..]:.:.':..~;.'.(.... x...<',.,,.-:.'...::~. .............................. Mun cipality / x .' 2. State existing use and occupancy of .premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ~ .~.~/~.~.~/../../../...~...r(~.~ .......................................... : .................................................... b. Intende, d use on~l' occupancy ......... L~.~,.././.'..'.. / " ' ' 3. Natur~ of work (check which applicable): New Building .................... Addition ......... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.....~..~.~...t.~..~..C~..z...:.."~.....~..-. Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. ~.)r'~4,~,.....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 ....... ~...c~. ...... Rear ..¢~..~...~. ..... Depth ...~:~... ............ Height ........... ~'. .............. Number of Stories ..£:~¢.~,~,j~__~. ................................................................................... Dimensions of same structure with alterations or additions: Front ...... ~.~. ..............Rear ....... c~.c~.../. ........ Depth ....... .~..~-~...../. ...... Height .............................. Number of Stories ....~ ............ 8. Dimensions of entire new construction: Front.....c¢~.~.~,~ ......... Rear ........ ~'.~'~ ......... Depth ........... Height ........ .~../~..~...'. ....... Number of Stories ...Z~ ..... 9. Size of lot: Front ...... .~...~"~.~.......~.. Rear ........... .~,~_,_~.,~ ..... Depth ....... ../x~. ~.~ ........ 10. Date of Purchase ........................................................ Name of Former Owner~....~ .................................................. 11. Zone or use d,str,ct ,n wh,ch prem,ses are s,tuated....../,~:. ......... .~-~,..~.. ................................................. 6-' 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises,,'~-~.z ...'~'.. ..O.~,~....Address ...~-~.,~/,~.2. . hone NO ..................... Name of Architect ............................../lz/,~_ ~. Z/,.,:~ ....................... Address ..... ,~ ............... -- ~ .................... Phone NO ..................... Name of Contracto~..~,~:~/.~/~..A~.L~..~?./.7~/.~:~. ...... Address .~'~"~/,:~'~).~ ...... Phone NO t PLOT DIAGRAM Locate cleorly and distinctly all buildings, whether existing or ~roposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description eccordinc to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~I~O~J¢, ~/ ) S S COUNTY OF (Nam .... g ' g PP' ' above homed. He is the....~..(~..~.C~".~ .................................................................................................................. (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 manner set forth in the applicatio~filed therewith. Sworn to bef~ me this, ~ ~ ........... of applicant) ~ ~ ~ ~ ~ ~/ ~~ffotar~ Pubhc, State o New YorN Noto~ Publi~/.r.~ ....... ~ounty No. ~2-0344963.