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HomeMy WebLinkAbout685-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z 542 Date THIS CERTIFIES that the building located at B/B ~y ~'~1~ ~e Strut Map No. ~'~..~lock No ......................... Lot ~o ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated of the opp[icob[e provisions of the Iow. The ~cupo~cy for which this certificofe is issued is .............. ~iw te one family This ce~ificate is issued to Arthur Johnson ( ~er~ (~ner, 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.o 685 z Permission is hereby granted to: at premises located at .~.~.t,...~.i[~...~i~.~'~.[e.~..~r.'[l/~ .................................................................... ..................................... ~,~m4~..Nm'.~o~t...~e~..~k ........... : ............................................................. pursuant to application dated ........................... l{a¢~'...~.~l ...................... 19.~'~..., and approved by the Building Inspector Fee $..~.~.0. ............ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. D 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances and regulations. J(Signature of applicant, or name, if a corporation) ....... (Address of applicant) State whether applica?; is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. .............................................................................................. Name of owner of premises ....... ~/.~../.../J...~....~...:.~'.~..L?..~O..~.../.~.. ............................................................................... 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 N~0~o: ............................................ Lot No: ../..~.'.~..~...~"~ Street and Number ............. .~~'?.?...~..~..~..~....~..:~.~.....~...~...~'~'..~..~'-~b~ 2. State existing use ~olcu'a~n~/~ise~s~a;~ i~nteUnn~;~a~-Jnd occupancy of p/~osed construction: .... a. Existing use and occupancy ........ ...~/.~:~;....~..~: ........................................................................................... b. Intended use and ~c~upan~y.........~...~..~...~/~.......~..~.......~4~..~..~.~.`..~....~.?..~3?. ............................................ 3. Nature of work (check which applicable): New Building .................... Addition ......... ~teration .................... Repair .................... Removal .................... Demolition .................. ,.Ot~her Work (Describe) .................... 4. Estimated Cost.......~.~.~..~:..~....~?..:..~ ....................... Fee....~.¥.~...' ..~....~. ................................ (to be paid on filing this application) 5. [f dwelling, number of dwelling units ............. ~....~_...~....Number of dwelling units on each floor .......... .~...~..~... If garage, number of cars ............. ~..6~........~. .................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. Height ............................ Number of Stories ........ .L'..,~t~... ....................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Heightk ................... ~.....Number o~f Stories .................. ~ ........... Height .....~~' ................... Number of Stories ..........~..~...'~ ~ J 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction vio.l~te,any zonir/g [aw, ordinancg.~or reguJ,ation? .... 13. Name of Owner of premises ................. ~..ss ............................................................... Name of Architect ........................................................ Address ............................................ 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 NF~¥!~°,~,, ~ ! S S OUNT ·., (Nome of F llvidu n,ng a lication) above named. He is the ........ ~....~.~ff .............................................................. : ........................................ ~ ~ (Contradtor 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 fi e this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work wdl be performed m the manner set forth m the app[~at~ fil~d thor wnh. Sworn to bef~ me this ~ -- , ~ -'~ x~~ ~ , ~~~of ~.~9~ ~/~x~x~.~ ~ s~'~na~re of applicant) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........... ....... 19. Termit ....... ............ ......... ............. ................... (Buildin~ Inspector) ......... Application No. ~/~J~-~ -- 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 Jocotion. c. The work cov. 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 promises 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, SuffoJk County, New York, and other applicable Lows, 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 gnd,fegulations. ~ /(S~gnature of apphcant, or nome, ~f a cg~?porat~on) .......... ~,.~ ................... L,...~ .......................... ~ .......................... (Address of a~licant) State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... .~/~.~.?.~)..¢Z.~;.~....:~.r~../,I..Z~..~..(~.ff.~ ................................................................................ If applicant is a corporato, signature of duly authorized officer. (Name and title of corporate officer) , , - ' . un,c,pa~y ~ 2. State existing use ~nd occupan~ of p~emises and intended use and occupancy of proposed construction: , a. Ex~st,ng use and occup cy ......... Y..~.f4.~.~;.,,,(~ ........................ : ................................................................... b. Intended ........... ~-.... ............. -~ ............. ~ ....... ~ ......... :...: ............... ::...,~ ............................................. 3. Nature of work (check which applicable): New Building .................... Addition ......... teration .................... Repair ................... ,,~Rerrjoval .................... Demolition ................. .~.Oth_,er Work (Describe) .................... 4. Eshm~ted Cost ........~ .............................................. ee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. ~...~..~..Number of dwelling units on eoch floor .......... ~,~Z..~. If garage, number of cars .............. ~~ .................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each tvp~ of use ..................... ..... .~:~- ~ ~ De th 7. D~mens~ons of ex~stmg structures, ~f any: Front.....~l ....... ... Rear ............................ p ............................ Height ............................ Number of Stories ........ f...~ ........................................................................................ Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ De~th Helght~ ............... Number of Star es ................~ ............ 8. Dimensions~ sntire new construction: Front ........... ~_~ ...... Rear .......... ~,~F ....... Depth .....~ ....... Height ...ZL.. .................. Number of Stories ....... ~..~ ...... 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ lh Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction vio~e~ny~zoni~ ~W, ~[d~an~r r~q~atiooP~.~.~¥.....z~:/ ....... 13. Name of Owner of premises.~.~ .................. ............ Address ...................................... .~.Phone ~0 ..................... Name of Architect ......................... ~.~ ........................... Address ..................... ~. .................. Phone NO ....... ~ ........... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and blodk numbers or description according to deed, and show street names and indicate whetber interior or corner lot. STATE OF NE-~ ~Y~.I~ ~,/~ ) ¢ S COUNTY ............................ ~ff.:~:....f~:.: ............ :~J ............ being duly sworn, deposes and says that he .s the apphcant (Name of ~dividu~-~ning a~plication) ' ' ' i the above named, me s ........ :~..~ ............. )~ ................................................. . ............. ;%. ............. ; ........................................ ~/ ~/ (Contractor, agent, corporate orT~cer, etc4 of said owner or owners, and is duly authorized to perform or have performed the said work end to make and file this application; that all statements contained in this application are true to t~e best of ~is knowledge and belief; and that t~e work will be performed in t~e manner set fort~ in the appl~n~l~ed therewith. Sworn to be[ e me th~s ...... K,Z ....... i,,,. o~ OT ...........