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HomeMy WebLinkAbout725-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...~....4..~ ........... ' Date ........................ ~?.,.~.....~...,.,4.., ........... , 19.._~..., THIS CERTIFIES that the building located at .]~.~....A~'~,~!,~..~ ..................................... Street Map No~ ............. Block No....~ ........... Lot N~..z~..,.......g.~?.~P..¢.....~:.Z..: ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................... ~T.l~e....,1,~ .................. , 1c).~.9...., pursuant to which Building Permit No..~...?~.~. .............. dated .................. ~..u~...e. ...... ,~.,0. .................. 19..~.~..., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupa, ncy for which this certificate is issued is ................ ........................ ~.~ ~,.~ .t,~.. ~.. $~...~.~.~ .................................................................................... This certificate is issued to ..... ~.A~,~.~..,]~9~.,.~.~.9 ....... .(9WJJf~.). ............................................................. (owner, lessee or tenant) of the aforesaid, building. r-', ..... Building Inspector FOI~M NO. t~ 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 725' Z Permission is hereby granted to: .............. ~,.:i,~ ~. ~....~...e. ............................................ ............... .c.~:~.~.?..,.....!!.:.{... .................................. to ....~...,..,....*.~.t.~.t.~..~...~.......~...t..~.~ .%~,...~.,..,.z..z. ~ ...................................................................... at premises located at .~./.~..,,,~.~,.,~..~!.~..~.e. .......................................................................................... .................................................... .q".~ .*..~...,.....~:~.-. ............................................................................ pursuant to application dated ............................. ~.~.....~. ................... 1~.~......., and approved by the Building Inspector Fee $~. ,e...0~. ................ ul alng nspector / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~ ~,~, ~-o 19 ~-~ Approved ........................................ 19 ........ Permit No ............................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... .......................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted ih duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, re]ationship to adioining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is part of this location. c. fi.he 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 issuanoe of a Buildin~ Permit pursuant to the Building Zone Ordinance of the fi.own 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 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. :./..,..,.:: Name of owner of promises ...... ~ ........ .~ ?.~....' ........................................................................ 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 ............ :~.:: .~ ..... .~.:~:~, :: r.~ ~:~ .:.~:~ ............. Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: b. Intended use and occupancy .......... ,~..'~?...~...~..~. .................................................................................................. property lines. Give street and block numbers or description according to deed, whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................... Addition ....,,,4~x, .......... 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 sa~in, e structure with alteration~s or additions: Front ....... .;;~....~m.....;,. .......... Rear ......... Depth ............ ~.~i ............ Height ........ /..~.'. .............. Number of Stories ........ ./...z.___~..~.. ............... 8. Dimensions of entire new construction: Front ............ ..~.~.~ ......... Rear .......... ~t ...........Depth ..../..~ ................ Height ............................ Number of Stories 9. Size of lot: Front ....../....~...~. ........... Rear ....... ./..~?..~ ........... Depth ....../....z/,.? ........ .~ .... ,/ 10. Date of Purchase ..~...../..~.,,~.~'.~.. ...................... Name of Form~,er O~wner .~..2./~..~.¢,,...../.~...~7~...~:...:.. 11. Zone or use district in which premises are situated ....................... ~ ......... ~ ...................................................... 12. Does proposed construction violate any zonina~ law, ordinance or rec~u[otian? .... ,,..~ ........................................... 13. Name of Owner of premises~(~..'.~..~..~2~.%~..Address ~'....~....~hLone NO.F.~.~..~..:.~....6~...7 NC) Name of Architect ....... ~I ....... ' .......... , .............................. Address ................ ~-~...cJ~..."' ......................... Phone N---- .~'.7 Name of Contracto ./..~....'.~7..~.~....~... ............ Address .............. Phone ,. .................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions'from and show street names and indicate STATE OF NEVf,'xYQRK,~/ ) S S COUNTY OF L // ............................ ..~...' ........ .~..~. ....... ~;..~<~.~:...~ .......... being duly sworn, deposes and says that he is the applicant (Nome of individual sigmn' ~ ap~t~) above named. He s the ............................ ~ ....... ~.~:~.z..~ ............................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and fs duly authorized to perform or hove 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 wi l be performed in the manner set forth in t~i.~p[lJ~n.~i]ed therewith. Sorn to before me this ~ ~0t~ry public, State of New ~or~ ~. day of .......... ~C~; ........ 19...~.~. cAAg,~,~ [;~t';~c~re o~pplic~t) / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined .......... ~.~ ..~-:'~ ....... 19.~..i/.. Approved ............................ ~ ........... 19...~.....Permi No.......~'? ....................... Disapproved a/c ............. l~..~. ~: .~-.~..~. · .~.?~'.'.~..~'.~: ~.~'Z.~..~z...~....~... ~ Application No....?..~'..~.~.[i .......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............................................................ 19 ............ 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 sfreets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this Iocafion. 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 SouthoJd, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction o~ buildings, additions or alterations, or for removal or demolition, as herein described. T~e applicant agrees to comply with all applicable laws, ordinances and regulations. ' ~.....~,~........ ..... ~ ~- ,, (Address of applicant) ~ 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 proposed work will_be done. Map No: .................. .~..~.~..~ ................ Lot No: ...~[i~i~i ......... ~tr~t ~d Number ............ ~.,~ ................................................. ~.'.~.~ ................... ~. ................ r ................................ Municipality 2. State existing use and occupancy of p~ses andintended use and occupancy of proposed construction: a. Existing use and occupancy ............ A~'(~ ....................................................................................................~ b Intended use and occupancy ~__~' ' 3. Nature of work (check which applicable): New Building .................... Addition ..... ~ ....... Alteration .................... Repair ....................Removal .................... Demolition ....................Other Work (Describe) .................... 4. Estimoted Cost ........ ../ ................................................... Fee ...~...9..-~... ............................................................................. (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 ............................ uep ............................ Height ...... /..~ ................. Number of Stories ............................................ Dimensions of same structure with alterations or additions: Front ........... ~...~ ........... Rear ~ ~// Depth ..... .'~ ~ Height ......... ./...~. ............... Number of Stories ....... ./...?..zz~ ............... 8. Dimensions of entire new construction: Front ............................ Rear ............................Depth ............................ Height Number of Stories 9. Size of lot: Front ....... ~,~ -,-~"6'"0"~" ......... Rear ....... /...¢..~.../. ........... Depth ...... "/'"~"~""~ 10. Date of Purchase ...... ./..~../~.~.....~.]....../.~i..~- ................... Name of Former Owner ..~.C...~/~...O.~..¢'2~.....~ .......... 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction violate,any z, eningdffaw, ordinance or regulc¢~ion? ........ ~..~.....~...!..'~.......' ..................... 13. Name of Owner ~f premise .~..:¢:../~.'..~:.Cc.'.~...:...Address ....~.¢.~r..~~ .......... Phone NC~-...~.:~..~.~..6..~..~ Name of Architect ....... ~...,~ .......~'7~ .......................... Address .....................,z~ ..................... Phone NO ..................... No me o f Cont ractor~/J.6.~.~.../..[r~r..~ ..d~.. .......... Address .~..~Z~.~...'~_ ~ P h o n e N C~)=,),~../-~/. ;'~- ~.~..~.~ PLOT DIAGRAM Locate clearly and distinctly ail 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 whelher interior or corner lot. STATE OF NE'~,,Y, gI~K,¢~. ) S S /~-) y~ V/~,I'1/-~' COUNTY OF .... .~.~.'i ....... .¢ ...... ) /.~ /// (Name of individual signing app' ' ) fication duly sworn, deposes and says that he is the applicant above named. He is the ...................................................................................................... . ....................................................... (Contractor, agent, core)orate 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 wil be performed in the manner set forth inluCff~l 6pCP,~io~t~filed therewith. Sworn to before me this r ~ot~ry pub c, stat~ oJ ~ew 0344a63 S~ffolk 6oum~ ~( r.~.~.~ No. 52 , . ~ .[~ ~ . ~.. day of '. ..........19~.~?re'ss ~ --' ,~ ~gnature o~,apphcgnt) ~. ~ ~ ~ ............. z. //, %%../~ou~ty ' ~.' Notaw Publi~..Z.~~ ........... ~.~'"~ " '~ ~