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HomeMy WebLinkAbout735-zFORM NO. 4 TOWN 0~: SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFF~CE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ~ 1:~5t~ Date ....................... A.~..~...a.~y.....2.~ ........... , 19..~..~.. THIS CERTIFIES that the building located at .e/~..~&Be~...B.~V~¢.~...SOB~O~Street Map i~o ....................... ~iocLi~o ....................... Lot No ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated J~e ~ 19..~.~. pursuant to which Building Permit No. dated ..J~..~ ................................ , t9....~.~ 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 .......... This ~fi¢~o~f~ is i~d to ........ ¢~..~b9.~.*...~.~.~ ............................................................... (owner, lessee or teno~t) o¢ the o,~oresoid building. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 735 Z Date ............................... J~e....P..5. .......... 19.~i~).... Permission is hereby granted to: Jolm Uarshut ................................................................................ 6~..T.~..t,~../L~ ...................................................... ........ .~.e..e.~..~.z. ~.....~...~... .................................. to ...~u~Ad..ne~..o~e.. f~u~v., d~e.t~J~ .............................................................................................. at premises located at E/S....~7~,~e~a....DI~ ....................................................................................... ............................................ ~g~i,~. ~a.~s~ ...... ~ou%hotc~ .............................................................. pursuant to application dated .......................... .3'~......~,~ .................... 1~....., and approved by the Building Inspector ' ' Building Inspector 1 FOR1Y~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLER.'S OmCE SOUTHOLD, ". Y. Exo mined.........~ ~...~..~77.... 19....,.~-/' Approved ........ ~..~9....~...Permit No ......... .~.....~..~'.~,~-~-- Disapproved (Building mspectorj Application No.....~....c~..... ....... APPLICATION FOR BUILDING PERMIT Date ?~. ·..~. :~.~. r.~.... ?.~...~.i 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 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 applicgtion, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premised 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 B~ilding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinancgiof the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the congtruction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to !f:omply with all applicable laws, ordinances and regulations. ......... (Ad-dress o~f/applica nt)' ; /. State wheth.er applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................... ~r~ .~..< ..'~..: .......................................................................................................................... Name of ewner o~ p m ..... .?~%~.,~ ..... ~.....:..~. .... ~ .~,~.~. ................................................................................. If applicant is a corporate, sidn~ture¢ / of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ..~/.~;;'~.~¢.;.8,'~¥'~....'.';(~.~:;:.':'!.~;~'{.ot No: .................... Street and Number .....4~-~TM......./~.2./,-,,~--¢~*,~,.~.,.,~/.'".~,-..,~,.....~c¢.~ ~.*../....)~," /'~ " . . ? .. ........... >~..~-'~,~.,-.<....f>~*.~~ ';~-' ' ...... '! r l .............. Mumc~pality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Bxisting use and occupency ...................... ~ ....... r...,..~.. ........... M ...................................................................... occu onc b. Intended use and p y ...................................... ( ................................................................. 3. Nature of work (check which applicable): New Building ....... ~ .........Addition ....................Alteration .................... Repa r .~....Removal .... Demo it on ............ Other Work (Describe) ............. 4. Estimated ........................ 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. Dimensions of entire new construction: Front ....... Z...~... ........ Rear ........ .?.....l~.. ........... Depth ..~....~.. .................. Height ............................ Number of Stories ....~ ........ 9. Size of lot: Front ~/..,,~...O.. ............... Rear ........ ../...~..~ ......... Depth /..~...~./..~'....?...~. ...... 10. Date of Purchase .......... ~......'./...?....~.....~.. ............ Name of F°/~eruOwneJ~'~"~"('~A .(~ .I ............................. 11. Zone or use district in which premises are situated ................... e/~ ........... ~ ................................................. 12. Does proposed constructionl~ ri/i~.¥~°late any zoning law, ordinanceT~._,~ __ f ?L~,l,_JL-z__°r ,regulation? ........... ./..J~,q ............................. 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 corr er lot. STATE OF NEW.._~OR/~ n J- ) S S COUNTY OF ....~.?~r~....)~ ~J/' (~ ~ _ C'¥~ ~ . ~ ~e-r-' ~ (Name of individ'0a~ signing application) above named. He is the .................... ~/ i .................... ~ ........................................................................................... (Contractor, agent, corl~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and t~'~nake and file this application; that all statements contained in this application are true to the bes~t of his knowJ/ed~le qnd belief; and that the work will be performed in the manner set forth in the application filed~e~with. I / ~ Sworn to before me this ~..~ ~ Il .il,, //,/,I ,', · . J~. ,. ,4 ................. ~=~.,~da~ of .......( ............ ~.,,. 19.....~...-]. ~otL-~a~ pJ,J~[~T~,~.to?(£~ignature/of applicant) /*~'./ · .a ~ ~ /./. I otary t'umlc, State of New York 1, · ! / /.'_.._-~--~ k~..e~.~_~'~_.. ~ n*" No. 52-0344963, Suffolk County _ Notary Pubhcc~-...~t~-~.~~¢.~..w,,~eu ,~ ~mmissi0n [xpit~$ J~ ~, ~/ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........... ~...~'~'. ] 9..~...~.. Approved ........ .~~...~.~ 9..~.... Per m it No ....... ~'. · .~.~. ~....-~.. Disapprov~.~ a/c .~....~ ....... 7....~. ............... ~ ................................... Application No ......... .,x~...~. ~. 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which Js 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 o 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 all applicable laws, ordinances and regulations. ......... (Address o~a~licant) ......... 'h' ..... State whether applicant/~owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , ............................................................................. ~aar~e .~fa~:r °fcoPrr~:~s .... pp 'c ' a p , ii~,tatu y ' ' . (Name and title of corporate officer) 1. kocotion of lend on which proposed work will be done. Mop No: .~.. .... lot No: .................... Street and Number ...~..~. ......./...L~.~'K~..'~......./.~.!..~ ............. ~,.~.~h,~:¢:~...~ ................ Municipality 2. State existing use and occupancy of premi%es and intended use and occupancy of proposed construction: a. Ex,st,ng use and occupancy' ' ................ ..~....O~.....:C>-c .......................... c~.~-~ ~-~-- ........ ~ ......................................................... b. Intended use end occupancy ......................... ~ ~.~.~-[ ................................................................... 3. Nature of work (check which applicable): New Building ....... ~ ......... Addition .................... Alteration .................... Repair . . :,....Remova ..... ,. ........ Demolition .................... Other Work (Describe) ................. -)3 4. Eshmated Cost ......~ ................ k:...~.:....~ ......................... 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. 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 ....... 7.....~.~'Z... ........ Rear ........ ~.~.....~.~ ........... Depth ..~:....~.. .................. Height ............................ Number of Stories ....~.'....~....-c. ....... 9. Size of lot: Front ~/...~,...~3. ............... Rear ........ ./..~..~ ......... Depth /..~..~.~....~..."~.~ ...... 10. Date of Purchase .......... ~?..?...~'........x(..2..~.'..;.7.. ............ Name of Former Owne~.,.~..~.:~'.:~r:'r:~'fL.~ ............................. 11. Zone or use district in which premises are situated ................... '.~..\.." ....... ~.?..+.~ ................................................. 12. Does proposed construction v~olate any zoning law, ordinance or~regulahon? ............. ~..~.~. ................................. ~ .4~ .~. ~.-^-..' .~..-Ad d re s s ..... f~..'. ............ ';.~..~..~' ............. ~ ..................... 13. Name of Owner of premises .~.-.~..~....t.~. f rchitect ~ '~ Address ~ Phone NO Name o A ......................................................................................................................... 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 NEW YOB~,,, ~ ) S S COUNTY OF ..~.~,~,¥YM{~......) ' ................................ u,.t..;.. . , ........ ,{-....; ..,~,~-,..~., ~ (Name of ,nd,~;~;; appl,cat,o,) above named. He is the ......................................~ ~~ .............................................................................................. (Contractor, agent, corporate off cer, etc.) of said owner or owners and is duly authorized to perform or have performed the said work and t~ake and file this application; that al statements contained in this application are true to the best of his know~d~e ~nd belief; and that the work will be performed in the manner set forth in the applicat~n filed~e~with. I J ~_ Sworn to before me this ~ ~' ~,, ~,~ . .......... ~ ~ '~ ~ ~ ~ ~ ~ Publ~C~ State of New . ~ Notc, w Pub[ic,~~ ................ m~;'.'~.0344~67 s~l~o~"~ /