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HomeMy WebLinkAbout795-zFOI~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. CERTIFICATE OF OCCUPANCY No ..... Z..~32 ....... Dote ................................................ ~.:. ............ · ~s c~s that th~ bu~di~g ~oc~ted ~t.~...~.~.~...~.~..L~2.~',.[~ ~S~e~ Map No.~...~ck No. ~* Lo S~ ~a~ O~ l~ ...... ........................ t No ........................................... ~ ............... conforms substantially to the Application for Building Permit heretofore filed in this ~ffice dated ....................... .~...~ .............. 19.....~pursuant to which Building Permit No ..... ~:.~ ........... dated ............................. ~...~....., 19.....~as issued, and conforms to ail of the ~uirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .............. .................................................... ........................................... ~eo~ e ~eilt~ o~er 7his certificate is issued to .......... ~ ....................... ~. ............................................................................. (owner, lessee or tenant) of the aforesaid building. / ROWARD M, ~RRZ 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 795, Z Date .......................... JLg&qll~...~e..~ 19 ........ Permission is hereby granted to: · ..~..7~ .............................................................. .................. .~.~.~.~.S.~..~.~....~.~ .............................. to ..... ~g~.. ~m~. ~. ~1~..~e:L~u~ ............................................................................................ at premises located at J~/.~..~':~JJg.t~li..~f~,,~..JJl~lJ...JJL~JO..~JJ.JJl,~ll, t4#lJ~.,JJJlliJ .............................. ............................................................ l~elr~...ll.T.. .................................................................... pursuant to application dated ....................... i ............. ~JijqJ~....~ ........ 1~......, and approved by the Building Inspector Fee .~...-. ~ ............... Building Inspector FOI~I~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............. .~...~.~...~..~ b. :'..! ....... Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c .......... {.......~. ............. :.'.'~. ......... ;.,.::.~. ....... .,../.: ~ .......... ?,.-:.:x ......... ..............i ................................. Application No ...... 2..~..~.':::: ...... 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 Jn whole or in pert 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 o 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 demolitions, as herein described. The applicant agrees to comply with oil applicable laws, ordinances ~ regulations. /: ~ corpora~n) ........ .......... (Address of applicant) -- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of - em ....... :, ..... ;: .......................................... ~; ..........:~: ......................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Street and Number .~:~ ....... ~' ............... /:~, ......... '~:' .................. ~'--,...., ...... ~~~:~ ...... / Muni~pality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: ,~ 4: ~ .................... a. Existing use and occupancy .......... ~ ................................................................... b. Intended use and . ......,, ............................... .......... ....,....,.~ ........... ..~ ............................... 3. Nature of work (check which applicable): New Building.......~... .......... Addition ....................Alteration .................... Repair ....................P~emova[ .................... Demolition ....................Other Work (Describe) .................... 4. Estimated Cost ....... ~'..'~./..'~-~.L~,.~...~...~... ......................... Fee....~../~'..~..r.~.~ .................................................................... (to be paid on filing this application) ! · 5. If dwelling, number of dwelJing 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 ....... ~ ............ Rear ....... ..~...~. ........... Depth ..... ¢:~-L~..~.. ............. Height ............................ Number of Stories .~,~.. ................. 9. Size of lot: Front .......... ../...~... .......... Rear ..........~ ........... Depth ...Z.~.~..:..~-.. ,z_~ ,~.~ ~ Name of Former Owner ..~..~..:..~:.h:~ ~ ~,., C' Zone or use district in which premises are situated ...... ..~.~..........~...:~..~..~'.~.~.: ........ 11. ordinance ~'~~¢/'~ ~~ "~' Does proposed construction violate any zon, n law, or regulation 13. Name of Owner of premis ddress ~-~.~. ............... ¢(~6~e~'~.~../.....i...'.. Name of Architect ...................... ~,/,- ,~_: ~;; ....... ;~...~..>~ .............. Address .......... ; ................................ Phone NO ..................... Name of Contractor.. ,~/.~.~..~.~..~....~fC~/....'~..Address ~~¢4 ............. 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 whelher interior or corner lot. __ .... b~ing duly sworn, deposes and says that he is the applicant above named6He is the ................ ~.~....'.~ ........................ ~. ............................................................................................. (Contractor, agent, corjborate officer, etc.) af sa d owner or owners and s duly authorized to perform or have performed,the said work and to make and file this app coton; that a statements contained in this application are 'true ,to t~he best of his knowledg~e and belief; andswornthatto befo~ethe workmeV~illhisbe performed in the manner, set forth ,n the appl~/~g/filed. ~//~,/~ 1, therewit~ ,,2 ,~ ~ ~ ~, ~' ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No ............................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and suOmitted 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 applicotlon 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 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 a Iterotions, q¢ for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances~c~'d regulations.'~' .~.~/,-~' .......... ~ ....,. ~ ~...~...~,<..x. ~.~.~.~: ...... ~.....~ ........................... ;:Wk~ ~/ ...... (~nature of applicant, or nome, if o corporot'io~v / /4Z? .-~-. .... -~., ¢._~.~. / ~ ,. 4_ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................... ......................................................................................................................... Nome of owner of premtses,.....~,,/.,C4-Ci~.!~,.~&...~4~ ......... ~..Z,~..,*,~.4~.,,.,~.~.:i~;.oz~,¢~4 ......................................................... If applicant is a corporate, signature of duly authorized officer, (Name and title of corporate officer) 1. Location of land on which proposed work wmll be done. Mop. No~j¼%~:r~,~¢, .~..'~e:~G/.~..f~..,. Lot Nm~<~-¢/--~ MuniCipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: b. Intended use end occup~ncy.....,~,r.,;;..;......:,.4,4.....¢. ....... ~¢:,....; ...... ~......~.,.;,.2'~: ....... ~ ............................... 3. Nature of work (check which applicable): New Building.....i/'~.... ......... Addition .................... Alteration .................... R~poir .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimaied ~' ~-', ~ Fee cost .......... ~,~.y..~, ................................ .~./~.z.~ ................................................................... (to be paid on filing this application) 5. If dwelling, number of dwellinfl 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 ~ny: 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 ....... ,~¢ ........... Rear ....... ~.~ .......... Depth .....~.~ ............. Height ............................ Number of Stories ..~ ................. 9. Size of lot: Front .......... ~ ......... Rear ......... ~ ........... Depth .../~~.. ,0. o, ............. ........... 11. Zone or use d strict in which premises are situated ...... ~.,..~....~;~..~,..~ ...... Name of Architect .............................. - ....................... ~..Address ............................................ e Phone NO ..................... ............. ..................... PLOT DIAGRAM Locate dearly and distinctly all buildings, whether existing or proposed, and indicate al( set-back dimensions from property Hnes. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y~R.~,~ /,/_ ) S S COUNTY OF ...,,~.~.',ff~(~...,)~ ' ' , above n~med~e is the ................. ~.~.~ ...................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and s duly authorized to perform or have performed tbf said work and to make and file th s o cation' that al statements contained n th s application are true to th~ best of his knowledge and belief; PP ' · · ' ' ' 't and that the work wdl be performed m the manner set forth ~n the appbcationff~ therew~ h. ~/~ Sworn to befo~ me this / ~/~//~ ~,/I_,~ ~ Hnv ~f ~~, 19..,.,~,~ J~DITH T Bo~g~re of applicant) ............ ~ ........ %~,-2~' Z'v~'""~Z-'~''' z ~ot~y ~l~:~, st~t~ o~ ~. y~ /