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HomeMy WebLinkAbout815-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~.,"~.~....~.~.%.~.e.E..~ .................... : ................ Street Map No~..z~gf ................ I~lock No ...... ::)f~:~. ........ Lot No. ~.~. ~ ...... ~.¢.~.'~q~.~.....~. ,.~,: ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................. ..A..~.~?.~....~.~. ................ , 19.:~..., pursuant to which Building Permit No....~.~.~ ............... dated ..................... ..~..~.[~.%. ...... ~ .......... 19~.~ ...... 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 ................ ........................ ?.~J,~.~t,~..~..£~,,~.. c1~,l;~,,/z~,¢ ................................................................................... This certificate is issued to ..... ~..~BbX'P, ...... .~..~rl~.~. ............................................................................... (owner, lessee or tenant) of the aforesaid, building. Building Inspector 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) No. 815 Z Date ........................... Aug~t~o. g,7. ............ 19.~9 .... Permission is hereby granted to: · .l~,z, eld..Ee~e~..&. ~ns .......... ./.. ~ ...... /.~..: ........... // 4.7t..l~'o~-.itvm~t~ ............................................... 'Betden~'"Ne~-.~o~-k ................................................ to ..builel..adclttion..on.. eXl~t,&m{~., em~i~i'el~'i.y, ell~e2llinff ................................................................ at premises located at ~/~.t~i,~.:]Loy..~,.~...~,D~.~.~..~/..Blt~..A~r~, .................................................... .................................... 1t1%~t%~ ~' · lt'e~/' 'i'O't~ ..................................................................................... pursuant to application dated ................................ ~t,~t~ltS, b.~ ............. 19~'~..., and approved by the Building Inspector Fee ~,O0..eheok..peid Building Inspector FORNI NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUT.OLD, N. ¥. Examined .......... . ..~.....~.. ~....~...?. ......... 19..~.~ Approved ........................................ 19 ........ Permit No ..................... : ......... Disapproved a/c .......... .......... ........................................... (Building Inspector) Application No. 6~ I ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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 oreas, and giving o 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 p art 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 issuanc,e 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 ¢o comply with all applicable lows, ordinances and regulations. (Signa~:'~':f appli~: or name, if a corporation) ..... .... ~'(Address of applicant) State whether applicant is owner, lessee~, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ............................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of Iond on which proposed work will be done. Mop No ............................................ Lot No: ....: ....... Street and Number ...... '~ii ........ 2. State existing use and occupancy of pr~emises and intended use and occupancy of proposed construction: Existing use and occupancy ......... .~~..z,,~...~,~..~/..~.~,-~ ' ,~ ,~ /2~ ................... ; .................... o. .. , .. d' b. ntenaecl use ona occupancy ................................................................................... ~...~.~c.~,¢~<..c..,~-. .......... 3. Nature of work (check which applicable): New Building .................... Addition .......... Alteration .................... Repair ................... .Rj~moval,. ................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ........... .~..y,.~..~Q...C~..,...~(~... ........................ Fee ..... .~,~./...~:~C.... ....................................................................... (to be paid on filing this application) 5.If dwelling, number of dwelling units ............... ./. .............. Number of dwelling units on euch floor ......... ./. ................ If garage, number of curs .......... ~ ......................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of e×isting structures, ~f any: Front ........... ~ ......... Rear ............. ~ ...... Depth ...~...(~. ............. Height ............................ Number of Stories ...... ~ .................................................................................................... Dimensions of same structure with alterations or additions: Front .......... ...~....~. .......... Rear ...~ ................ Depth .......~,,/.~....~........"--/ Height .............................. Number of Stories ............L ................. 8. Dimensions-- --of entire new construction: Front .......~,,~.~.~ ........ Rear ...~...~.~. ..........Depth .....~..~.,~C¢~.....~..... Height ....... ~. Number of Stories ....... ./.. ................. 9. Size of lot: Front ............~ ....... Rear ...... ..~.....-~.. ............. Depth ......./....?.....CZ~. .......... 10. Date of Purchase ............... ./..~.~..--~..i ......................... Name of Former Owner ......... : .............................................. 11. Zane or use district in which premises ore situated ............. .~......~--~--~. ................................................ 12. Does proposed construction vJo~e~,~,~ ,- ~ ~.~-. ,/~.~/~.~-,~any zonin~zla~.~ance or regulation? .................................................... 13. Name of Owner of premises.~.~~ss~..o.~.z...°...~..~.~._~one,~C} ..................... Name of Architect ..........~d~.~ ....... Address ..~...~...~..~.~.' ~...'"'~' // ~"'/~~ ................ Name of Contracto~~....~..~.~ddress ~-~./5'.~.~'~;~¢~,~~~....-?....~...~.....~). 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 numt ,~rs or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~(~'~I~A~' ) S S COUNTY OF ..,~,~..~.....) .................. ~./~ ............................... being duly sworn, deposes and says that he is the applicant (Name of individQal~_~pin~',applic~t. Jon) ' 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 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 ig the application fi[~ t~rewith. Sworn to before me this ........... 2~0 ~°f~~ 197 .... ,,giT. pplicant) Noto~ Public,~~Z~....~un¢¥ ~o. 52-0344g~3, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (Building Insp~tor) 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 fo 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 p art 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 all applicable laws, ordinances and regulations. ~ /.. / ,,/ ,~,,/ ............ ...................................... (Signatur~of appliczrrtf, or name, i~ a corporatio~i ......... ...... .~-.Ii.....:. ...... . . . ., . . . . ~'(Address of appiic~ant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ..... ~.~x~.~...,~. ~ .................................................................................... If opplicant is o corporate, sionoture o{ duly outhorized (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No:~... './~,-. .................................. Lot No: ............ Street and Number .:,,/.......~,,...:~.:,~...~~,~--.-"~ ..... ~~. ....... 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: Intended use and occupancy .................................................................................... :~".2~ :~:,,~ ......... property lines. Give street and block numbers whether interior or corner lot. 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 .......... .z ................. If garage, number of cars ............'¢~.Z~.~¢,~ ......................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. "' ~!//) "'~ Depth ...~?',¢(..~.~. ............. 7. Dimensions of existing structures, if any: front ........... ~,~.;.¥: .......... Rear ............... h ..~ ...... Height ............................ Number of Stories ../ ....................................................... Dimensions of same structure with alterations or additions: Front '~'~.~. Rear ,...~..?.::~ Depth ..... ~'..~/..',q,....z¢ ....... Height .............................. Number of Stories ............L. ................. / . B. Dimensions bf entire new construction: Front ........ ~.z,~ ........ Rear ,,.~.,,,,:,,..,.~-.~ ............ Depth .,.f~.;~. .... ~.~..., Height ....... ,'~"-~..... Number of Stories ....... ~,. ................. 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 viol~re any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises~.~.~.~.`~.~c.~.¢¢~..~..~rc~s?/~.~`.~.?~...`~;~/:~.~..~`~ne biO ..................... Name of Architect ........... ~:~,~ ,~.~..~.~.r,~,~ ........ Address .f(~&%.:~-.:.:.~::/.:.~,:..~':"./r.~....P~dne ~D. ~ ................... Name of Controctor~'.~,?;~ ,~;,~...,~Odress ,~.-..~?,Z.z,Z~.~;,x~t.,,~/~6~,'x..~.-.;~(f¢~-. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from and show street names and indicate or description according to deed, STATE OF NEW~C~,,,';2/Y: ) .......... (N~me of individu~l'~g~in~ opp~ic~on) above named. He ~s 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 all 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 fJl~ t~rewith. Sworn to before me this / ~,,]~,. ~,~.~, Nota~ Public, ~~ .....