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HomeMy WebLinkAbout564-zFORM NO. 4 TOWN OF SOUTHOLD BUmLDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY ....................... IJote ................................... : ...................... , THIS CERTIFIES that the building located at~.~.'~...~.~1/~.~..~.?.~..~..'~.~ti~.~.~..~..~.~i~.*.C'~..~`~*e~t ~ae~,l, 0~, :~Z Se~ . ,~** - No....~..~:. ........................................................... p INO ......................... OlOCK No ......................... LOt conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~j.~:.~.~., ~9......., 19.~?..., pursuant to which Building l)ermit No. ~ dated ............................ ~.~..g].~..~.¥.....~.,,~..., 19....~..?., was issued, and conforms to all of the requirements of the applicable provisions of the law, The occupancy for which this certificote is issued is .............. ............................................... ~t.~.~...g~.. ~!,.~..z.~..~.~.~.~.z..~ ................................................ This certificate is issued to ....~.?,..0..~.~.,~...~?...,.~.,~,,~,,~,,~.~,..0.~.~,~,,,~.~.. ......................................................... (owner, lessee or tenant) of the aforesaid building, Building Inspector / Hm~d 1~, T~ex'r~r TOWN OF SOUTHOLO 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) at premises located at ..................... ~ ......................... pursuant to application dated ......... ~ ............. /.....~. .......... 19-~..~., and approved by the Building Inspector Fee $: 1.0........~.........~ & 'd' g sp c Dr [, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLDr, N. Y. Approved ........................................ 19 ........ Perm.t No. Application No....~.....~... ]~. ............. Disapproved a/c .............................................................................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................ :)...q.Z¥...I.) ........................... 19..:4.(%... 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 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances ,~nd regulations. State whether applicant is owner, lessee, agent, architect, engineer, general contra, clot, electrician, plumber or builder. Name of owner of premises ......... ~.~.~/.~..~;?.'.?.~..M ......................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~ ~.'c -]~(/.)~ ~ ~"~.!~ .$,,) 1. Location of ~and on which proposed work will be done. Map No: ~.~?¢....~..;'?.-~...~..?.~.~...-....,.... Lot No: ....::'?' .............. ~'/ Street and Number ...~.~.~'.',..?.t:..~.~.!:~.':.~.....~.cf.~.~..~ .................................. .L.~..c..~.~..M~ ..................................................... Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use aha occupancy .................................................................................................................................... ---- b. Intended use ond occuponc¥ ....................... ~ ........................................................................... 3. Nature of work (check which applicable): New Building ...... C...~........Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ............. ,,.~,'~..~..'Q"O' ................................ Fee .J../}...~ .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling umts.....~?.Z~..¢~. .............. 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 ..... ~..~...':.2.: .............. Depth ..~.~...~. .................. Height .......... /.~...( .......... Number of Stories ...... ./. .................... 9. Size of lot: Front ..... /..~.:.~ ............. Rear ...... /....'~'. ........... Depth ...../...~?...~. ............. 10. Date of Purchase ..............~ ........................................ Name of Fo m Owne ..... ~ ...................... ~.~.; ....... 11. Zone or use district in which premises are situated ...... ,J.~.~:.~.f.(!.~:..L/.."..! ................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ...~.~ .......................................... 13. Name of Owner of premises ............... ~-z,¢~.~-~ .~..M ....... Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Controctor.....b:~,~.L...~;..~...e,.I..i...5 .................. Address ../~,~..u.,~,.~./.-..L.~t~.l~¢.~7~t .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 end indicate whether interior or corner lot. STATE OF NE~YO~t~, ,]. ) S S [ COUNT, ................... ~-~.~......~~. ......... being duly sworn, deposes and says that he is the applicant (Name of individual signing a~plicatjon) , 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 ~nd 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 in the application filed therewith. Sworn to before this [i0~{',E ~'0~'~es~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined..... ~¢.~.~:~.......~.....i ...... 19...~...)' v ~, ' 19 'Perm.t ~ ~ ~' ~: ..... Approved .................................. : ...........~.. ' No ....................... Disapproved a/c .............................................................................................. ............................................... .%.~...C ............. ] ......................... x..~.~..~..~... ............... .................. ( ~...i.l., .i. · -...-.--..-- --BUd ng Inspector) ....... ~ ................. Application No..~..~....~...~?.~. ............ 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 ~djoining 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 cov, ered by this applicatio~ may not be commenced before issuance o~ Building Permit. d. Upon opprowl o~ this ~ppiic~tion, the Bu~1d]ng Inspector will issue ~ Building Permit to the ~pplic~nt, SuCh permit sh~li be kept on ~he premises owil~ble for inspection throughout the progress of the work. e. No building sh~ll be occupied or used in whole or in p~rt for ~ny purpose wh~ever until ~ Certific~ge of Occupancy sholl heve been gr~nted by the Buiidin~ Inspector. APPL]CATION IS HEREBY MADE ~o ~he Building Dep~rtmen~ for the issu~nc,e of ~ Building Permit pursuant to the Building Zone Ordinance of fhe Town of Southold, Suffolk County, New York, ond other ~pplic~ble L~ws, Ordinances or Re;ulofions, ~or the consfrucfion o~ buildings, ~dditions or ~lteroflons, or for removal or demolition, ~s herein described. The applicant agrees to comply with all applicable laws, ordinances ~nd regulations. ................................... (Signature of applicant, 9r name, if a corporatian) ~ ~~ ~ ~ ., (Address ~ app icant) '~- State wheth,er 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)~ !?i . ~,. ~(~1~I !: ]. Location of land on which proposed work will be done. Map No: ..~....~.~.~.~;.~.1.~.'~.(/..0..~(.'!~? .... o N ..... ~.'~.///;'. ........ Street and Number .~. ....... ~ .......... ~:-.-~ ....... .,,~ ......................... k~ .............................................................................. Municipally 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy ............... ~-~ ~ 3. Nature of work (check which applicable): New BuJ d~ng ......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ....... ~'.,~.Z..Q ........................................... Fee ...L..Q. ................................................................................. ~-' (to be paid on filing this application) 5. If dwelling, number of dwelling umts.....¢~,~...C.v .............. 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 ................................ B. Dimensions of entire new construction: Front ...... .~...?~ ............... Rear ........ ~..,,~ ............. Depth ............................ Height ........ ./.~..'~ ........... Number of Stories ...... Z ................... 9. Size of lot: Front .......,,' ..... ~) ........... Rear ....J.:2,...~-.). .............. Depth .......................... 10. Date of Purchase ......... '../'...~.~.~. .............................. Name of Former Owner .~..~..&...~...~' .~P...: ............ 11. Zone or use district in which premises are situated ........ ~.¢~¢..~.~:?.~."~.~*./. ................................................................ 12, Does proposed construction violate any zoning law, ordinance or regulation? ..... ./..~..~. ........................................ 13. Name of Owner of premises ............... ~..c:.ct...~.~¢~.~x ...... Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO .................... Name of Contractor.....~'..~tl...~.~....~:¥..Ci.C/.,b. ..................... Address ./~.g.'Lh.~:;!..%,'.!~....c.~..q¢...".]'./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. COUNTY OF.~V~ ,~, '_ ,~,, ~V, ,~'~:t:Y~:'"'")~ ' 1. , ................... ~~C~...~~ .......... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) 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 Jn the manner set forth in the application filed therewith. Sworn to before me this ~ ~o~a ~ (dav of .... ~ ~ , ~ ??~'.~,]:.~?~t~°r~ (Signature of applicant) ................... .