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HomeMy WebLinkAbout567-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at...~/..~......~..O...l~...c.t...A..V..,e. .................................... Stree,t o ~xx ~ttit~ek~ ~,~. Map No. ~ ................. Block No....~ ..............Lot N .................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............................. ~9~..~.....~...., 19~...., pursuant to which Building Permit No...~..~.~. ................ dated ............................. ~..~....Z~.....~.~...~ 19..~...., was issued, and conforms to alt of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .............. Private o~e ~amily dwelling This certificate is issued to ...~.~.~..~¢..~..~,~l~...~.e~D~.cg ............. ~.?..~..e..~.~ ................................................ (owner, lessee or tenant) of the aforesaid building. 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? 567 Z Dote ................ 5at?ua.r~...2.b .................. 19.~,}.. Permission is hereby grunted to: ......... ~ .t ~.~. e~..&.-Re~e.-.. ~qepko .................... ................ ~'o~zz~--'.~ ~e .......................................... ........................ Ma~-t i.tuek.~.....-N~.~ ~ .................. to. ~u'i'~ c}"~t"dwe't'~g ............................................................................................................... at premises located at ~/{¢'~ g'~gtt~d~ A?~ 9iat ~.;J; t~c~' "t~,~, pursuant to application dated ...............-~'~,Z~...-.~.~..: ................... 19.~9..., and approved by the Building Inspector Fee $"tOa'O0 .......... Building Inspector Application No ..... ..~....~... ~.~.. ........... Disapproved a/c .............................................................................................. (Building Inspector) APPLICATION FOR B~JILDING PERMIT Date ......... .................. :7 .............. : .......... ....... INSTRUCTIONS o. This application must be campier,ely 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 detoi~ed description of layout of property must be drown 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 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 port for any pul'pose 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinance,~ 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......~..:~....!~....~~..~.*~''~''''~''.'~'' ....... L."..~.'~...~.~.~.'~..'.~:~....~Z.,~...'~. ........ If applicant is a corporate, signature of duty 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 .~../~.~..~.....~..'.~..f.~...~.(~,.~... ................... ~.~....~..~.....~........."~'..~.~...? ....................... Municipality 2. State existing use and occupancy of premises and intended use and occ~upqncy~,pf proposed construction: a. Existing use and occupancy ............. .(.;~.~.~..c..~ ........ ~:~.....~.-.~. ~. ................................................ b. Intended use and occupancy ............. ~'¥'?'"~1 ................................................................................... 3. Nature of work (check which applicable): New Building....../~.............Addition .................... Alteration .................... Repair ............ _., ...... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Fstimated 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, Jf 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 ..~..0. ..................... Height ............................ Number of Stories ....~ ......... 9. Size of lot: Front ..~..~....~. ................. Rear ...~.'.~.J~. ............ Depth../..~../...~..~.~ ...... 10. Date of Purchase ....~..~...~..~..~, .................... i. ~'ame of,,~ ~ ,~'~,-'~-t~F°rm,e;'~(~'~;'ii~'~"'~ ..... 11. Zone or use district in which premises are situated ............ ../~....~~Z ...................................................... 12. Does proposed construction violate any zoning Iow, ordinance or reguJation? .~..... ........................................... 13. Name of Owner of premises.~)..'(:..~..~'-.~.. ................... Address ...~..~'..~ ................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Cantractor...'~';..~-d~...~. ........................... Address ...................... ~' '.' ..................... Phone NO ....... k ............. / PLOT DIAGRAM Lecate 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 NEVA Y,O,P,K~ ~ ) S S COUNTY OF ............................ ~~.....~'~..~.. .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ................. ~i ................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forLh in the application filed therewith. Sworn to before me th s ................ ~.. day of .~. ............... ~ ............. ~1~ .......... ~o ,',~,,,, county (Sjgna u~e of 9pphcant) s~on ~pires ~arc TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, BI. Yo ~xam,nea....~)~ .............. i'i .............. ' ~"'""' Approved ........................................ 19 ........ Permit No. '~' TM ~'~ ~ gisapp roved a/c ...... ~Y~'~.'~L~'.~-~'L~'::~'"'~ .......... .............. (Building Inspector) // Application No. ~ -/ APPLICATIOBI FOR BUILDING PERMIT Date ......... ~....~..'~.~.....~ ....... .~.~..~....~.. ........ 19...~...~ .... INSTRUCTIONS a. This application must be comp[et.ely 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 I~ept on the premises available for inspeetion throughout the progress-of the.work;_. ' ' .: ..... ' e. No building shall be occupied or used in whole or in part for any pu?pose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Sou'thold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or o Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. .... ~;q.....:..:;~:;.,.:.;.;.2 ........ x'~...,i: ...... rx~ ........................ (Signature of,~plicant, d~ name, if a corporation) >.x" , /"'1 -- . . ~ , . ~. . . k~-~ ~. ~. . . . .4~.m ~ .................................................... State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , ............................... ................................................................ ~d. ~:~ .......................... ~A~.,~x.,.~ ~ :~4~/~.C~ (0~.~.,,. ~¢ '~ -~ '~ ' lf'~.,.,.-.~ ''> ., ~.~..c Name of owner of prem,ses......~.( ............................................... J....I;..~.].~. ................................... ~{' ....................................... If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work wili be done. MaD No: ............................................ Lot No: .................... Street and Number ...... .......................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and oc~ncy~of proposed construction: a. Existing use and occupancy ................... ,~ ................................................................................................................ b. Intended use and occupancy ........................................... J .................................................................................... 3. Nature of work (check which applicable): New Buildlng.....~.......,...Additlon .................... Alteration .................... Repair ............ .~, ...... Removal .................... Demolition .................... Other Work (Describe) .................... 6 5 4. :stimoted Cosf:_...~,~ ................................................... Fee .,/.4,~ ................................................................................... (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.....3..~..! ............... Rear .....~,~; .................. Depth ~'0 ...................... Height ............................ Number of Stories ...~ ......... 9. Size of lot: Frogt ...~.~..~.. ................ Rear ..../(.~'~ ............... Depth ../...~.~/..,...Z.~ ...... 10. Date of Purchase':...~/~.../.~..~...~.. ..................... Name of__ ,, ~-_~F°rmer Owner ....~..~/~:.~&r,J,~...~,,~__ __ ..... 11. Zone or use district in which premises ore situated ............. ~..t~,~,~.~. ...................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .~ ............................................ 13. Name of Owner of premises~,~,.~,~¢~,~,.~ .................... Address ................. Phone NO. Name of Arch' ect ........................................................ Address .......... ' ........... ': ...................... Phone NO ..................... Co n t r o c t o r.. ,¢~',.. ~.,,i~,'.-'./~,~. ........................... Address ........ ,. ............ : ...................... Phone NO ..................... Name PLOT DIAGRAM Lecate clearly and distinctly all buildings, whether e_xis, ting or proposed and indicate all set-back dimensions from property lines. Give street and block numbers or description 'd~c'6rdiBg 't0:~ti~i~l, add shaw street names and indicate whether interior or corner lot. STATE OF NE'~ "A3~1~6 ) COUNTY OF ~...'~.,~.~..~ ....... ) ............................ ~::.~..,..~ ..................... being duly sworn, deposes and says that he is the applicant (Name of individual slg~~ 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 oil 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 n the application filed therewith. Sworn to before me this ~ ~ ~ of ~ ~ ~ , ~ ,, ,,,: ,~ , ~v Yot~ (S ~nature of a~p cant) Nota~ Pub I ic,~.~..~.~~...~o~nty · h-'/Ar'~,7" z-~'~f',L k' o A-r