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HomeMy WebLinkAbout572-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE SOUTHOL~ N.Y. CE~.TIFICATE OF OCCUPA~4CY THIS CERTIFIES that the building located at....O.][-~....O.1::[=.e.~.~?,~-...~,,~t, fi ................................. Streert Mop No..~.~ ................Block No, .~ ...............Lot No.~.~,,,,...,,.F.$~}.!~.~:fl..,I.~.n..d.~.....~..*..Y..~ ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ......................... ~'~.~. .......... ~ ........... , J 9~..c)....., pursuant to which Building Permit No..~..~.~..~. ................. dated .............................. .¢T..~.~. ...... ~.~. ........ , 19..~.., was issued, and conforms to orl of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .............. ................ P.~,~ft.¢~...~r~..~.'~,1~:..~.e.'J. ltt~ ..................................................................................... This certificate is issued to ....9.ob, t,.....%'.ad,4.~m~on.......(.O=~.) .......................................................... (owner, lessee ar tenant) of the aforesaid building. Building Inspector FOEM NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Sou'rHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES uNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .... .......... . ~...-Y, :. ,o ...... ~...'~~ii~:....~~ ........................................ .......................... ~ ................................. - ........................ .~.~..~. ......... i ................................................ pursuant to application dated ..... ~ ....... ~.....~. ......... 19~...~.., and approved by the Building Inspector ~ FORH NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SO~JTHOLD, N. Y. NOTICE OF DISAPPROVAL PLEASE TAKE NOTICE that your application dated ................ ~-~..~...~19....'~.. for~permit to construct .~ ........ at the premises located at ~~ Map ........................... ~ ............ lock ............................................ Lot ........................... is Building Inspector TOWN OF SOUTHOLD BUILD{NG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .................... ~..~ ................. 19...".....Permit No......~.......~...?...~ Application No...~...~ ....... Disapproved a/c .............................................................................................. (Building Inspector) Date.....~.~.~. ....... ~....~..' ................ 19..~.~...~ .... INSTRUCTIONS a. This application must be compiefely 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 punic streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is port 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 issuanoe 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 app cant agrees to comply with all applicable laws, ordinances 90'~1,,~ regu]l~tions.:,~,~ ......... i~i[;~'~'ij~ or name, i a co porat'on) .......... .................... (Address of applicant) 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) 1. Location of land on which proposed work will be ~lone. Map No: ............................................ Lot No: .~.]'. ................ Street and Number ....~..~./..~.~.....~...-:~....~...~..~.~.....~~ ................ '~"'~'"~'" "~"'~'"'~"""~"~'~':-':'~'." ........... Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use end occupancy .................... ~.'Z..:~ ................................................................... occupancy ~~'- ' b. Intended use and ................................................... ~. .......................................................................... 3, Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost..~..'?~...-~'....O.'....O...:..~.~....~ ...................... Fee ./...0....~ ......................................................................... (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 occuponcy, 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 ....~..'..O. .................. Depth ....~'...~.. ................... Height ............................ Number of Stories .~ ............ 9. Size of lot: Front ..... ./.....~... .............. Rear ..... ~ .......... Depth .,./.i~..~.~....../...~.~.~.~.. 10. Date of Purchase ..... ../...~.'~...'~....~..~ ................................. Name,,~ x'~ , '~)'.~-"ii°f Former Own r ~.....~.....z~........~.....~!.....~(..~..~......~...~.~ ..... 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..~.:....~...?..,cY.~,~?Address ............................................ Phone NO ..................... 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 t,~o deed, end show street names and indicate whether interior or corner Iot.~,,7~S I T'o va ,7' STATE OF NE~ Y,O~RI~,.~ ) S S COUNTY OF ~:..~7.. ...... ) ' .......................... _ ..................... ~. ................ ~¢....~. .................... be ng 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 th s application that ail statements contained in this application are true t~ bes~ of h~ knowledge and belief; and that the work will be performed in the manner set forth in the applica~~h. Sworn to before me this ~ ~Z~'~'~ ' - ............. Z.~.. ,~ ~~~ ~¢.~,. FORM NO. 1 TOWN O~: SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ .~.-. ......... 9.~...(. Approved ...................... ~. ................. 19..::....Perm't No...~....~.~.~.Z..~..~.'T .... Disapproved a/c .............................................................................................. (Building Inspector) Application No...~ .~...?.m. ........... APPLICATION FOR BUILDING PERMIT Dote -' '~'~'"~' / ~'./. ............19.,z5..~. .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and sL~Smitted 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 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, ord inances/,//~ regu ations. ......... iii ............................ ......... (Address of ap~'iicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................. ~'..x~r.~ .................................................................................................................................... Name of owner of premises.. .;:,h ...... ~.. ,%..~,..~.z...~,~,,.,. ............................................................................................ if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ........... '~ .......... i...'.'......-. .......... Lot No: '- ' Street and Number ...~../~......~----~..,~.,'~-,'.~....~,~ ................ ~..~.,,,~,,~,,,.,,.,~....;~%...~.r ......... ?..' ........... Municipality 2. State existing use end occupancy of p~emises and intended use and occupancy of proposed construction: b. Intended use and occupancy ~~ ~, ~A 3. Nature of work (check which applicable): New Building ................ dditJon .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost..~...7~,...~....O....(?..:..~.~.......~.~... .................... Fee .../..0...2 ......................................................................... (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.......,~.....°. ................ Rear ..,~Z.Q .................. Depth ...,,~..,~.. ................... Height ............................ Number of Stories .~:~ ............ 9. Size of lot: Front ..... ./..(.~:'.~ .............. Rear ..... ~ .......... Depth .?..~?.~.-'5l.?....~.~,.~.~... / ,.5-~ ..~. ~./_~ .-,z_~ ~ c~ .- 10. Date of Purchase ....... ....... Z ................................... Name of Former Owner ...~c<..~.~.~...¢,~.,>...~....~.f~,.~'..~,,~>., ...... 11. Zone or use district in which premises are situated ......... ~-:L..~,~.,...d~. ~:~....~ ............................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~...r) .................................... 13. Name of Owner of premises.~.s~:z,L.¥.:..~.%~,~.~4~.~.Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Lacote 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 .~..'.: ........ ) ' ~r~/_~,_~r,,~ ' ~,,~ ~-" ''~) 0L~,z~'~- ~'~c~ be n~ 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 t~e be~ of h~s knowledge and belief; and that the work will be performed in the manner set forth in the applica~~h. Sworn to before me this ~ ~~f/~ .