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HomeMy WebLinkAbout587-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~ N. Y. CERTIFICATE OF OCCUPANCY Z THIS CEJ~TiFJt~S that the building located at...~..~...~..~.~.~..~.~..~.....~.?...~.j....~..~...~..~..~...~.~...~.~...`~..~.~.* S~ Map No ......................... Block No .........................Lot No ..................................................................... con,arms substantially to the Application for Building Permit heretofore filed in this office dated February 28 19..~.~.., pursuant to which Building Permit No. dated ..................~.~Z..~ ......... , 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 .............. PH~'ATE 0~ F~IIL~ D~LLZNG v~ ~,~,~ ~ ~ ~o ..~.~.~K..~.~.~...~F. .................................................................. of the aforesaid building. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~, N. Yo Application No. ,~ 7 ... Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c .............................................................................................. ............. (Building I ns'~'i ................ / .............. / APPLICATION FOR B~JKLDING 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 adioining 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 coYered by this application may not be commenced before issuance of Building Permit. d. Upon opprovo~ of this opplicotlon, 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanae 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 applic.able laws, ordinances and regulations. ......... ....... ............ (Signature of applicant, or name, if a corporation) (Address of applicant) State wheth,er 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 land on which proposed work will be done. Map No: ............................................ Lot No: .................... ber ~-x'/~ ~ 0-~ O~,~ ~ ~~ ..~. /V' ~ .~..: Street and Num ..... w.... ........................................................................................................................ Municipality 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 ~nd occupancy ................ ~ ............................................................................. 3. Nature of work (check which applicable): New Building ....... .............f Addition .................... Alteration .................... Repair ............ .~.....Removal .................... Demolition ....... ~. .......... Other Work (Describe) .................... 4. Estimated Cost.~.../..?.,,~..~.....?...?.~'~' -- - ....................................... Fee .~/...O. ................................................................................... (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 ...... ..~...~ .............. Depth ..'..o~...~ .................. Height ............................ Number of Stories ............................ 9. Size of lot: Front ......... ./...O.....~. ........ Rear ...... /....~... ............ Depth ......... ~..?.. ..... 10. Date of Purchase ..................... ./...Z.....~.......~.. .............. iName ~o,,~?rmer~)~r ...~..'~......~....~ ............ 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 prem,ses.t,~.....'x..~ ............ Address .....~ ..................... Phone NO ..................... Name of Archltect.....~..~'.~...~.~..~.~.: ............... Address ..~ ................ Phone NO ..................... Name of Contractor...~.?~>r~....~ ........... 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 to deed, and show street names and indicate whether interior or corner lot. (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 oil statements contained in this application ore true to the best of his knowledge and belief; Swornand thatto beforethe workmeW~llthls' be performed~ ,~ in the manner set ~ da of ~.~.~ 1~ ~ r,; ;~" ~''¢ c'~' ~gn~u~ of app cant> TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLDI, N. Y. Approved ........................................ 1?....'....Permit No ............................... Application No ..... ~.~..'.. ~ .......... Disapproved a/c .............................................................................................. APPLICATION FOE BUI~.DING 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 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 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 to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) ........................ ~ .~. ~-:.~.: ~ .~... f:.. ~..~ ................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of of remises .~...~O~,,~'~,[~' ~.~..~ ..... ~:.~..x~.:~.~._,~. ................................................................ owner p .......... ~ .... , ............... 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: ............................................Lot No: .................... Street and Number .,~Zi~~. .........~.~...~....~;~.~.~....C.~.~.....~..~z~..?. ........... ..~..'~...?...~.x:.~.~.,~,:.~.. ~ ~.~'... './/... Municipality 2. State existing use and occupancy of pr, emises and intended use c~nd occupancy of proposed construction: a, Existing use and occupancy ............. ~:....~.~..~,~..~. ............................................................................................ b. Intended use and occuponc¥ .............. .~.5~:~ ............ :;.:?. ............................................................................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition ................. ;..Other Work (Describe) .................... 4. Estimated Cost...~../..~?.,,.~.5....°....O.. ...................................... Fee!,LO. .................................................................................. (to be paid on filing this application) 5. If dwelling, number oF dwelling units ........... (~'......'9:w....~7.. ....... Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. Iic 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 .4~,1,..~ .................. Height ............................ Number of Stories ............................ 9. Size of lot: Front ......... ~...O..h~. ........ Rear ...... /...0T;t). ............ Depth ......... ~....~..¢a ..... /Y 10. Date of Purchase ........................................................ Name of Former Owner ./..:~:~.?:f...%......~.~ :!'i .9.':.~..i ............. 11. Zone or use district in which premises ore situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... ......., ........................... ....................... p 13.Name of Owner of premises.~.. ~ Address .....[~.r;'..,...z.,;. hone NO Name of Arch,tect....~,~....~...!....~.. · .................... Address "1~";,' .................................. Phone NO ..................... Name of Contractor...,/.d~..~.-.~..?.rt4m~.,..,...~, .......... 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 to deed, and show street names and indicate whether interior or corner l,~t. STATE OF NEW~Y,Q~.K,/, ) S S COLLNTY .OF ..~::~?...~.;,S: ........ ) ' ........................... ! .................................... ~ .................................... ~ 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 hove performed the said work and to make and file th s 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 mana~Ls _e_e~tl~njfbE~e application filed rtherewith. Sworn to before me th,s , ~ a~a~,~ · ~ 0~.~e~ y.~ , . .-' M ~ day of ' .' [~'*'~ ¢ ";~'i ~ ~]~.. s2.e:, zs',0""z /" (S gna~ure of app cant) Notaq ........................ Publi~--.~:.....~;:unty'' ............................... ' ' .... ""~";;~' ' ~ ; '' ''~ '~ z, .[.., /' 1'~ '¢~'"" I'