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HomeMy WebLinkAbout615-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at...~'~L.'~.%t~..J~)~d ......................................... Street · G~r~, B~y Es%~. . .. xx~ 100 & 101, F~e% Marion, ~,~, Map ~No ....... . .................. ~oc~ iNo .........................Lot No ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated Mat, ah 26 19...~.?..., pursuant to which Building Permit No. ~, 015 dated ............................ ~.~.a..~......2..~. ....... , 19..~.~..., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate i.s issued is .............. .......................... ............................................................................... This certificate is issued to ..... .0.~.~.o......~.~.~.~.~.~..~ ......... .r~.~.~ ............................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FORM 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) N? 615 Z Date ..................... ~?,.9.~,_.._~..6. .................. i 9~.9..... Permission is hereby granted to: ~,..~abe....,~/.~..0.~.. ~..~.,. ~.o. ~.t. .......................... .................. ~.~.~.~0~.~.~.....~ ?~.~. ............................. M~e an exi~tin~ d;?ellin~ to this lo~ation at premises located at ...~:.~t:~...~..~.]:.~..~...~..~.~.~.~..~..~.~..~.~.~:~...e.~.~.~?.~ ........................................... ..................................................... [~ ~.¢... }f.~.o. ~ ,,. ,~?f.: ........................................................................ pursuant to application dated ....................... .~.y,.~.....2..$ ....................... 19.~..., and approved by the Building Inspector Fee $.]'..0...*5.0.. ............. ...... t..,~ ........................................... ~ ........... .3 .......... Building Inspector ~ FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... l...~..';. ................. ~r..... ~ ~, ........ Approved .......................... .~.: ........... 19....~....Permit No. ~'' Disapproved a/c .............................................................................................. (Building Inspector) \ Application No....~..~...?. ............... APPLICATION FOR BUILDING PERMIT Date ...~.~.~.....~.~ .... 19....~..I. .... 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 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. (Signature of applicant, or name, if a corporation) ............... ................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner of premises....~ .......... l.~ .................................................................................. Name of If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land onw ' P P ' . p : ................................. ~ ......... LOTNO:, ............... hch ro osedworkw Ibedone Ma-No ..~.....1~...~ ff'~-~ ..~, Z~/O Street end Number .... ~.. .. .i :.. ~ .......... ~ .................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use end occuponcy ..................................................................................................................................... b. ntended use and occuponcy ..................................................... 7t. ................................................. 3. Nature of work (check which applicable): New Building .................... Addition .............. Repair .................... Removal .................... Demolition .................... Other Work (Describ~.~~'I 4. Estimated Cost.....~.~..O..?..?. ......................................... 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, if any: Front ...... .~.....~ ............. Rear...?7.....~..'' ................ 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 ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front ...... ~...~.....'.~.. .......... Rear ....... ~../( ............... Depth ./...?...~/~¥.~..~. ...... 10. Date of Purchase ............?.....~.....~.....~. .......................... Name of Fozrqer~,Owne~.~ ~ ................................................ 1]. Zone or use diStrict in which premises are situated .................... <...: ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...~4~....~.. ....................................... premises O .~...~' ........... Address .....~.....~....~ ............... Phone NO. 13. Name of Owner of ...... .-...._...~f! .................... 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 to deed, and show street names and indicate whether interior or corner lot. STATE OF NE'~"YCJt~K,o ~/ ) S S ' COUNTY OF ....'~....~....[..~......)~__ ' ............................................ be ng duly sworn, deposes ond soys thor he is the opplicont (Name of individual signing application) /~ J ~ . - above named. He is the .................................... ~~.~.~ .................... :';: ............. ~ ........................................ (Contractor, agent, corporate omcer, etc.~ of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this app cation; that a statements contained in this application are true to the best of his ~owledge and belief; and that the work will be performed in the ~nner~.~ i%~e application filed therewith. · ~ ~blic, Sworn to before me th~s ~di · $~ e o~ ~ ~ of ~ ~ ~ ~ ~ %~[~?~'~ (Signature of applicant) ............... ~..~. aay ................................ n '~s~fi'~ ~'/~0o 7 ~ Notaw Public,~...~~''':m''~nw ~/~. ( FORM NO, I Examined ......... ,} ....................... ~..:~19...:;... TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. Approved ........................... i. ........... 19.....'...Permit No. ~. ~;~ I ~ Application No ..... ~..(.,,?. .............. Disapproved a/c .............................................................................................. (Building Inspector) \ APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su6mitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to odjoining 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 a Iterations, 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) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ' ............................. ..................................................................................................... · ................................................................................. Name of owner of prem~ses.....k~: ................................. ; ........... ?. If applicant is a corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) ....?..;~/C~'~ ~.,~.,~ ~', ~,, · ·'/h~ ~/ 1. Location of land on which proposed work will, be done. Map ~o: ............ = ......... "t' ....... hot No: .~.= ......... Street and Number ..~:.~:.~....~.~:.[~...~A...~.(~...:.~.Z ......... ~'J:~....~.~;~ ................... Municipali~ 2. State existing use and occu~ncy of premises and intended use and ~cupancy of proposed construction: a. Existing use and occupancy ......................... c.....Z...~..M' ......................................................................................... ~, .~. b. Intendod use ond ~cup~ncy ..................................... ~ .............. ~..4 ....................................................................... 3.~ Nature of work (check which applicable): New Building .................... Addition .................... Alteration .....,,...~ ....... ~. ~ Repair .................... Removal .................... Demolition ...... ' .............. Other Work (Describe. ~; , 4. ?stimotea ~ost.......~.:~..? ................................................ Fee ...t....m ............................................................................... , (to be paid on filing this application) '. 5. J'f 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 ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front .... /..,~...~ ........... Rear ...... ~./. ............... Depth ~.~.,-/,~...z.t .......... 10. Date Of Purchase .........../...~...~,...~. ........................... N me of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated .................. '.~..~; ........ ~..,~,.,,t ................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ..~-...(~ ........................................ 13. Name of Owner of prem,ses~,~:.,.i~z~.~;I~ ............. Address '"C~.~'w;.:j')/~,'-'::"~.:: ................ Phone NO ..................... Name of Architect ...................................... iI/ ................. Address ............................................ Phone NO ..................... Name of Contractor.../~., ....... ~.:,~t~e,~u~ ............. 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. STATE OF NEW~_---~D.R)~ ~ ) S S COUNTY OF ..... '.-~. · .~..~. · .'..: ;~...) ' ................................. ~..~.'..,....~.~ ~...being duly sworn, deposes and says that he is the applicant (Name of individual signing appllcat~n) 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 ~st of his knowledge and belief; and that the work will be performed in the mann~t~ in the application filed therewith. Sworn ,o before me this , '~ ~,~ ~ 't(~ ' of ~c~ -~.~:~ :~ e0,~ (Sg~ture~f app' ant) .................