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HomeMy WebLinkAbout630-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 '. Z'8"'"R~'""AVG ............................... Street conforms substantially to the Application for Building Permit heretofore filed in this office dated dated ...... ................. ~"~'~'""~0 ...... 19.~.., was issued, and conforms ¢o all of the requirements of the applicable provisions of the law. The occupa, ncy for which this certificate is issued is ................ This certificete is issued to ..... .l~l~o.....t~an~t~t .................. {..;O~ne~.~ ........... : ........ :: ..................... ' [owne. r, lessee or Tenant') of the aforesaid bui!ding. FORM NO. 2 TOWN OF $OUTHOLD 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? 630 Z Oote ......................... ~r.i.l....z..q ................ 19.~.~.... Permission is hereby granted to: ~ .t.~z..t...~......~.~.e. ~ ..~1~....~..t. ~.. ~.~,~. ............... Ma.t~i.tuek...~w..~[ork ......................................... to build addition on exizti..~g one-£ami.l~ dwelling at premises located at .~..i..]r.e.~....A.Y..e..~...~.e..,...~.~.t.~..t¢.q.~..~.,..~.e..~....~.Pr~ .......................................................... pursuant to application dated ...................... .~.~?...i..1...~..O.. ......................... 19.~.~...., and approved by the Building Inspector Fee ~.,..~... ................ Building I~)spector H~war~ M. Terry' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD', N. Y. ~pproved ........................................ ~ ........ Permit No (Duilding Inspector) Application No ............................. APPLICATION FOR BUILDING 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 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 Sou'thold, 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 °f c~PP an~/~ ""--'---'--'""'-Iic"--- .......................... State wheth,er applica~./l~t 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 o~ficer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number .... .~..4z..~>, ..................................................... / Municipality 2. State existing use and occupancy of p~emises and intended use and oc~c.upancy of proposed construction: a Existing use and occupancy ~j~ 4~.~.~..~..~ ........................... ; .......... ~ ......... .................. ...... ......... .... 3. Nature of work (check which applicable): New Building .................... Addition ...... ~...Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... (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 notuse and extent of each type of use .............................. Height ............................ Number of Stories .... .~....~iz... .............................................................................................. Dimensions of some, structure with alterations or additions: Front ........~.....~... ..............Rear ...... Depth .............. ...~...~... .... Height .............................. ~ Number of Stories ...... ~.~Z. ........... 8. Dimensions of entire new construction: Front ........ ?~..~.... .......... Rear .....'~..~ ............. Depth ........c~.....(..~.. ........... Height .......... ~ ........... Number of Stories ...... ~......, ..... 10, Date of Purchase ........................................................ Name of Former Owner ........................................................ 12. Does proposed construction violate,,,~ ,,-~ --any"¥°n'ing law, ordinance,-~,,,'z ~~°k regulation? ....~ ................................... Name of Architect ........................................................ Address ........................... ~. ............... Phone NO ..................... Name of Contractor..~..~/~--~.~....Address ....... ..~..~one NO ..................... PLOT DIAGRAM Lacate 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 7 .g~,~'/,~ ,~)~' S S COUNTY OF .... obove named. He is the ............ ~.~.~...~ .............................................................................................................. (Contractor, ooent~ corpor~to officer, etc.) o~ s~id owner or ownors, ~nd is duly authorizod to perform Or havo performed tho soid work ond to m~ke ond file thls opplic~tion lh~t all st~tomonts contoined in this o~¢l[c~tion, oro truo to tho best o{ h~s knowledoe ond belief; ond thor tho work wil be porformed in tho m,~nner set {6rth n tho opplic~t~ion flied thorowith. Sworn to b~ this ............... ..................... Nota~ Public, ~..~~......~,~o~t~,,~ FOI~IVI NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 1 9 ........ Permit No .............. Disapproved a/c .........:,,~,...) .................. ~,~.m. ................. : ................................. (~uildinfl Inspector) o Application No ............................. APPLICATION FOR BUILDING 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 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 k, ept 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 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 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 applican~/l ,. State wheth,er applicajpt is,_owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......~--~?~¢r~......~...EY.~/.L~L~¢<:Z':f~.~ .................... ; ................................................................. If applicant is o 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 ..,~,~,~,~/..~.~i~,'t.-~x~,~,m".,%.>, ....... ~4~4~,~~77.~.~. ............................................... / Municipality 2. State existing use and occupancy of p,emis~s' ai-i~ in'fended use and o/c,.c,,,ppancy bf proposed construction: a. Existing use and occupancy ...... ~.~4.~.¢.-.~.//.~.,.~:.:¢/. ............... ;...;...;;~..:, · .................................................... b. Intended use and,,.oceupency...~..~.'-.~..~.~..c'~.~/~ ~ ~,~</g...r~.~.~...~.~.~. d~.~~...~/~:~'?'" .......... 3. Nature of work (check which applicable): New Building .................... Addition ...... ~...AIteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... ~.x~/~../J~' .................................. ~ Fee '~'~"~ ~' ~ 4. Estimated Cost ~ (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 Height .......... ~2 ............ Number of Stories ...... ¢(~z~ ..... ~ ~j ~ 9. Size of lot: Front .............. ~..,~ar ....... ~..~ ......... Depth ............................- ...... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use d~stnct ~n which premises are s~tuatea .................... ~.~ .............. ~...~ ....... ~ ..~.....~... 12. Does proposed construction violate anv,,zoning law, ordinance ~ r~gula~on? ...~ ............ ~'. ....................... 13. Name of Owner of prem,sos~...~:.~;.....Address .~....~.~.....n~.~e ' ' ~ ~ ~0.....................' ~ ~ ~ ~ '~ ~ ' Nome of Architect ................... ~ ................................ Address .......................... : ................. Phone MO ..................... ~me o{ Controctor .~.~ ...... Address ....... Phone ~0 ..................... 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. /&A/ , , STATE OF NEW YQR'I(,/,/ /~// S $ .................................. re.~..~elng duly sworn, deposes and soys thot he is the opplic~nt (Nome of individual~n~ applic;~ 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 in the manner se~rth in the application flied therewith.