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HomeMy WebLinkAbout949-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No.....Z...6~ ........ Dote ......................... ~l~le.....~:~ ............ , 19..60. THIS CERTIFIES that the building located at F,/.S...~jeeve...Alte...(....~e~..¥.;[e~4..~treet Map No..:y~ ........... Block No ............. ~'~..... Lot No. ~:}~.....~a,~.~r~:~tJct.....~.,:]~, .................. conforms substantially to the Applicotiqn for Building Permit heretofore filed in this office doted ......................... ~)ee/~l~e~. ...... .~.~, 19...J~, pursuant to which Building Permit No....,~...c~.~.c). .......... dated ......................... ~.e,~teJ~,'.....~.... 19...(~, wa.s issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ................ ........................ ~'~.v~t e...o~te...~a~..l~..~e~.Z.~f~ .......................................................................... This certificate is issued to ..... ~s,l~.~..~..}z~.~t~.e~ .......... (...Ll'e/l'J,e~.). ................................................... (owner, lessee or tenant) of the aforesaid, building. In FORM NO, 2 TOWN OF SOUTHOLD BUILDING DEI~ARTMENT TO~N CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o Z Date ................ ~T~jj~tjc ....~ .................... 191~ .... Permission is hereby granted to: G~t,..~L...&(~ .~.t,. Z~.~ ...................... ........ g.~&~...~J~,, ........................................ at premises Jocate~J at ..~...~l~J..~J, iJli..~,lit..~D~..ti~.Jl~llllll~.~ ................................................ ................................................ Ile.t,~$.t~Xe....ll~ ................................................................................ pursuant to application dated ............................. ~i~....~. ......... 19~..., and approved by the Building Inspector Fee ouilding ~nspector FORI~I NO. 1 TOWN OF SOUTHOLD TOWN C,ER <'S OFFICE SOUT.O .D, ,. ¥. Approved ........ ~-~ .~.. 1 ..c~.../~e r m it No ....... ,~..~../~ .~.. ...... Disapproved a/c .............................................................................................. Application No .......... .~.~... ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ...... ~. ................................ 19 ..... 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 gi~;ing 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 Lows, 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) ................. ................ (Addre~ of applicant) State whether 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 titJe of corporate officer) Location of land on which proposed work will be done. Map No:~..~.~...~.~ot No: .................... 1. Street and Number ..~.~...m.~.m~~¢....~'~ ............ .~~...1....~....:..V.: .............. ....... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use ond occupancy .......... (~..'~ ...................................................................................... b. Intended use and occuponcy......~.'m......J~¢~-...~...~...'~,....~.......TM ..................................................... 3. Not'Lure of work (check which applicable): New Building ....... ~......Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... (to be paid on filin~ 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 ........'~......~.. ........... Height ........ /...'~. ............ Number of Stories ~ 11. Zone or use district in which premises ore situated...~...'.....~....~....'a'. U 12. Does proposed construction violate any zoning law, ordinance or regL, Llation? ...,~..J~......'? ................................. 13. Nome of Owner of premises.~.L~.~..Address ..~,~..¢~.-.J'y,~/.,.Phone NO Name of Architect ........................................................ Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly aad distinctly all buildings, whether existing or proposed, and indicate ali set.back dimensions from pro?erty 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 (ORK, ) S S. COUNTY OF ............................ ) (Name of individual si~nln' g.~appl~ion) above named. He is the ........... ~ ............. ~ .................................................................................................................... (Contractor, agent, corl~orote officer, etc.) of se d owner or owners, and is duly euthorized to perform or h~ve performed the said work ~nd to make ~nd file this oppliceton; that a statements conteined 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 in the appliF~ion filed th~ewith. Sworn to bef~ me this~ 9,~ ~'~ ~ .............. o, ...... ..... ~ -- ~/ ~~ __ ~ota~ I)u~l]c, Stato of New York FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Application No .......... ~.?....~..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ......... ~..'....~.....~. ...................... 19.....'~...~. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su~omitted 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 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) ............. ......................... (Add'dss of applicant) State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .......... /4~'~.~....]..~....~ ................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ..................... Lot No: .................... 1. Location of land on w~ch proposed work wdl be done. Map No: Street and Number ~'~..~¢,~~ ...~ ....... .(R,~..-~,~..'~,,../.......~....~,,/.~, ..................... · '" Municipality · "" ~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. £xisting use and occupancy ........ ~. .~...~.~.. ......................... ~_ ............................................................ b. Intended use and occupancy....~..~..~..-,<~...~ ......................................................... property lines. Give street and block numbers or description according to deed, 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost, ........ ~.,..>.~?,,,~,,,,,c~ ............................... Fee ............. /....?..:....rd...'~R... .......................................................... (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 ..... .3.....~ ............. Depth .......~.......~... .......... Height ........ /...?&~ ........... Number of Stories .... 9. Size of lot: Front ..... /...,3....~.. .......... Rear ..../...~...~. ............. Depth ,.~....~..~...~C..."~ .... 10 Date of Purchase ..../....~....~.....~'~ ................. Name of Former Owner ../~..:.....~.~..~.....~..~..~'~ ...... 11. Zone or use district in which promises are situated,,,~ ........... ./~/..~'X-:~¢~.: ............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation?U ..... ./...i~f.......-. .................................. 13. Name of Owner of premises.l,~,~C,~,"~'....l.~.~Address !..f)c~,S,,.~%.~.,¥~,.Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor. ,,_,~ , ..__..~....'......Address ...... ...Phone NO. PLOT DIAGRAM Locate clearly and distinctly all buildings, whetheF~existing or proposed, and indicate all set-back dimensions from and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ) S S. COUNTY OF ............................ ) .... .~,~...,.~....k,=-~.X~.:-~.....' ....................................... being 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 ail 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 in the application filed therewith. ,, Sworn 'to before me this ~'~'~ ~1~,, of .~ , 19 .~...~... (Signature of applicant)