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HomeMy WebLinkAbout957-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANGY THIS CERTIFIES that the building located at .~/.~.....~.f~.C~.e,~.....~.~.~t~ .......................... Street Map No.~.13TX~f~.t4..~.~. Block No....,~¢, ............. Lot No ..... ~ ............ ~.t~..~,~,O~.....~.,.~',, conforms substantially to the Application for Building Permit heretofore filed in this office doted .......................... ,,T~l%~.~t~.......*L'l ..., 19..6~., pursu.ant to which Building Permit No...~..~.~/. ........... dated ........................ ~T/~z~.G.~'~...,~ ...... 19.1~.0.., was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupa, ncy for which this certificate is issued is ................ ............ ..................................................................................... This certificate is issued to ...A~,,~.Q~...~,o...[C~i'~ .................. (...(~t~..) .............................................. (owne. r, lessee or tenont) of the aforesaid, building. Building Inspector FOI~M 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.o 957 Z Date ..................... ',~l~tl~'... ~ ............... 19/00 .... Permission is hereby granted to: Doug I~ o~ ~.~. ·. · _t¥~,...~.t.i¢~ · ~ ,.. ~Lr~. ................................ ......... Ea~4~ ....~.~o~,....N,Y ~ ................... to ..... ~.1~.. ~ew. one..f.~ty..dwe.~ ~L~g. ........................................................................................... ot premises Io¢oted ot ....W/~....Oo&~Sc..~I':LT~ ................ J ....... .' ............................................................. .......................................... Ea~-. ~..ri~a ~. · ·. ~ ,.Y., ............... ~ ................................................................. pursuant to application dated ........................ ~l~tr~'.....~' ................... 19~0..., and approved by the Building Inspector Fee $'~0 ..00 ..l~:~d..eheek FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. "' /~ 19 ~..~ermlt App roved...~/~,,,~,.._,,~F. .......... ........ 'No ..... ,.-.-.-.-.-.-.-.-.-~..~- ..~:.-~.~ ~'.-~- ........ Disapproved a/c .............................................................................................. (Building 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 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 puFpose whatever until .o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 oil applicable laws, ordinances and reaulg, tions. ~. ~ .............. ,~,~;' ,~,,~ .,~. ,~,.... ~..,~ .¢r~.¢ ........ ~.) .................................. (Signature of applicon, or n~i~ if a corporation) (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ../'~...{/.~.i~.~....:S~.t.....~. J./.C..~... ................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work~,ill be done. Map No: .z......~)J~'........~., ..................... Lot No: ..r~.....~..i .......... Street and Number ....... ~...~.( .~;7....~.~..(.~ ........~.,..L~.~,.~.~...~:-~.'.~...z~..~..~...~.~:.......~.~.~.~?.../~... -~..i....~.?..~..~.~.'~ ..... Municipality 2. State existing use and occupancy of premises and inten~d~d use and occupancy of proposed construction: a. Existing us a occ p y ............................ ~ .................... ' ................................................................................. b. Intended use and occupancy ........... ~....'~.~..~Z..~....~?....: ........................................................................................... 3. Nature of work (check which applicable): New Building .................... Addl ion .................... Alteration Repair .................... Removal .................... Demolition .................. Other Work (Describe) .................... E t t ~7Z ~) ee ~//~ 4. s ima ed Cost ....... ....... ~.O ................................... F ......... ,~..~¢..: .................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling unit~ ......... /.. .................... 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~.....z-,~, ................... 8. Dimensions of entire new construction: Front ....... .~.,...~..~ .......... Rear ....~....¢~, .., ........... Depth ......~....~, ............... Height ........ .~...~ ............. Number of Stories ...... /.. ................... 9. Size of lot: Front ......~....,,~...; ....... ~ Rear ....~ .................... Depth ...'....~ .................... 10. Date of Purchase ............~../.._f../..~.....~. ................. Name of Former Ow,,ner,,..~_~...J~..~.¢...~,...../...('...~.../....7..-~..(~?//~. 11. Zone or use district in w~ch p~remises are situated ................................... ~....~.; ......................... Z........../ 12. Does proposed construction violate an, y zoning law, ordinance or regulation~ ...... ~...~.......~: ...... t ................... 13. Name of Owner of premises...~../.~.¢....~..'.;~.~../...f~..~..Address ..,,~¢~r~.~..~...~.~..~..~.~?. ...... Pho?e~N~.' .1~'..~....'~..~.~..~"]~ Name of Architect......~'~..'~.....~...~../J~....~. ........Address ........... ~ .............. (.f ......... i....Phone NO .........~.1. .......... ~ ~ ~- ~ P n Name of Contractor...J~..~...,!~...../~..!.f~.¢.,..~. ........ Address ...J,C;z.~..J..,~:~.~.(...~.~.. ho e 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 Pot. STATE! OF NEWrSfOJ~,0/,~ ) q S COUNTY OF ,....'~;~.~,....) ~ ' ~ ............ ~....~..~..~.....~....~.....zlr.,~.:..J?...~ ....................... being duly sworn, deposes and says that he is the applicant (Name of individual signing app~ation) 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 set forth in the application filed therewith. Sworn to before me this ............. ~t~.P~ s~f(~ tt.~,.~.~...~..~ ......... ~..~ ~ / 7~,-~ ~"~'~' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD', .. ,. Exom i n ed. ;...~'~/~.../~... 19..~x...~.' App roved. J.~.~.~..~ .~..~,~..../..~ 9.. ~Pe r mit No ...... ~.~ ~.~..~. ..... Disapproved a/c ....................................... ~ ........................................ ............... (Building 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 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 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 puFpose whatever until a Certificat, e 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 re. gul~/?/fions. ~ ................ ~ ./..J~../..<~?:...~;..?..~-. ................................... (Signature of applic~f, o~_,~ if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................... ~:~J~:..~..~................-~-~% ....................................................................................................................... premises ...~....//. ~Z ~. ::~..!. ~../. 'Z~~ ......... Nome of owner of ........ -] ..... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ,. ,o, No., ./.' 1. Location of land on which pro!~d wgr,~ ~1 bo done,, .M/P No' ' Street and Number ....~..~...~.;.....~'./.~.-~.. .......,~}i:.~.~..~~J;Z;;;J~~~JJJ.JJJJJJJJJJJ;; MunJc{pal}ty 2. state existing use and occupancy of pr,em}ses and {nte~d use ~nd occupancy of proposed construction: ............ .............................................................................. b {ntended use and occupancy ......... ~..~..~....~....~~ ' ~'~ ......................................................................................... 3. Nature of work (check which applicable): New Buildlng ....... ~Addition .................... Alteration .................... Repair .................... Removal .................... Demolition....._..~r ....... Other Work (Describe) .................... 4. EstimatedCost....f..//.(,,'):/....~..~ ................................... 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 ............................ 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 ..~r~.. .............. / Height ........... /...~ ......... Number of Stories ....... / .................. 9. Size of lot: Front ....... /..~..(~..; ....... Rear ...../.(~..~ ............ Depth ...~.....~...~.. ............... 10. Date of Purchase ............. .~...'..//1../...Z....~...~. .................. Name o~f,,(orn~r O,wner .....~.¢-?.¢.t.... :.~.~..~......~..~.~Z4.~-~, 11. Zone or use district in whic~ /emises are situated ............. .~........~.....-'~... ....................................................... .~-....../ - Does proposed construction violate any zoning law, ordinance or regulatj,on? ..~......~....~ .......... _..~.. ................. 12. 13. Name of Owner of premises....~..C~..&..~../...~'...~.Address .....~.....~.~.£.¢~....~.,.r~.~.4..~:..¥~.J?.Phone ' O1~...2..-.~..~.?.'..:~'/~ · /,,,c)~./_~/~,~, ' '1 r Name of Arch,tect......~ ../.-~O/f.,..,...,....~..~.~.~.~. ............ Add ess ............................................ hoe NO ..................... Name of Contractor.....~..O.~.. :. ......,4f.~.~..F,~.~..z. ...... Address ../k~.'~..,'~..~........'~.,~/~.~.l...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 Y.~.OR[~,,',]/)./ ) S S ' (Name of individual signing appl~ation) 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 tb9t the work will be performed in the manner set forth in the application filed therewith. Sworn tO bef~rm~l~ T