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HomeMy WebLinkAbout1004-zFOI~V~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at "'t/f/L~'""~'E'~/~r'-'"Rual~' ................ Street conforms substantially to the Application for Building Permit heretofore filed in this office dated .............................. ~h. ...... ~.~.., 19.1~.., pursuant to which Building Permit N~..~OOJ~ ............ dated ....................... ]~1~eh.....~' · ......... 19~,(}.., wa:s issued, and conforms to all ofl th"e requirements of the applicable provisions of the law. The occupancy for which this certificate is i~sued is ................ Lowner, ~essee or te~,ant) of the aforesaid building. ~,~ I ' FOI~I 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 AUTI:IORIZED) N? 1004' Z Permission is hereby granted to: to ...ballL~l..ne~...one...£amlLllr...d~.l,l,t~g .................................................................................. ~att~tu~3~, Ne~e '~rk pursuant to application dated l~lC'etttt ~'! 19 60, and approved by the Building Inspector Fee $.. ,t,~ ~.~.~...g~...e. ~. FO~ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ..... ~...~, .......... ,.....~ ...., ...... ·.....~../..~-.'.~...~.. Approved ~.~.~.f].~..f..~)..../,., 19..~..~.~ermit No. Disapproved a/c ........................................................................................... Application No ........... ./..~'~.~... ...... (Building Inspector) ....... APPLICATION FOR BUILDING PERMIT ote ......... ............... , INSTRUCTIONS o. 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 shah be kept on the premises ava. liable 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) If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1 Locat on of land on which proposed work will be done. Map No: ............................................ Lot No .................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ........... .~..~.~..~../. ............................................................................................. b. Intended use and occupancy ............. · .~c../. · .~. ·... Jl ,~.~....'~.' .~....~.?. ~ ~. · ............................................................................... ,/ 3. Nature of work (check which applicable): New B I ui ding .................... Addition .................... Alteration .................... Repair .................... I~moval .................... Demolition..i ...... i .......... Other Work (Describe) .................... 4. Estimated Cast ...... ~ '-~--./(...../..././.~ ............................. Fee ...... .~...~.).:....~.. ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .............. L .......... 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 ........ ..~...~. .............. Reor ....... .~.~ ............. Depth ........... q~ .............. Height ........ /.~..! ............. Number of Stories ....... /. ....................... 9. Size of lot: Front ....... /...rr)..~..~. ........... Rear ......... ./...o...~..~. ....... Depth ....... ~..0..~..C~.~ .......... / 10. Date of Purchase ...... /~...?...../..~..~...~. ...................... Name of Former Owner ....~./~...~.-..~...~..~.~.(..~.. 1 1. Zone or use district in which premises-- !are situated ..........~.~.~.£4/~.Q~.,rfT~.~...~..-. .......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................... ; ................... 13. Name of Owner of pre, g:~es...,/..,~..~.),~., .'/'J~...J ............. Address ...... ............ Phone NO. ~..r..!...!../.':/.:,___ 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 come.r lot. STAI'E OF NE~W~'JD, I~K..~/ ) S S COUJNTY OF ~.~,.~,.~./..~?......) ' ' . . ''., . . , .~ ~ ~ ~.~-~ . ', .....· .I........................... ....... ......................... be.ng duly sworn, deposes and says that he is the applicant' (Name of ~nd~wdual sigmn~,apphcat~on) above named. He is the ............. ~ ....... ~ ................................................................................................................... (Contractor, agent, corporate, officer, ~tc.) 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 ........... ~ ......... aay,~o~ ........... .~,; 6...~Z~.;~]7..]~ .... .~ ......... Notary Public, (Signature of applicant) FOILM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTJ~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ..........~ ....................... No ................................. Disapproved o/c ................. ~..;;.~ ...... :::]]]]]~ ............ ] ]]]]]]] ...... '--'"~"_L ._ (Building Inspector) APPLICATION FOR BUILOING PERMIT INSTRUCTIONS ' o. 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 sho~l be kept on the premises ovo.iloble 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 o~wner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... ...................................................... . ................................................ No me of owner of prem ises....~.~: .~.. ~ ]~%/~......~.,.....f~. ~.. 1~-~, )~ ....................................................................... 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 Numbe~/.~...g.~...~.~'~/,.~.~r'TA-~.......~. .......... .~....~.."~.. ~.......~...~..O......~.~.z~.....~. ................ Municipality State existing use and occupancy of premises <~nd intended use and occupancy of proposed construction: a. Existing use and occupancy ........... 4 .............................................................................................. b. Intended use and occupancy ............ ~.~.~,~..~...~.~:.~..Z ~ ................................................................................ 10. 11. 12. 13. Nature of work (check which applic ~b ): Ne b~lilding 'i ~ , . , . ................ ai ion .................... tera on .................... Repair .................... ~emo_val ............... .~,. ~. De~lition...~,.. ~" ......... Other Work (Describe) ..... If dwelling, number of dweJling umts ........................ Number of dwelling units on each floor ........... ~ .................... If garage, number of cars .................................................... : ........................................................................................ If business, commercial or mixed occupancy, specify nature and extent of ~ach type of use ................................ 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 ................................ Dimensions of entire new construction: Front ~ Rear ........ ~.~. ............ Depth ~. ~ r, Height'. ....... ~ .............. Number of Stories .......[ ....................... Size of lot: Front ....... Z~.~. .......... Rear ......... ~.~..~ .......Depth ....... ~.~.~ .......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali 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. STA Of NE~'~BF-~,~ ) S S COUNTY OF x~'~,~(~'..,~.:...,) ' ' ~n~(Name of ,nd,v,du~n,n~'~pphcat on) .............................. ~ ....... ~ ....... r~ .................................. ~ duly sworn, deposes and says that he is the applicant . ~ .... 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 opp[ication; 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 ~n~the application filed therewith. Sworn to before me this (Signature of applicant)