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HomeMy WebLinkAbout1103-z TOWN OF SOUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, N, No ..... ~:? C£RTIFICA'I~E OF' OCCUPANCY Date ......................0~tlobi~ilC. · 20. ........... 19.60' THIS CERTIFYES that tixe building located at Map No ....... ~.~.~ ........ Block No ....... t~.~ ......Lot No .... ~.*t ................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................... ~..-~ ............ 1PIP... pursuant to whicl~ Building Permit No....Z..,~3 ..... dated ................... ~.q...7 .............. 19.~0.., was issued, and co~forms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ~.~M~...~,, ~l~I. ,~LL~..... t~., ,~S.I~.S S .. B~ I~D.I~. .... This certificale is issued to ~,...~.~tot..~a.i~....o~~ .............................................................. (owner, lessee or tenant) of the aforesaid building. 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? 11o3, z Date ,.Tl~e ? 60 Permission is hereby granted to: 277 8~xt.h &venue .. ~ .~.~,...~.a~...a.,,...~e~...~.o. ~ ................................. to .~d..a~d~.~n ~n .~.~g ~m~.~ ~.~.~..~...g~.~.. ~.~ at premises located at ...aZ~...~:~..~....~..~.?/a.}.,,...~,~,..~..~ .......... pursuant to application d~ted ....................................... ~...~ .......... 19...~.~, and approved by the Building Inspector F~e $..~.*.9.9..~ ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ...........~....~.~.......~....., 19..~F~Permit No ......... ~_~../....~...O.....~.... Disapproved a/c ............. .~ ...................... .~. ................. ~ Application No ..... ~..~..~..J~.... ............ (Building Inspector) c~',,~,,,,~ APPLICATION FOR BUILDING PERMIT Date ......................... ~z~.~..~........, 19..~...¢1 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 ava.ilable 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. (Signa~re of opp~,~nt, 9,c-;no,ne, if ~ cc~rporation) .......... ...... .... (Address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................... ............................................................................................. Name of owner of premises...J.~/~ .Y~.-~/.~ .~....~..~.... .................................................................................... . If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate, officer) 1. Location of land on ' ' ~ which proposed work wdl be done. Map No: ..................................~ ......... Lot No:.....~. .............. Street and Number ........ ~7/~""'~' 'f~"~<"Municipality'"~'"' ' ''~'''~ '"~'" "'~' "'~" '~' "~~'~'"~'~"~'~'"""~ .... 2. State existing use and occupancy of premise,~ and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. ~Z..<~~/...~~~......r~.....~.~..~... ................... b ntended use and occupancy ...... Z ..... /<~../....~..-~:'~...-z:~... ~..~.... Locate clearly and distinctl property lines. Give street and bi whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................... Addition....~ ....... Alteration .................... Repair ................ ,.... Red, oval .................... Demolition ......... '~"'"Z' Other Work (Describe) .................... 4. Estimated Cost ........... c'Arf.~(r;2...~...~...~ ............................ Fee .....bM. ................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... d ......... 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.~'~'/Z~.~.~"~ 7. Dimensions of existing structures, if any: Front ....... ~,.~ ..... Rear ...... :.,~-~......~...... Depth ........ ~.....,"~... ............ Height ............................ Number of Stories ............... ~;~ ................................................................................. 2 ' Dimensions of same structure~.LIJ¢ ctlterations or .additions: Front ....... ...~...?.~. ............. Rear ....~.././. .... Depth ................................ He,~ ......... ,L,./d .................. ~f- .... Es ................................ 8. Dimensions of entire new construction: ~ront ......... ..~.~... ........... Rear ........ .~.....~... .......... Depth ..~.'.....~ ............ Height ............................ Number of Stories ......... ./. ..................... 9. Size of lot: Front ........... /...~.L.~. ...... R~ar ..... ./..~2..~? ........... Depth ....../....,,~,,g~.. .......... 10. Date of Purchase ........................................................ Name ~of Former~Owner ........................................................ 11. Zone or use district in which premises are situated .............. ~.~F..~... .......................................................... 12. Does proposed construction violQte any zoning law, ordinance or regulation? .... ~ ......... ,~ .............................. 13. Name of Owner of premise -..~...Address ~.:~..~.~ NO ..................... Name of Architect~..;) ...?,~.~ ~~- ,/Address ....................................... Phone NO ..................... Name of Contractor ,~..~......~-'/-~.~..~'~.Addres~~~)..~..'..~... Phone NO ..................... PLOT DIAGRAM ail buildings, whether existing or proposed, and indicate all set-back dimensions from ~!~ numbers or description according to eed, and show street nQmes and indicate ,/ STATE OF NEW~O~I~, ,~,~) S S COUNTY OF ~....~z~/~....(~./.c.~ ' ' ........................ ~cf:~ff....~.~.~¢.~ .~f. ......................... b ' g 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 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 ma~r. ~et forth Jn the application filed therewith. ........ ....... oho, Notary Pubhc, ~,.~~ C~u..t7 ~ (Signature of applicant) I~OP~i~ 1~0. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. ....... ~.c,.,:~..., ApprovedEXamined ........ ~Z~_.~ .~.,1 ~K?.. Permit No ............ ..... ~ ~ Disapproved a/c ................... ~y..~.~~ .............................................................. .................................. ................... ,.. Application No......~...'~...~....~. ............ (Building Inspector) APPLICATION FOR BUILDING PER/vtIT 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 ava.ilable 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. (Signa~re of applicon, t, or name, if o corporation) ....................... ,.,~ ............. ., ...... ~..~.~...+.,.,.~....:.~ .... (Addres~of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................... ~,~,.~?.,..<fi~.~.~.~',<:~ ~4.~. .............................................................................................. Name of '~"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 will be done. Map No: .................................. :, ........ Lot No:....~ ........ .- ... -./.., . ,. - . Street and Number ..... ;,....~ __~.~/~ .,~: . Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. ,~,s,,~.,e.n~occ.~o~,~ ............. ~~~ ~& ~ ~ b. Intended use and occupancy ......................................... ~ ............................... //~/..~?~f;~.~:~.~z.~ff .... 3. Nature of work (check which applicable): New Building .................... Addmon ............ Alteration .................... Repair .................... Re, g)oval .................... Demolition ........ ..~,.....~.. Other Work (Describe) .................... 4. Estimated Cost ........... c~...(~..~..,~...~ ............................ Fee .....,~. ................................................................................. (to be paid on filing this application) 5. tf dwelling, number of dwelling units ..............~. ......... Number of dwelling units on each floor .................................. If garage, number of cars .................... ~ ................................................................................................. 7 .............. ~' If business, commercial or mixed occupancy, specify nature and extent of each type of use.~.~ ....... :f.....~..~.~ 7. Dimensions of existing structures, if Gny: Front ....... ~(.~.... ......Rear ........ ~....~ ..... Depth ........ ~ ............... Height ............................ Number of Stories ............... ~..~ ................................................................................. ...... . .... Dimensions of same structure~ ~lterat~ons or.addmons. Front ............. ~ ............. Rear ................ Depth ....... ~...~:~ ............. Hd.g.s ........ ~.~...L...~.~s ................................ 8. Dimensions of entire new construction: ~ont .........--~ ............ Rear ........ ~..~. .......... Depth ~..~. ............ Height ............................ Number of Stories ........ ~ ..................... 9. Size of lot: Front ........... ~[~. ..... Rear ..... ~. .......... Depth .....~..~ .......... 10. Date of Purchase ........................................................ Name gf Former ~wner ........................................................ / 11. Zone or use district in which premises are situated ............... :........~.~:~'. ......................................... ~ ............... 12. Does proposed construction violate an~ zonigg,.law, ordinance or,,regulat[gn? .... ,~..,.......~. ............................ 13. Name of Owner of prem,ses~X~%...~...~.Address ~....7. ........ ,..,A' ........... ~e NO .................... Name of Architect ........................ ~ ........................ Address .............. ~ ............................ Phone NO ..................... Name of Contractor .~,.......~,;~,.......~.._.....Address%~~ :~,'~..,..,_~. Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and b!)ck numbers or description according to eed, and show street names an~ indicate whether interior or corner lot. ,, , STATE OF NE~OR~ f ~) S S ' .............. ~,Z~ g ............ ..~ ~ -%,-',.- x'-z ~. ,. ~ e' deposes and says that he is the applicant ........................ ~.~; ...................... K~,....v. ................................. bmg duly sworn, (Name of individual sig~g o~gti~) above namea. ~e is ~ne .... ~* .:'.~ ........ : ........ : ....................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to mak~ and file this application; that all statements contained in this application are true to the best of his knowledge nd belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to befor~ me this ~ ~6 .,~'") Illllllt,~llUrl Ex~es~arcll 30, ]~J ............ ~.. ..... day of .......... ~¢~-~;~...~... 19..~...W. .~.