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HomeMy WebLinkAbout1123-zFO~i~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFXCE SOUTI~OLD, N. Y. CERTIFICATE OF OCCUPANCY ....... ..... Date ................................. THIS CERTIFIES that the building located _Map No ........... ~.~..... Block No...~.......~. ....... ~,ot No ............ .*.....~....*. ................................................. conforms substantially to the Application for Building Permit heretofore fried in this office dated ............... .,])~.~...~,.7. ............. 19..~.0.. pursuant to which Building Permit No ........ g...[&2~, ~lated .................. ~.u~...g'J. ............ 19~..., w~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 ............................... p/LI~AT~...ON~ ·. FAMILY...DI~tELL ~.N6t ........................................................ This certifieale is issued to ...... ~7O'nl~..W~....]~Ck'}-"'O%ql~e~ ....................... ' .......................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FO~'~ 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? 1123, Z Date ............ :....t. ........ ...~-~...~J~.. 19./~.~ Permission is hereby granted to: ~ ' at premises, , located, c~t . .: ..~.: ........................................ ~ .............. .. . .~.~.~..'. ~../.. ,~.~.~-~..~:. :~., ·..................................................... ~urs~on', ta'o~p',cot~an dated ......................... ....~~....~:?......~..~ o~d op~ro,e~ by th~ Building Inspector Fee . . ........ ~ ~c.~r: i'nspect o~r~ FORiYI NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~ ~ ~ . . ~.~..~_/~.~.. ~:... Approved ........ ;.~¢~¢~.~....~....~...19..~.Q.Perm~t No. ~-~ (~ Disapproved a/c .............................................................................................. (Building Inspector) ~/'~_~ ~ APPLICATION FOR BUILDING PERMIT Application No ......../..' ./~....~...~. .... 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 locution of lot and of buildings on premises, relationship to odioining 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 Occupangy 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ......... .................................. (Signature of appJicant, or name, if a corporation) (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................................... .(2. .................................................................................. Nome of owner of premises ......... ~.,...-..¢~.....~..~..', ................... ~ ........................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work wJII be done. Map No ............................................. Lo No ..................... Street and Number ........... ~......~..~. f..~.'~(~..~¢ ~. 41..,... ~.,~ .GC'~ ...... ~ ........ ....~.~~- State existing use and occupancy of p~emises and intended use and ~cupancy of proposed construction: a. xi,,in .,e =,o=.p=c, ............... ............................................................................. ................................. 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition ............ ~ ....... Oth,~r Work (Describe) .................... 4. Estimoted Cost ...... f._?.c.~.c..¢.?.~. ......................................... 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 struct0res, 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 ........ %~.~....~.~....f.... Depth .~ ............. Height ............................ Number of Stories .......... ../. ............... 9. Size of lot: Front ........... ~/....."mff.. ........ Rear .............. ./...~?.. ....... Depth ........ ,,~ .......... - --.....z ~ -- 10. Date of Purchase .............. .~..~..~.~..-'.~. .......................... Name o~ Form_er Owner ...... L.~..C'.c??.-...~.....~....'~....~'~ ...... 11. Zone or use d~stnct m which premises are s~tuated .................................... 12. Does proposed construction violate any zonj, ng Iow, ordinance 9-~ regulation? ../~.....~--~.~ ................................... 13. Name of Owner of premise~6¢' '~'':c'~'¢C''~'Address,-~ ~ ,,_ ,x,, -- ...~.~'~..~......~....~...~~ne~--'" NO 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 er description according to deed, and show street homes and indicate whether interior or corner lot. COUNTY OF ~......~....Y~. ' ........................................ ~~.....~..J/.~'...~.....~.being duly sworn, deposes and says that he is the epplicant (Name of individual si~qning a~oplibation) above named. He is the ........... (~.~.~-.¢,~p ............................................................................................................... (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 applicatio~led tbe~with. Sworn to before me this '~ ~/(/ ~- ..................... · ~ ~ ~, ~ u c, State of New York Nota~ Pubhc, ~4~..,~. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........... ...~,~,.:~....~.. 19...~..~ Disapproved a/c ........... ..~ ................................................................. Application No ..... .,~...~.....o~.. ~.~ ..... (Building sp ctor~ ~../j~_,~ 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 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 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. ........... Z."...-~..~ ....... ~ ........... .~...C.....'2L...~ ................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ f~.c~.~.i,~....~-,~/,...:;,~'~z:~,:;.;~\,~~:'~;,rc- ............................................................................. If applicant is a corporate, signature of duly authorized officer. Location of land on which proposed work will be done. Map No: ..................... ~ ...................... Lot No: .....-~.. ............. ..... · ............ Street and Number .... State existing use and occupancy of p~emises and intended u~e and occupancy of proposed consCrucfion: .............. .............................................................................. ........ ................................. b. Intended use and 3. Nature of work (check which applicable): New Budding .................... Addition .................... Alteration .................... Repair ................ _.~,.Removal .................... Demolition ............ .~ ....... Oth,~r Work (Describe) .................... 4. Estimated Cost ...... .(.~..U....cr.~. ......................................... Fee ..... .4. .................................................................................. (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 ............................ Number of Stories .......... ?. ................ '~ '~'' .............. ~.'..-~..../. Depth ........ 9. Size of lot: Front ............ ~ ........ Rear 10. Date of Purchase .............. ./..~.: ...... ~.. .......................... Nome o,f, For~er Owner ........ .~.-~.~.~,,-~',-:'~.~L~f.C..~,.rr~ ...... IlZone or use district in which premises ore situated /E)J /~,q _ ..................................... ........... ....................................... 12. Does proposed construction violate any zoning law, ordinance or reauiation? ..~;...../..,~ ................................... 13. Name of Owner of premis .E~...~..~.Address . ,:~-Ffone NO ..................... Name of Architect Address c.,' Phone NO Name of Contractor..~cr..r,¢.~..*.~(..~......~: ........... Address ....... ;~./..~t4...~.~r.~.~r~,~Phone NO ..................... PLOT DIAGRAM Locate cleerly and distinctly oil 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 NEWJ~'OI~F¢. /2.,~r) c c cOUNTY OF ............................... ...........~.. ,~...~.../.~....?..'~.'~...being duly sworn, deposes and says that he is the applicant (Name of individual signin~pp~cation) 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 fife 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 appiicatio~ile~t~with. Sworn to before me this _~/~ ....... ~ ........... day ~f ......... ~'"~'¢~"/1~"~""~t~ Notaw Public, .~-~.~¢~...~..~.,= ................