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HomeMy WebLinkAbout1541-zFOl/~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No .......... .~...:~.~.~ .... Date .............................. ~ttllt~ .-~ ........... , 19...J:J THIS CERTIFIES that the building located at .JJ~J~iJj/..-J[l~J~..~JJ~[~ill~l~ .................. Street Map No ....................... Block No....~...~..~.. ............ Lot N~JJr~3 ..................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................. .~..?.~....~..~.~.~..~..~. ...... , 19.....~...Z pursuant to which Building Permit No..~J..~l,,q~Z dated ...................... ~.J).t~..l~..., 19 ...... ~'as issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .......... ........................... .1~./~,~...0~.. 1~1~.'.. ~l~r.~ ................................................................... This certificate is issued to ............ ~J~'.~-..~t.l~i~,..~ti~ll~'. .......................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FOI~NI NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1541, z Date .................. ~opt~l~.....6 .......... 19.(~.. Permission is hereby gronted 1'o: t o ...~ t&.. ~n.. ad ~.~ &~ ~.. ~.. ~...e~ s~ng...d~ ~.~ t~ ....................................................... ot premises Ideated at .....~O.t..~,~:~:~jT;.~O~OO~..(~.~.~.) .................................................. .................................................. ~....~F...~ ............................................................................. . ............................................................... .~$~e~ .......................................................................... pursuant to application dated ................................................................ 19 ........ , and approved by the Building Inspector Fee $.¢,..00 .............. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, ~1. Y. Examined ........ ~K.........~.. ........ Approved ........................................ 19 ........ Perm t No ............................... Application No...~..'.'~.....~...I ............ 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 o detailed description of layout of property must be drawn on the diagram which is p6rt of this location. c. The woi~k 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 kep~ 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuonc,~ 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 nome, if a corporation) (Address ~' 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 title'of corporate officer) 1. Location of land on which proposed work will be done. Map No: ................. Lot No: .................... .............................................. Street and Number... ~/ .' ......... Municipality State existing use and occupancy of pr, emises and intended use and occupancy of proposed construction: o. Existing use end occupancy .............................................................................................................. b. Intended use end occupancy ........................................................................................................ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock din lines. Give street and block numbers or description according to deed, and show street ~ame,~ property whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Remova~l .................... Demolition .................... Other Work (Describe) ~r -- cz) -%- 4. Estimated Cost ..................... .~r ............................ Fee ................ ~......~ ......................................... ~ .......... (to be paid on filing this application) 5. If dwelling, number of dwelling units ................................ Number of dwelling units on e~ch 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 o~ entiro new ccnstruction: Front ........... ~ ............. Root .......... Depth ............................ / t ~ Height .......... ~ ............ Number of S or'es ............................ 9. Size ~f lot: Front ........................... Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................. ~.~.~~. ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation~ 13. Name of Owner of premises.~.~..~ ......... Address .~~~.Phon~~~. o, ...... ..................................... ..................... PkOT DIAGRAM ~ensJons from and indicate STATE OF NEW v~R~,~, f,~_) S S c o, ' . ..................... ~..~..~...~~. ................. being duly sworn, deposes and says that he is the a~pllcant (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 applicaton that a statements contained in this application are true to the best of his knowledge and belief; and that the work wil be performed in the manner set forth in the app ication f led therewith. Sworn to bef~ me this & -- ~ JHf~IT~ T. BOKE~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ ~).:~...~.W?.:......(-? ......... 19.~.-f .... Approved ........................ !.~. ............. 19.....~./.Permit No...~';./..i~i..~.'~.J ......... 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 detailei~ 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 p art 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) ....... (Address or ra'pplicant} State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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 .~' ~..'. '~y~.~ .~. .'. ~.. .-. .2' ~ ~ %unicipali '~ ' ; ! ..... .......................................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ .~....~ .............................................................................................. b. Intended use and occupancy ........... ~..~ ............................................................................................. 3. Nature of work (check which applicable): New Building .................... Addition ...~ ........... Alteration .................... (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 ............................ Height ........... ~. .............. Number of Stories ............................ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... l l. Zone or use d~stnct m wMch premises ore situated ............... .%.. 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ~. ......,,~ ......................... Name .................... of Architect......,¢-~ ............................... ~ ............... Address ....... ; ............ ,~ ........ ~, ............ Phone NO. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicatej~ll set-back dimensions from property lines. Give street and block numbers or descriptior-r-r-r-r-r-r-r-r-~v.d;nG to 4,~,~4, ~nd sho~ street names and indicate whether interior or corner lot, ~ __ /~,4~ ~ -- STATE OF NEW .~)P..KW. ~J~,) S S ":'~ ~'~~ ........ being duly sworn deposes ond says that he stheapplicont obov6 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 th~s oppllcoton; that a~ statements contained in this application ore true to the best of his knowledge and belief; and that the work w be performed in the manner s~Dt~rt~ ~E~e application filed therewith. Sworn to befo~ me this ~ . ~ota~ Public, State al New York