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HomeMy WebLinkAbout1580-zF~F~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at N,J~..~Ja&~'i...~c~d ........................................ Street Map No.Z....~f.. ................ Block No ...... ~ .......... Lot No. ~.....~.O..~...~..~..O...~..~..t....~.'...Lr.". .......................... conform~s substantially to the Application for Building Permit heretofore filed in this office dated .................................. .O.~.t~.l~f~'...,~.~ ........ , 19.~,... pursuant to which Building Permit No .~..]...~..8...0. .... doted ......................... ..0..q.~...o..~...e..~.....~.~....., 19..~..~...., was issued, and conforms to oil of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ .... ................................................................................................................... The certificate is issued to .~d.~..~tl~c~ ........... O~rl~. ................................................................... (owner, lessee or tenant} of the aforesaid building. FOi~i~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z 163.8 Date THIS CERTIFIES that the building located at [~.~Qa~......JgQU.~l~l~..,,h, ............... Street Map No ...... e~ ............. Block No ......... *~ ......... Lot No ....... ~.a ............................................................ conform~ substantially to the Application for Building Permit heretofore filed in this office dated Octo~e~ 10 19...~.~ pursuant to which Building Permit No. ~ 1580 dated .......................... ~.9~.~...~..., 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 ........ ~TIQ~ STO~ The ce~fificofe ~s ~ssue~ $o ......... ~.~..~.~.,...~e= ............................................................. Building Inspector FOP~M NO.~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. BUILDING PERMIT (THIS P, ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1580, z Permission is hereby granted to: Ed~.ar~..~id.ds .................................................... ......... ~aLn...~o...~ ................................................. ............... Smu~ho. Id ............................................... to .....Mo.~e...~m.a...~ot~J:.!~:~..~nc~:...a. tt,~ol.~. :to...an...e~,,~t f~g...b~,~lneas...huild£u~.. at premises located at ..I~/~.....}f'~:~gl...~ .......................................................................................... .................................................... 8.O'at, tt~t&~"""~,'~Z',' ........................................................................ pursuant to application dated ............................... 0O.~O~X~:~.....~L ....... 19.~..., and approved by the Building Inspector Fee $...~.,.0~ ........... ~ui~aing inspector / FORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ~, ./, .! ......... , 19.,~..,(.. Approved ........................................ ~ , 19 ........ Permit No ................................. Disapproved o/c .... ................................ ................................. App,ication,No...../....~...~ .......... APPLICATION FOR BUILDING PERMIT Date., ..... .- ... ........ /,P,, ........................ , 19~./. ........... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink (]nd 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 application. 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 pa rt 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 ali applicable laws, ordinances and regulations. .......... ......... .... ........... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. J~L .__ Nome of owner of premises ................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Looation of land on which proposed, work will be done. M(~p No: ....,~ ........................................ Lot No: .................... Street and Number ........... ~.~'..i.~. ...... /. ...................................................... Municipality State existing use and occupancy of premise, A~ intended use ?~d~o~/~p. ancy of proposed construction: ~. i~iSe~n~dU~iea~dO~!a~ ............ {~/~"~-J,¢..'~_'.,~.,~....~'..r.-:...r:.:-~,,~~~ .................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .............. ;~.... Removal .................... Demolition .................... Other Work (Describe) ........................ (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 ar additions: Front ................................ Rear ................................ Depth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front ........ ..."~T...~ ................ Rear .....,c9~....~. .................. Depth .~ ..................... Height ~q-O' Number of Stories ......./.,..o~c.. .................... 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 regu[Qtion? L0 Name of Architect ...................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail 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 NEWrY~I~, ~f ) c c COUNTY OF ....,,%~'...,/~....L..~....) ,~.°. ~ ............................. ~.. . ,~ .............. being duly sworn, deposes and says that he is the applicant (Nome of individual signing application) above named. He is the ..................~~ ..................................................................................................... (Contractor, agent, corporat~ 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~ ~t~h in the application filed therewith. Sworn to before me this ~ot~V ~btic, st]te of ~e~,~k _. 0344963 SuSa ~ Co~t~ ~.~ ~ ............... ~/ ~ ~ ~/~_ // ./~ ........ ~.~ .................... ~r~ ................................. Motory Public~ .~~.n~..~2/ff'C~unty (Sionoturo o* opplicont) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Ex,amined .......... ~:~.:g....~..., .(..( ........ , 19..~.!.. Approved ................... :..'. ................. , 19....'....Permit No ..... .,~,~,..,/.,'~...~....). ...... Disapproved o/c ...... rj ........................ ~ ............................................. ........................ ......................................... (Building Ins?ector) Application No...../...~...~.~.'~.C?. ......... APPLICATION FOR BUILDING PERMIT Date ......................................... .~. ............. , t9 ................ 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 a~eas, and giving a detailed description of layout of property must bedrawn on thediagram which is part of this application. 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 pa rt 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 I~egulations, 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. ........ ....... ................................................... (Sign.ature of applicant, or name, if a corporation) ..... .......... ................ (Address of applicant) State whether applicant is owner, lessee, agent, archffect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ......................... ~. ........................................................................................................................... If applicant is o 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 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exstn useandoccu anc g P Y .................. ~ ...................................................................................................... ntended use and occupancy 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .............. ;~.... Removal .................... Demolition .................... Other Work (Describe) ........................ I ~L O 4. Estimoted Cost ....~ ...................................................... ~ee .......................................................................................... (to be poid on filing this opplication) 5. If dwelling, number of dwelling units .............................. Number of dwelling units on eoch floor ............................ If garage, number of cars ................................................................................................................. ~2~ ...... 6. If business, com~rcial 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 .~ ..................... t · /~ Height ......... ~ ........... Number of S ones .................................. 9. Size of lot: Front ...:~..... ............... Rear ........... ~.....~ ...... Depth ........................................ 10. Date of Purchase ........................................................ Name of ~orm~r Owner ...( ................................................... 11. Zone or use district in which prem ses are situated ..... ~ ..~ ............................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~ ...................................... , me of Owner of ...... ............ ............. Pho. ,o ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome 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 corner lot. STATE OF NEW._Y~O~I<~, ,~ ) S S COUNTY .OF ..~.-/~'~'..~.(,,.,....) ' ' ............................. -.L~.'....~.~.~.~., .............. being 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 m~r ~e¢~th.ia the application filed therewith. Sworn to before me this ? -, I'uhhc, State of New.arK .hu 52-0344963, Suffolk County ~ ~, / ~ ~ ~ ................. .................. -