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HomeMy WebLinkAbout1406-zTOWI~ OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CI~ERK'S OFFICE $OUTHOLD,- N. Y. CERTIFICATE OF OCCUPANCY TH~S CERTIFIES that the building located at .~.~..1...~.~.~...~.]..~...D.~? .,...~.O...~...~h.0.~.~lStreet Map No ......... ~.~.~. ....... Block No .........~.~.~' ......... Lot No ........ ~...~..~. ....................................................... conforms ~ubstantially to the Application for Building Permit heretofore filed in this office dated ................... ~.a.~g...~0. ................ 19...~..~. pursuant to which Building Permit No ...... ..~....~ dated ................. ~'...~.~ ................. 19...~.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .................................. ~..~.y..~.~.. q~.~.....~. ~,,.~.~......D.~. .................................................. This certificate is issued to ...... ..~.~.~.~.~...15f.a...t;~.~..g~.¢.....o....wD....e.~ .............................................. (owner, lessee or tenant) of the aforesaid building. '~:OWN CLERK'S OFFXC~- SOUTHOLD. ~'. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ,.~ll...C~.t~k ~)~l.V.e ................. Street Map .~'o....~..~. ................ Bioc~ ~o ..... ~ ............... Lot ~'lo.~ ........ ~..o.~;~ ................................... conforms s;ubsiantially to the Application for Building, Permit heretofore filed in this office dated ..................l~/{y.....,~,~ .............. 19.6~.. pursuant to which Building Permit No. ~...~.~.~ dated ................... ~a~.....~,~. ............ 19...~k., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ssued is ...... ~.l.~.~e.. o~e...i'.ara£],¥., d~el.~ing ............................................................................. This certificate is issued to ...WJ~l,...~ghi~ ................ ~e~ .................................................. (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? 1406~ Z Permission is hereby granted to: at premises located at ~ ~.....~...~.'.~;?...~..~. ~;, ................................................ pursuant to application dated ..................................... .~...~.c:~.../.~......19..~.../..., and approved by the Building Inspector Fee .~...~ FORM NO. 1 TOWN OF SOUTHOLD ~UILDIHG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .............. Approved ......... .~.~.-~...~.~-; .~. ;..., No ........ ~..~ .~,. ..... Disapproved a/c ..... ~ ..................................................................................... Application No ......,,/~, ...~,...~.. ,,~., .......... (Building Inspecto~'.,~'~ APPLICATIO~ FOR ~UILDING PER~IT 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 prope`rty 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 ova.liable for inspe.ction 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 Lows, 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 aT/applicant, or name, if a corporation) ~ ................... ...... (Address of applicant) State whether ap, R~icant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... applicant is a corporate, signature of duly authorized officer. (Name and title of corporate, officer) 1. Location of land on which proposgd work will b~ done. Mop No: ............................ ~. ........ ,~... Lot No:.....'~.. ............. Street and Number .~. .~. .......... ~ ..... Municipality State existing use and occupancy of premises an1~i~_~_d~d use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .................... Addition ....... ~ ........ Alteration .................... Repair ..................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. ~stlmotec/ L, ost ........ '. ................................................... tee ..... .~ (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 ....... Z.~.. ............... Number of Stories .............[ ............................................................................................... Dimensions of same structure with alterations or additions: Front ~2 Rear ~ 3 ¢ Depth ' ~/~ Height /3 Number of Stories ........../. .................... 8. Dimension~ of entire new construction: Front ........... ~.~. ............. Rear ............ ~ .............. Depth ....... .~...~'. ................ Height ....... ./.~ ................. Number of Stories ............. ./ .................. 10. Date 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... ./...~.~. ....................................... Name of Architect .................................................... Address ......... Phone NO ..................... Name of Contractor ..... ~T.C¢~.~..q ............. ?.~ ............ Address ....~.~.f Phone NO....~.?....~...3./..~3.. P'LOT DIAGRAM Locate clearly and distinctly all buildings, whetl~er 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. OF ,,w s s .................. >~r:;'~.~,~..~........~_..~.~ ........................ being duiv sworn, deposes ~nd soys that he is the opplicont (.~c~o of~ndividuo~ si~nin~ oppHcofion) obove homed He is the ............ .~ (Controctor, o~ent, corporote officer, etc.) of s~id owne' or owners~ ~nd is du~y outhorized to perform or hove ~erformed the soid work ond to moke ond {He this applic*ti~n; thor oll st~temonts contained in this opplic~tion ~re truo to the best o{ his knowled~o and bolio~ ond thor the wor~ will be performod in the monner set {orth in the opplicotion fi[ed therewith. I JUDITH T. BOKEN Sworn to bef, reme this Notary Public, State 0f New York  N0, 52.0344963, Suffolk ' ~ ~: .~;,~s~,~x.~res ~h County (Signature of applicant) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .........././.~...'.'.~..../...~.. ...... , 19....~.../. Approved ........:.~.~./.~./~.../....~./...., 19..~...//..Permit No..~.~..../......~.~..~ Disapproved a/c ........................ 6Z~ .................."~-"~'~L ............................ ......... ................... (Building Jnspector)~/~~'c~ Application No ................................. APPLICATION FOR BUILDING PERMIT Date ........................................................ , 19 ........ 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 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. ~'g ture at 6t~plicont, or name, if a c~rpo~tion) ........ ...... .... Z iiiiiiiiiiiiiii' (Address of applicant) State whether q~plicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... .................................................................. ........................................................................................... Name of owner of premises .............. .~J.~.~ ......... ~..~.b~.' ........................................ ' ................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate, officer) 1. Location of land on wh ch proposed ,work w I be~done. Map No: ......................... ~ ....... .~. ..... Lot No:.....~.. ............. Street and Number ...................................................... Municipality 3. Nature of work (check which applicable): New Buiidin.cj ................. Addition .................... Alteration .................... Repair .................... Removal .................... Demohhon .........~ ....... Other Work (Describe) .................... 4. Estimated Cost ................. 17.....cT~-~.. ................................. 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 / 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 ........... .3...~?. ........... Depth ...... ~.~ .................... Height ........... .":? .............. Number of Stories Dimensions of same structure with alterations or additions: Front ................ ~/..C~ .......... Rear ....... .~.~./. ................... Depth ............... q.~ ............. Height ............. /b'~ Number of Stories / 8. Dimensions of entire new construction: Front ......... ..Z.¢. .............. Rear..............¢ .............. Depth ......Z...'./. ................ Height ........... (.-.(. ............. Number of Stories .............. ( ................. ........... ,7.. ............... Rear .............. ~..7.. ~ ....... ~ ,~~~~"~ 9. Size of lot: Front ~ ............... ~..¥ ....... Depth 10. Date of Purchase .............. ~. .......... ~ ~c:'~.~ ...... /.~(.~...Name of Former Owner ..... ..~ff.:....~.... ] 1. Zone or use district in which premises are situaled ..................................................................................................... 12. Does proposed construction violate~,, ,-~,/-~/,',any zoni~l?w, ordinance or regulation?,///./ .,~ ............... ~. ................................... 13. Name of Owner of premises.....zZ~./~.'.......2'/~ ........ Address ....~/..~.-.~..~.,//~.¢~%...//..~..e.... Phone NO. b..~...~f.c...~..,~..Z./ Name of Architect ................................................ Address ........... Phone NO ..................... Name of Contractor ................. .~ ....... .c.~ ......... 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~)I~ //Z ) S S COUNTY OF .~/~'~.~./-~..) ' ' ~-~/~'~ ~P ~)------------~"~'"~ be n du sworn de oses and sos that he s the a-- cant ................... ~......':~ .................................................... 'g y , P Y (Name of~ndividual signing_ ~ ~app~cati°n), above named. He is the ............ ~q~-Z~]Z~ ...................................................................... (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 application filed therewith. Sworn fo before me this ............ ~. day of ............ Notary Public, ¢__.,~~...~__' (Signature of applicant)