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HomeMy WebLinkAbout1412-zTOWN OF 50UTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~/..l~...~.(~l'O.O.~...~{~{~14~.,...~.~D.~-~.~,,. Street Map No.*:..~.~ ................ Block No...~'~, ............Lot No ................... **,g ........................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. ~'...~;~. ...................................... , 19..6.~,. pursuant to which Building Permit No. dated ....~..~..Y'....~.~. .................................... 19.....~..~ was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is .......... ............. ~A ~VAr~.. O~.. ~'AM;~,~. · ~0 ................................................................................. This certificate is issued to ............ ~..~.~....~.~.~..~...ri.=..~....~.~..~.. ............................................................ (owner, lessee or tenant) of the ~foresoid building. .......... ..................... Building Inspector "[ FORi~I 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? 1412, Z Permission is hereby granted to: ..... .~,.. ~ ~......~.~,~.t .. ~O&¢l .................................... ............... ~...l...~...~.~.t..,......~.,. ............................. to .~.U~..d....~......~C!.d..~.~..J-.CU..~.. ~...e~,~.~,r~...d~e~.]J,M ......................................................... at premises located at l~.~.....~¢O~d....~.~ .................................................................................... ............................................. .~.~.U.t,~O],¢I ............................................................................................... pursuant to application dated ........................... .~.1~.....~,.~ .................... 19..6'1., and approved by the Building Inspector Fee $. ~..?..0..0. ............. Building Inspec~br FORM: NO. 1 vow, SOUV.O,D BUI,D ,G TOW, C,E,,'S OFFICE SOUT.O,D... V. ........ ....... Examined Approved .......................J.[ .............. 19...~.....Permit No. ~'//~// ......................... ................................ ' (Building I nspectlr) Application No.../...~I..!..~ ......... APPLICATION FOR BUILDING PERMIT 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 areas, and giving o detailed description of layout of property must be drown on the-diagram which is port 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 o 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 o 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 demo~itlon, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or nome, if a corporation) (Address of applicant) State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Agent for owner Nome 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 ..~T/~.....,QD~1~.O..O.~ ~,~ ~ B.o~hoZd .............................. Municipality 2. State existing use and occupancy of pPemises and intended use and occupancy of proposed construction: a. Existing use and occupancy....~.~.~ .............................................................................................................. b. Intended use and occu~anc~ " WSth anaadditio~ 3. Nature of work (check which applicable): :New Building .................... Addition ...... ...~.., ........ Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimoted Cost .............................................................. Fee ..... ~.~¢~¢1 ........................................................................... (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 .............. ~.8 ......... Depth ......... 3~ .............. Height ............................ Number of Stories ..... (3~ ................................................................................................. Dimensions of same structure with alterations or additions: Front ......... ~/~m~ .............. Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... ~t6 .............. Rea~ ........... ,].6. ........... Depth ......'l~. ................ Height ............................ Number of Stories ...Ol~e .................. 9. Size of lot: Front .... ~0~ ................ Rear .............. 3.(~ ....... Depth ....~/....~0¢) ....... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .......... ~.,~l.~...l~.~.t. ................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .................. ~3 ............................. 13. Name of Owner of premises....l~.~:e3ff, a.t~l~ ................. Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor...' ............. !! .................................. Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly afl buildings, whether existing or proposed, and indicate oil 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 NE%/ YORK, ) COUNTY OF SS, ~ ................................ ~],~3ff.~f~...Ch~l~3, ............................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ....... ~.~...~.~...~. ................................................................................................................. (Contractor, agent, cor~0rate 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 ~oj~the application filed therewith. Sworn to before me this EoI.~ PuHic, State of New York ................. ~.. day~f ............. ;~:.'~;""~5~ ~ ' ~ ~ (Signature of applicant) TOWN OF SOUTHOLD BUll:DING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Exam'n ....... .~./[.....[< ........ c......19~ .~... Approved ....................... ~l. ............... 19 !! Permit No ........................ Disapproved a/c . /.. ~.......~......~..~.... ........................ ................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su6mitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildlngs on premises, relationship to adioining 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 insl~ection ~'hroughout 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 $outhold, 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 ell applicable laws, ordinances and regulations. " ....... e ........................... (Signcffure of applicant, or name, if a corporation) 9h--2~ L~lbt Road~ Elmhurst~ N.Y. (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Agent for owner Name of owner of premises ....... ~.a..~oy.......l~.9..IL~..]3.~ ................................................................................................................. 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: ........ ~f/~ .......................... Lot No: ..,~.~.K. .......... Street and Number ..~./.~ .~.W.O.O.~ ...L:,9.~qP,~ ~qu.tho. l~L .......................... Municipality 2. State existing use and occupancy of pr, emises and intended use and occupancy of proposed construction: n o dwell in a. Existing use a d ccuoancv ~ ~ .............. b. Intended use and occupancy ..........................w..l..t..h.,...a..n..~.a...d.~..1..t.~,.o..n.. ................................................................. 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .............................................................. Fee ....~.....O...o. ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... .0.~.~ ............... 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 .... .o.b.e. .................................................................................................. Dimensions of same structure with alterations or additions: Front ........ ~.~.~ ............... Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... l~ ............... Rear .......... ~1.~ ............. Depth .....~,2 .................. Height ............................ Number of Stories ...0.~. ................... 9. Size of lot: Front ...l(~. ................. Rear ............. 3-~)3 ......... Depth ...8.~J...'l~cJ ........ 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? ................. ~O .............................. 13. Name of Owner of premises...~.~.~..P~*~ .................. Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor ...............!! ................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM I.ocate clearly and distinctly all buildings, whether existing or proposed, and indicate alt 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 YORK, ) S S. COUNTY OF ~.?.Ct~.~ ........... ) ....................................HJ-~&].~'.~:f~...G~)~ ~l~.~tD. ............................. beng duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the tt~e~l; ..~oz'....o..~.~.z'. ................................................................................................... ......................... (Contractor, agent, cortborate 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 thi.s gpR~,j,f~tion are true to the best of his knowledge and belief; ~ t an ~ I "6'] " e a hcat,on filed therewith and that the work will be performed 'n he i~'0ntaryrtu~ic,Tc,Ts~tf~ ~[le~r%~;~ PP' .' ' ' · Sworn to before me this No 52.0344963, Suffolk County; ~.,~ Com~mssiO. n ExJ?irgs March 30~ ................ .2..~... f ................... ~'.~r+ ............. ~19 .... (Signoture of applicant)