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HomeMy WebLinkAbout1498-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..~...3.236. ............ Date .......... i~Ug'.~lg.~..-2~.t ...................... , 19~08... THIS CERTIFIES that the building located ot ...S~,~'~,..RO~,d ........................................... Street Map No ....................... Block No ....................... Lot No...E&a~,..M&~,tor~,...lg'e~..Yo~k...,l~o~,..2.7. conform~ substantially to the Application for Building Permit heretofore filed in this office dated ............................ ~T~.il,.l~..,l~.t ................... , 19....6,1. pursuant to which Building Permit NoZ...~L4.98... dated ................. ~.llg.~,l~.t..3., ................ , ~ 9..~3.., was issued, and conforms to all of the requirements of the epp!icobie provisions of the law. The occupancy for which this certificate is issued is ........ ............... l~ ,t..v a.~e · · erie...~.aret,.l..~,., d~el.t.t,ng ................................................................................ The certificate is issued to ........ l~e.t::e~..F~tllaei;ltlL ........................................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspe~t~;r' "/ ' TOWN OF sOoTHOLD 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? ,1498' Z Date ..................... Permission is hereby granted to: 2e~,.e~...~.umentJ, .............................................. .......... "3'3 .]..2...-.D~ a.tur...A.-¢e ............................. .............. .~.r. or~_., ~? .............................................. to ........ !~t ]~d.. ne~z., one.. £~z~IJ-Y....d~'~ L!i r~ ............................................................................... at premises located at ~¢/~...~.t,a~-S..AO&~.....(.O,.]D~A,~.) ................................................................... .................................................. .E~,s.~...~r.i~n. .................................................................................. pursuant to application doted .................................. 07~.~. .......~.. ........ 196..J~...., and approved by the BuiJding Inspectar Fee $. ~L.O~.OO .......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No ............................... (Building Inspector)/ 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 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, ordinan'ces and regulations. ..................................... (S'g a u o app 'cant, or naSal'if a c~}~j"[ ...... ..... ......... (Address of applicant) / State~eth.er apylicant 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 whic~ proposed work will be done. Map No: ......................................... Lot No' ..~ - ................ Municipality 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 .................... Repair .................... Removal .................... Demolition ........... ~; ....... Other Work (Describe) .................... Cost ~ ~% , ~u' ~', ............................................... 4. Estimated ...................................................... Fee //~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ~' Number of dwelling units on each ioor....~ ................... 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 ..~ ................... Hdght ............................ 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 ..../~.e.~..~.~ .... Rear ...~.).~.l..~.~ ..... Depth ..~.~.¢.~..,.....L~ 10. Date of Purchase ...... ~..,..~.~..:.~../ ..................... Name of Former Owner .~......~.: ............ 1 t. Zone or use district Jn which premises are situated ................................................................................................ 12. Does proposed construc~n vio/~ any zoning law, ordinance or re~latiqn .... ~...~.~.~ Name of'Owner of pr~~~' add~e~,aa/~ NO~'~ 13. Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO..c.~ ............... 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 /../ ~~ ' . . . / STATE OF NEW~; .~ ) SS COUNTY OF 7~~) ' ](Name of individual sig~ :. ............. ................................................................................................................. (Controctor ~ent, corOorote officer, etc.) of said Owner or owners, and is duly authorized to perform or h~ve performed the so d work and to make and file this app ication; that all statements canto ned in this application are true to the best of his knowledge and belief; and thati the work will be performed n the manner set forth in the application filed therew th. Sworn td befor e this ............. ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om ned .......... .......... Approved ........................................ 19 ........ Permit No ............................... Disapproved o/c .............................. (..~,d'..'.1._ ........ ;.~.,,.%".%; .__ ...... ~ ............ ................................................................................................ ........... ........................ i'~'6'i'['~'i;'~'' i ~;'~;~'~'; ;i ....... / ....................... Application No. //~1 / ~ APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and suSmitted in duplicate to the Building' Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to odjoining premises or public streets or areas, ond giving a detailed description of lo,your of property must be drawn on the diagram which is part of this ~ocation. 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 inspectign throughout the progress of the work. e. No building shall be occupied or u'~ed in whole or in part for' any purpose what~dr until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Dqpartment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southotd, 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 applicgble laws, ordinahces and regulations. ..... ~ [% .............................. ~ ........... ~. ..................................................... (Signature of applicant, or name, if o corporation) p ' , , ¢" /~ ¢ , (Address of apphcont) }tote whether '' -- ' V~) ~' ~ ~ applicant is owner, lessee, ogent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............. ~.....~.~.. .......... ~: ........................... i ..................................................................................... If applicant is a corpgrate, signature of duly authorized officer. / (Name and tide of corporate officer) t/ 1. Location of land on which proposed work will be done. Map No: ..... ,.. ............ : ......................... Lot No: ...:.~.'.7. .......... 5treet OhO iNumDer ........ ~T;..T.T,T.r ........................... ; ......... : ............................................... .~.(...; ..................................... Municipality 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 ...... ~.~.: .................... ~ ............................................................................................. Addition 3. Nature of work (check which applicable): New Building ........................................ Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost......~._-..-:..' ....... :...~ ................................... Fee ..... .f..~.r..~ ....................................................................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling units .........~. ..................... Number of dwelling units on each floor.....q~ ................... 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 .......... ~-.~.......I ........... Depth ...,~.~. .................. Height ;~ ~ Number of Stories /' 9. Size of lot: Front ..... ~..~...O..:.F....~.. ..... Rear ...... ~..~,..o....I..~r.. ..... Depth ../..~....~.?°.....-t....(.~. '/4 10. Date of Purchase ....... ..~...Z..~...'~.....'Z....~...~. ..................... Name of Former Owner~..J~...a~,......~ .............. 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed constructian/,,~/.~,~ ~t' ~-,-zvi°late any zoning law, ordinance or regulation? ....~ ......................... ~.. ............ Add res~,~..~../.~.~......~.~..~.....Phone 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 or description according to deed, and show s~reet names and indicate whether interior or corner lot. j~D~...r ~ 1~ I~ ~ ~ i~1 ~'W ,r i // ///~ ,"'~ ~, ~ ~ STATE OF NEW~OJ~, ,:~ ) S S COUNTY OF?~//Z~ ~) /-''~f-~''') ' ,, .................... ~.~.~,~'~.....~-~/~:.~.. .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ....... ~.~ .................................................................... 7; .............. ; ........................................ (Contractor, agent, corporate o?t cer, etc.; of said dwner or owners, and is duly authorized to perform or have performed the said work and to make and file this app.cation; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed~j~ th~npe~(~ forth in the application filed therewith. Sworn to be~me this ~*~i~t~ o~',?'~w Y~r~ ............ .ZZ .... day of ........... ~~'r~: , , (Signature of applicant)