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HomeMy WebLinkAbout1650-zFO1LM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ~own~ H~ils . . Map lx~&-~Oj:~i~.[jj~~. Block ~xlo ..... **~. ......... Lot No ................... **.* ............................................. conforms substantially to the Apphcation for Building Permit heretofore filed in this office dated ................... ..~....t~..~..~...~'....~.~ .................... , 19....~.~. pursuant to which Building Permit No ........... ~...~.650 dated ......... .~...~..~.~.a.~:...~..3.. ................. , l_...g ..... l~2, was ,ssued, and conforms to all of the requirements of the opphcable provisions of the law. The occupancy for which this certificate is issued is ........ The certif,cate is issued to .............................. ..~..~..~.~.c...e...~x....~..~...~.~..~.~.....?~....~..e.~. ....................... (owner, lessee or tenant) of the aforesaid building. FOI~M NO. 2 TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL F~LL COMPLETION OF THE WORK AUTHORIZED) N°. 1650, z Date ............ ~ ...... .~. ........... 19.. ~?~ Permission is hereby granted to: Igattltuek l~on~ .l~r. er.....A/C....llea~rlca ...:Ea~t_~. ~ &Ano ...... I~t.M..~.~k ................................................... to .l~?~e..;tn.. an..ex/~ .tf~ng.. ~wel ] -~-'Z.-.to..th~.. l~eatIon ............................................. at premises located at ...T/~...,.j~lll.t.~... T~ne..~j~t.~t~Lt~l:~l .J~OlCJ~,Jti..~;}_~.'l _~ .......................... ............................................................... .Orlent ~...1~.~. .............................................................. pursuant to appficat~on dated ........................... I~]~KFy ...~. ......... 19(;j~..,, and approved by the Budding Inspector Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUII~DING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD,' N. Y. Approved ..... ~ ....... .~.! ........................ , 19...~;....Permit No. .,~._,/~, ~'6~ Application No. /..~,..~¥....C?. ......... Disapproved a/c ................ .~ ........ ~ ........................... L..: .................. ............................................. ........ .......... (Building I nsl~ector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter'or in ink ahd sul~nitt'ed 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 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 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 pa ri' for any purpose whatever until a Certificate of Occupancy shall have been gra:nted 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 alteratiens, or f~ar remova~ or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and Fegulations. .................................... (Signature of applicant, or nome, if a corporation) ..... ......................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect engineer, general contractor, electrician, plumber or builder. Name of owner of prernises ,....~.~....-~.~......~....~.....~...~.~ .................................. If applicant is o corporate, signature of duly outl~orized officer. (Name and title of corporate officer) 1. Municipality State existing use and occupancy of premises and i ntei~d~J_.gse a~d bi:~uD'ohcv of oroDosed construction- b. Intended use and occupancy .......... ...~......~.....~' ...~' ' '~ _ / 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteratio. g ..~...~ .... Repair ............... ..~.. Removal .................... Demolition ................ :... Other Work (Describe)/~.~....~r~ 4. Estimated Cost ..~..'..~. 2..:.~......~...........~... ........................... 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 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 ...~....,~C... ................... Height ............................ Number of Stories .... ./.....~.... ............................. : ............................................................. Dimensions of same structure with alteratj0ns or additions: Front .................... ~.::.., ....... Rear ................................ Depth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front .......................... ...... Rear ............................ Depth ............................ Height ............................ Number of Stories .................................. 9. S ze of at Front ./...?. i~ Rear / .7 0 Depth /' ~; e ~ ...................................................................... 10. Date of Purchase ....... ./.. ............................................. Name of Former Owner ~...~~ ................... ]]. Zone or use district in which premises ore situated ............................................................................ 12. Does proposed c~nstruction violate any zoning low, ordinance or regulation? ...... ~..~ ...................................... Name of Owner of Dremise~......~.-~-~-~ cO~'-~A r Phnn~ Jxl~ 1 3. ~ ......................................dd ess ........................................................................... Name of Architect~'~. ..................... ~(_~/~,,, ~ ....................... Address ...~,~..~~, ......... Phone No ..................... Name of Controctor/.~..~.~.. ....... ~...-~../..*.~dress ............................................ 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 NEWx,,,¥O,~,~ ~ ), S S COUNTY OF .~?...~z....) -' , ........................... · ..~..~:.'.'~..~...~~.c~...~.......beir? duly i~worn, ~Jep0~es ahd soys that he is the applicant (Name of individual signi~) , 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 ~n the manner ~et forth in the apPlication filed therewith. Sworn to before me this ~ ~ luimh r. ~,~ ~0r~ ~ ~ ~ ~ Jar publ c, St~te ........................ da~f ........... ~~..~[6a.~ir~~~4/ ~ Noto~ Pubhc, ~~~" (Signature ~:;;~-"