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HomeMy WebLinkAbout2091-zFOEM NO. ~ TOWN OF ,~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. 'J,"~-973 ............. Date ............................. O~obe~......~.O, 19..6.~.. THIS CERTIFIES that the building located at P.~.T.....R,Ig.,.W.,...~.~...I~I]...~J. .............. Street ~pO°N~o~L.a....~.°..~;..e.~... Block No..S~e...1 ......... Lot No....~.1 ........ ~.e~k.n:L~.,...N.,.Y, ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................................ ,]'~fie......l:~ ....... , 19~.3... pursuant to which Building Permit No. ~.0.c).1..~. dated ............................ ~I~tG.....~)+ ......... , 19..~.~.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ · ~..~a.te...oz~e..£~mi:t~..d.we.ll~.ng. ............................................................................................... The certificate is issued to ..~e~...~.o...r~J'.al:to1/~l. ............................... .OWJr~a~ ............................ (owner, lessee or tenant) of the aforesaid building. ~ · Building Inspector FOP.,M NO. 2 TOWN OF SOUTNOLD BUILDING DEPARTMEIqT TOWN CLERK'S OF;ICE SOUTHOLD, iq. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 2091 Z Dote ....................... ~.e ....... ..'J..~. ............. 19~... Permission is hereby granted to: El~ert..A~.n.....A]~...-?~er...T~oYa .......... ........... ~reen~% .............................................. to ~u~ld..a~ ~d~io~ ~ m~e...alt~i~...~..~...~g,~n.~..~.~.~.~ng at premises located at **~G~..*~*~*.*...~eGO~iG...B~O~eg ..................................................................... ............................................. ~..R~a4..W/~..**~lZ**~e.~,****~eeO~e. ................................... pursu~mt to opp[icot;om doted ............................. ~e**...~ ................ 1~****, amd approved by the Build/m9 Imspector Fee Building Inspector I~OE~f NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No....~.,.?...c~..! ............. APPLICATION FGR B~UILDING PERMIT INSTRUCTIONS o. This application must be completelv 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, relo.tionship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is port of this applica- tion. 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 applica,nt. 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 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 Lows, Ordinances or Regulations for the construction of buildings, additions, alterations, or ft~r removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) ...........~,~""'"'""'""""'"'"'(Address ...... of'"'"'""""'"'""'""'"'"'""'"'""'"opplicant) State whether applicant is owner, lessee, agent, architect, enginee~r~tar, 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 which proposed work will be done. Map No.: ........................................ Lot No.: .~:.,,~. ........... Street and Number Municipality 2. State existin~ use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy 3. Nature of work (check which applicable): New Building .................... Addition ...... Alteration ............. Repair ............ t~'" Removat .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost'~..ff...~...~, .............................................. i. Fee ................................................................................... (to be paid on filing this application) 5. If dw;elling, number of dwelling units ..... /.. ........................ Number of dwelling units on each floor ..... /. ............... If gdrage, number of cars ....................................................................................................................................... 6. If bdsiness, commercial or mixed occupa.ncy, specify nature .and extent of each type of use ...... ,~...'.,~..~' ................ 7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ......................... Height ............................ Number of Stories .../ ..................................................................................................... Dim?nsions of same structure with alterations or additions: Front ................................ Rear ........................... Dept,~ ................................ Height .................... : .......... .,,,Number of Stories ................................ 8. Dimensions of entire new construction: Front ............... Rear ...... ..2.._/ ............ Depth ................. Height .............................. Number of Stories .............................. ....... .~. · ..~.../¢~M ..... Rear ..... ,~..~..~....~... .......... Depth ...../....~..~... ~.. ..... 9. Size 'of lot: Front 10. Date of Purchase .......................................................... Nome of Former Owner .................................................. l l. Zone or use dis/'r ct n which premises are situated. ~ .................................................................. 12. Doe~ proposed construction violate any zoning law ordinance or regulation? ............. .~...~ ........... , .................... 13. Na~e of Owner of premises ..~...~..~.~.~..'~... Address ./.~...'7....~..'z....~....~...,..c~.....~ No .............. Narde of Architect ....~2./~ ......... {,,~. ......................... Address ;i~~i'iiiii;iiii;iiiiiii Phone No .............. Name of Contractor . .c~-....-./(~....k_/kcv::~md,,~ ........ Address Phone No .............. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property lines.. Give street and block numbers or description .according to deed, and show street names and indic whether ittterior or corner lot. STATE OFi NEW.~YOR~, ~ Ir ) ~ ~ COUNT, ....................................................... being duly sworn, deposes and says that he is the applicc (Nome of individual s~~) ' above named. Fie is the ................................................~~~ Z;7. .............................................................................................. (Contractor, agent, corporate officer, etc.) and file of said owner or owners, and is duly authorized to perform or have performed the said work and to make this applicatiort; that all statements contained in this belief; , application are true to the best of his knowledge and ahd that the wlork will be performed in the manner set forth in the application filed therewith. Sworn to ~efore me this ~ ................ J..,, do of ................................... 19 ........ Notary Public .~~*1~..~<~'. ~?;t~uJ~tl~ (Signature of applico'nt) ~ re o! New York ,.~.. ~xp~res March 30~ TOWN OF SOUTHGLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................. Approved ........................................ , ]9 ........ Permit No ................................. Disapproved a/c .............. ................................................................................... ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT ote ........ ............... ............. , ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink end 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 o 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. (Signature of applicant, or name, 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 premises ...O~.~.u..~.....'-~......"~.~- .......... ~.~1.~...~..:,~1.?..~.,':.~...~. ............................................. 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: '~--c',~,-~- Lot No: Street and Number ?.-. ~ ~-- -~-~,~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~ ....... Z~. ~.~ ................................................................. b. ntended use and occuoancv ....... ~ ....... Z~ ....... :. .~....'z~. .~.. .~... - 3. Nature of work (check which applicable): New Building .................. Addition ...... ~.... Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ...,~....~.....-Z. ....................................... Fee .. (to be paid on filing this application) 5. If d~,elling, number of dwelling units ...... (' ....................... Number of dwelling units on each floor If gbrage, number of cars 6. If business, commercial or mixed occupancy, specify natureand 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 Dep,',th ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front.....~..~../.. ................. Rear ..,:~....D../.. .................. Depth Height ............................ Number of Stories ....... ~ ........... 9. Size of lot: Front ........ ~..~ ................. Rear ....... .:~...0 .............. Depth ..... ./...2..../.....~. .................... 10. Date of Purchase ......................................... ............... Name of Former Owner 11. Zone or use district in which premises are situated ....... 12. Dogs proposed construction violate any zoning law, ordinance or regulation? ....... .t4/0 13. Name of Owner of prem~ses0'...:..(~,~..~m..s.',~¢.~,...~-..~...~.....Address ........... ~ .......... ~.....~..c..= ....... ~ ~ne~o. Name of Architect ...................................................... Address ............................................ Phone No. Name of Contractor . .~...-...~...~..-.L.:...~z.:..~ ........... Address ......~.~.~.~..~.;. ................ Phone No. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions fr property lines. Give street and block numbers or description according to deed, and show street names and indic whether in'.terior or corner lot. STATE OF.. NE~)Y(~(//"~,.~-' ) c c Z. ~ , ~cy.~ c~...~ c .... ................. : .............. ~..~.C~.~ ....................... being duly sworn, deposes and says that he is the applic. (Name of individual sig ' above named. He is the (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make and th s app dation; that all statements contained in t~jag~lication are true to the best of his knowledge and bel and that the work will be performed in the m~rPm~f~f~r~pplication filed therewith. Sworn to ~efore me this ~ co~?. 52 0344963, Suf~01k County ~ ~ ................ :.[.~ d~of ......... ~~;~..., 19....~. ~4, U ~~ ~/ ~~ n (S~gnature of apphcant) ......................... · ........................ - ...................