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HomeMy WebLinkAbout2118-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~/l~.....Oa,~l,e,wA"A...A.Y.e .............................. Street Map No .........~.... Block No ........ ~ ..... Lot No ......~ ......... ~.~.~.~.h~.~..~.~...~...~.~..,. ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................... ~T.l.tr~.....],O ................ , 19..6~. pursuant to which Building Permit No...Z~,,[~L~.. dated ........................ ff...'l:~...~. ........ .~...~. .......... , 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 ........ .... .l~z't. Va.~c e...otte...fami.!y...dmt.l, ing ............................................................................................ The certificate is issued to ..... ~,~,~-~l, ................... .Ow~e~. ............................................................ (owner, lessee or tenant) of the aforesaid building. Building Inspec~r FOI~M NO. 2 TOWN OE SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS P. ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N,° 118, z Oote ..................... Z~t~ ....... .t0 ............... ~9~.3... Permission is hereby granted to: Corwin Gz~ at h~h.1... · ..A/~. · ...E.~. · .G.,...~i.~.t ........................... --~.u.~hog~te ........................................................ to..Bui.td.-.an-.a~d i.t ion...o~.-e~--e~i.s~t.~g" ~t'~.~ ....................................................... at premises located at "~/~'""O~W~".~'~/e .............................................. ....................................... .................................................... ~.o',t~b,o~d-~...,N~.~ .................. : ........................................................ pursuant to application dated ............................ ~--l~t~.~ ....... '].0 .............. 19.6~.., and approved by the Building Inspector Fee $.-~,OG ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×omined ............. ~.~..C~.. ;-~ ........ 19.;...../. Approved ........................................ ]9 ........ Permit No ............................... Application No ...... ~7...C.~ ........... APPLICATION FOR BUILDING PERMIT Date (~;~z'~'~ ~ lO INSTRUCTIONS o. This opplicotion must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plen showing Iocotion of lot ond of buildings on premises, reletionship to edjoining premises or public streets or areos, ond giving o detoiled description of leyout of property must be drown on the diogram which is port of this Iocotion. c. The work covered by this opplicotion moy not be commenced before issuonce of Building Permit. d. Upon opprovol of this opplicotion, the Building Inspector will issue a Building Permit to the opplicont. Such permit sholl be kept on the premises ovailoble for inspection throughout the progress of the work. e. No building sholl be occupied or used in whole or in port for ony purpose whotever until o Certifico/:e of Occupancy sholl hove been gronted by the Building Inspector. APPLICATION IS HEREBY MADE to th'e Building Deportment for the issuanc,e of o Building Permit pursuont to the Building ZoDe Ordinonce of the 'Town of Southold, Suffolk County, New York, ond other opplicable Lows, Ordinonces or Regulotions, for the construction of buildings, additions or a Iterotions, or for removol or demolition, os herein described. The applicont ogrees to comply with oil applicable laws, ordinonces ond regulotions. .... ......... ............................................. (Signature of opplicant, or name, if a corporation) ............. ........ (Address of applicant) qtate wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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: .................... St reot and Number ....~.......~...c.' .................................................... ...~.. ........................ ~...~.. ........................................ Municipality 2. State existing use and occupancy of pr, emises and intende~ use and occupancy of proposed construction: a. Existing use and occupancy .............. ....................... ..'::. ....................................... ~ .......... ~ ....................................... b. Intended use and occupancy ........................... ~..'. .................... ~'.~ ........... ..0;..?.~..c..~. ....................................... 3. Nat.ure of work (check which applicable): New Building .................... Addition .................... tion ................ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated C ................................................................. Fee ~ {to be paid on filing this application) 5. If dwelling, number of dwelling umts ................................ Number of dwelling units on each floor ........................ If ~jarage, number of cars ........................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .......................... 7. Dim~ensions of existing structures, if any: Front ......... ..-"~......~'. .......... Rear ............... ./. ........... Depth ...~.....O.. .............. Height ............................ Number of Stories ...................¢~J~1....~ .................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ............................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dim.'ensions of entire new construction: Front .......... ~....,~.. ........ Rear 7 ~ Depth / Height ............................ Number of Stories ......... ~ ..... 9. Sizb of lot: Front ..../...~....? ............. Rear .....~.-...G. ................. Depth ./.../..~./......?...~/..... 10. Date of Purchase ........ ~C~..../....~...~.~...7..~ ................ Name of Fg~rmtr%4 ~t,\ , jOwner ................................................... JJ .... 11. Zone or use district in which premises are situated .................. /~ ...... ~.~ ................................................. J .... 12. Does proposed construction violate any ,zonin~ law, ordinance or regulation? ........ 13. Nah~e of Owner af premises ...... ..~_..'1:~....../...~ ........ Address ............................................ Phone NO ................ Name of Architect ........................................................ Address ............................................ Phone NO ................ No'me of Contractor .................................................... Address ............................................ Phone NO ................ PLOT DIAGRAM Locate dearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions f~ property lines. Give street and block numbers or description according to deed, and show street names and indic whether interic or corner lot. Bm STATE OF NEW,OInK, ~l ) S S COUNTY! OF ..... .':~¢J~...~C... ) ' , ............... " ...................... n~..~ ................... duly sworn, deposes and says that he is the applic l(Name of individual signing application) above named. He is the .................................. ~.J ............................................................................................ (Contractor, agent, corlborate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and this appli'catJon; that all statements contained in this application ore true to the best of his knowledge and bel and that 'the work will be performed in the manner set forth in the applicatiory,~filecJ therewith.,x//0 /) /~. Sworn to i''~''~'~ef°re dayme o~fthis ~' 19....'~.~J... Ju.mm T ............... ...... ] ......~"'~'"' Notary P~bhc, ~..~.... ~-"~:tt'th~ qomrm,s,on ~X~lraS March 30, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved t~, ~ ~ ~)-~ i I ...~... ........................................ , 19 ........ Permit No .............................. Application No.-~...!...!.......~.. ........ 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 p remises, relationship to adjoining premises or public streets or areas, and giving a detailed description of byout of property must be drawn on the diagram which is part of ~his 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. S, uch 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 Southo~d, 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 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. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Loc.orion of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ....................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex st ng use and occupancy/ .................... iA'":/'"~ .............................................................................................. b. Intended use and occupancy ............................................................................................................ 3. Nature of work (check which applicable): New Building .................. Addition ...~ ...... Alteration ............. Rel~air .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Esti!moted Cost .................../~.~72 ............. Fee ........ ~.~.mZ~. ................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .............................. Number of dwelling units on each floor ........................ If g,arage, 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 .......................... Hei:ght ............................ 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 ........ ,(~.../. ........... Depth /"~ / Height ......... /~..( ........... Number of Stories ......... /. ...................... 9. Size of lot: Front ................................ Rear ............................ Depth ........................................ 10. Date of Purchase ........................................................ Name of Former Owner ................................................... 11. Zofie or use district in which premises ore situated ........................... ~'-~'1 .............................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ............ ~_..k~.. .............................. 13. Name of Owner of premises ................ Address .. ~. Phone No ............... Name of Architect ....,~ ............................................. Address .......................................... Phone No ............... Name of Contractor ~ .......... Address ..... ' · Phone i.d. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali set-back dimensions f~ property lines. Give street and block numbers or description according to deed, and show street names and indic whether idterior or corner lot. X/z: I>'. STATE OF NEW YJ~RI~,/ ~,/) ~ COUNTV, V,v,v,v,v,v,v,v,v/~OF ..~~../(~,) '~"~' ............................................................... being duly sworn, deposes and soys that he is the oppli¢ (Name of individual signing application}, ~ above named. He is the .................................. dgT~w.?.~.~ .................................................................................... (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 this application; that all statements contained in this application are true to the best of his knowledge and bel and 'hat the work will be performed in the'l~E~e¥°.~_...fflj~t~h in the app]icotion filed therewith. Sworn to before me th~s Ix ('~034/~963 Su o k Cou.ty , / ~ ...................... .. }..., ........ ......... Notary Public, y~.~., z..~~:~ (Signotur~"(~"~l~'i'~'~nt) .............. : .......