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HomeMy WebLinkAbout2173-zFOF,~I NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...;$...;~.0.3~ ........... Date ......................... ~o.v.e~l~e~......9....., 19.~.tt.... THIS CERTIFIES that the building located at .N~.~.....~.e.~t,p}~ta.,,Rcl, ......................... Street Mop No .......Y,.Y~ ........ Block No ........ ~ ........ Lot No. ~ ............ ~,t;:f~Zla~......~,?Z, .......... conforms substantially to the Application for Building Permit heretofore filed in this office doted ...................................... ~e~t;etrae.blt...~., 19..6.~.. pursuant to which Building Permit No..2,1.~..~..~* dated .......................... ~.eT).~.....3 ............. , 19.6~..., was issued, and conforms to c~ c~the requirements of the applicable provisions ~ aw. The occupancy for which this certificate is issued is ........ .............. P.~iv.a.te,..one..f. ami~...dwe.ll£ng. .................................................................................. The certificate is issued to ..,~..~D~...P.~I~. ................................................... ~l~. ...................... (owner, lessee or tenant) of the aforesaid building. uuilding respecter FOEIV[ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 2173, Z Date ..... : .............. 8e~e~*oe~ .....~ ........~9.6.3.. Permission is hereby granted to: 6eorge....~Le~.s.....A/~.....A~.~.z~...~e~ .......... ............ C.u.~hc~ .............................................. to .....1~,t. I4-. ~e~.-o~e...~.am1.t¥.. ~et.l.J:~ ................................................................... ot premises located at ..~ ....... W4~,~a.~.'$&...R:O~ ........................................................................ ............................................... ~tt~tu~k ........................................................................................... pursuant to application dated .......................... ~J.~t,.....~ ................. 19.~.~.., and approved by the Building Inspector Fee $ ~,,Oe-QO. ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. c~/ '7---~ Approved ........................................ , 19 ........ Permit No ................................. Disapproved a/c ......... ....... ................................... (Building InspectOr) APPL~CATIOi~ FOR BUILDING PERMIT Dote .................. ............... ,7, ................ INSTRUCTIONS a. This application i~qust 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 adioining premises or public streets or areas, and giving a detailed description of layout of property must bedrawn on thediagram which is part of this Oj)plication. 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 wil~ issue ~i 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 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, ordinances and regulations. (Sign.ature of opp~cont, or name, if a corporation) (Address of applicant) State whether applicant is owne~,~~ architect, engineer, general contractor, electrician, plumber or builder. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed wor¥~will be don_e./~Map No: .......... 7_m.._.j~ ................... Lot No: .................... Street and Number ............... ~..~...~.:.~.%~j.~.i.~.i~~~L~.~I.~-/~/I ~ ~ // ...... ~ ..................... ~ .................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy ......................... ~i ................................................................................. b. Intended use and occupancy .................. ~ ................... ~,, ................................................................................. 3. Nature of work (check which applicable): New Building ~' Addition Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ........... ~...:~..¥.~..Q.~. .............................. Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units .............. ~ ............. Number of dwelling units on each floor If g~rage, 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 Depth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front ..............~..'~.'.~.. ............ Rear .......... .~..~. ............ Depth Height ......... ~.~ .............. Number of Stones .................................. 9. Size of lot: Front .......... f../...O.. .............. Rear .....~.~.f...?.5"~.. ....... Depth .......... .3..~.~.. .................... 10. Date of Purchase ........................................................ Name of Former Owner 11. Zone or use district in which premises are situated ................................................. 12. Doe~ proposed construction ~/iolate any zoning law, ordinance or regulation~ . ..~...~ Name of Owner of prem ses /)r)l~c .J..~i~ Address ...C~7~ /t~/,;~ ........... ~"~.'~"J''/'':''' 13 .................. ~?V... .................. /q .' ¢1.~ Phone No. Name of Architect ...................................................... ~ Address ............................................ Phone No. Name of Contractor ...~'.~.~.¢.~.c.... .¢..f ...................... Address~..~:?'cr.~......~..~.......(.X/t~;/~ ..... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property /i~es. Give street and block numbers or description according to deed, and show street names and indic~ whether interior or corner lot. STATE OFi NEW )/0~1</2'' COUNTY OF .~....), ,~' ' ................... ,~..~ ....... ~..]'.]...,.., ......... , .............. b'eing duly ~wam, 'deposes and says that he is the applicc (Name ~individua' signin~.~2~ above named. He is tke .................... ~.~.~.t ........................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized fo perform or have performed the said work and to make and f this application; that all statements contained in t~is a~j~ation are true to the best of his knowledge and beli and that the work wiU be performed in the manne~ ~}~ ~pplication filed therewith. Sworn to before~e this . ~o. FORM TOWN OF SOUTHOLD BUILDING DEPA~,TMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................ (~.: .................. , ........ Approved ........................................ , 19 ........ Permit No ................ Disapproved o/c ....... ~ ......... .~ ............ ~ ............... ...................... ................................ Application No.~.I...~Z ~ .............. APPLICATION FOR BUILDING PERMIT Date ....................................................... , 19 ................ 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 bedrawn on thediagram 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 g~anted 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, blew 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. ..................... ........................ :E .......................... (Signature of apCJJicont, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, FJ~ architect, engineer, general contractor, electrician, plumber or builder. blome of owner of promises ............................. ~ .......................................................................... If opplicont is a corporote~ sionoture of duly ~uthorized officer. (Name and title of corporate officer) 1. Location of land on which pro,~,,osed wor~ will,:be done.rMap No: ............ =...,~...../~ ................... Lot No: .................... ................... Street and Number ........................ (~ ........................ /~[~'i~ii;'~ ............................. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................... b. ntended use and occupancy 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ........... .~..~..,~.f~..~..~. .............................. Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units .............. ~. ............. Number of dwelling units on each floor If g(~rage, number of cars ....................... .J. 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 .......... ~...~. ............ Depth ....,~.., Height ......... ~'.~.' ............ Number of Stones .................................. 9. Size of lot: Front ... ! I O ..... / "~ , ....3...O.~' ............................. Rear ...... ,1~. ...... ~,.~ ......... Depth ................................ 10. Date of Purchase ........................................................Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construct on ¥ioJate ,any~ zen ng aw, ord nonce or regulation? ,,~..~ 13. Nome of Owner of premises .~.J.~?.~ ;').,.'~)/ Address ..~5 .?.!t.<.....~..(.!....~...q.. Phone No. Name of Architect ...................................................... Address ............................................ Phone No. Name of Contractor .~.~).,~.~:....J~../?..~.~ ...................... Address~,~.~.tCS.......~..~...,...~:.~f.!~,.... 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 whether interior or corner lot. .................. ~ ...... ~ .................................. being duly sworn, deposes and says that he is the applica above na (Z~;;;~i;i.~.~.~.'..:.i.~:.i.~.~~ ........................................................................................................ J... (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 are true to the best of his knowledge and and that the work will be performed in the manner ~lication filed therewith. Sworn fo b~fore~e this ................. : ........ , ~ .... ......'7"~'" ::::~ F'~'" %> ....... ' Notary Public ',~ ~('rr ?~. .................................................... :~.. ~ ~ applicant)