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HomeMy WebLinkAbout2196-zTOWN OF SOU'rHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..~.~....J~J. Duazd;h...A,v'.e ............................ :. Street /V~...,~..~...°..~.....~..e...~.~J~[~lk No ....................... Lot No.,~.[(, .......... OY.~.~.~.[.~.t...,~.i~{. ................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................................... .~.,e.~.~...,.~,~ ........ , 1~..~,... pursuant to which Building Permit No, ,~,,~..CcI.,~....~,.. dated ............................... ¢~.{9.~.....2.~ ...... I c).(~..., 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 ........ ~.:.iv. ate...one..~.amil~,,~w~.llin¢ ................................................................................................ The certificate is issued to ,J~.t,~l.e~.~..D,,....~.~.~])~.e.~. ..................... .~.~.e.~. ................................ ~ ........ (owner, lessee or tenant) of the aforesaid building. FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. I~UILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2196 Z Dote ................. .~.e~.~..e.~%~,~.,....~.8. ......... ~9.6.3... Permission is hereby grented ~o: ........... ~.t~,.t .. ~ ,... ~t~.p.le ~ ........................... ....................... ~ .~.l.~eJ~.~-..A~ ......................... .................................. G.~e~n~e~.t ......................... to..B'a:~ .~ c~.. m'~.. ~dd.~,.t,£o~.. cm.. ~...e~. ~t~.~...d~ee.l.Z..~ ........................................................ at premises located at .:Lot..;.3.~.....~J~,~h&.~8.t,o~..~le&.~Y,~ ............................................................. .......................... .................... · W.i.~ar~h...AVe ~ .......Ore e~p~r +~' ........................... " ......................... pursuant to application dated ...... ~ .................... ~e~,, ....... .;~ ............ 19~.3..., and approved by the Building Inspector Fee $..~..0.0 ............ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ ~ ............... , Approved ........................................ , 19 ........ Permit No....~._. ........................ Application No. ~ [ ~ ~ Disapproveda/c ~ ........................................................... ..... . ...... _ (Building I n/pector) APPLICATION FOR BUILDING PERMIT Date ....................... , .... INSTRUCTIONS o. 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 odioJning premises or public streets or amos, 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 cam menced 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 buildin9 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 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. ......... ................. , 'g . pp' ,o marne, if a corporat'i~i ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name 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: .......... (/F.....~.../(.....~..~-4<~_ot No: ..2.~/. ........ Street and Number ......................... 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 ,~9,~...~..~...~ 3, Nature of work (check which applicable): New Boildin9 .................. Addition ..... ~ ......... Alteration ................ Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ..... /~..~,.¢.7,6. ........................................... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ...~'2L~.. ................. Number of dwelling units on each floor ........................... If garage, number of cars .. ~ ............................................... 6, IF business, commercial or mixed occupancy, speci fy nature end extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front. 2G Rear .;~.¢..,.~, ..............Depth ....... ~, .................. Height ...... L./-J, ................. Number of Stories .......... ~__,)..-¢g~. ..................................................................................... Dimensions of same structure with alterations or additions: Front ..... ~...~.. ................... Rear ...... ,~..~ .................. (. r Depth ..... 2...~... ............... Height ....... ~.../ ................... Number of Slories ...... 4¢:)..~I¢.~ ...................... ~ I 8. Dimensions of entire new construction: Front.....,~.~ ............... Rear ....... /.~ ...............Depth Height ...~...CJ...¢. ............... Number of Stories....4~ .................. / , ~ t 9. S ze of at Front /.2=...~'.. . . Rear '(~.,'.~.. ....... Depth /, .~..~.). 10. ~-''~ ' ~/ ............................................... ~~'-'~ -~¢- '· Date of Purchase ..,.,...~,~)../..~.y./,.....~..~ ...................... Name of Former Owner ~~.~ ............ 11. Zone or use district in which premises are situated ............................................................ 12. Does proposed construction violcte any zor~ng/~ow, ordinance or raga at on?~..,<¢~ ................................. ome o, Owne. of premises phone N o.~.'.~. ~ Nome of Architect .~.P-,-~..,'J/,'/~.,~,.~r~,. .............. Address ........ Phone No.~./~..L~,?/~..~.., Nome of Contractor ................ L..: ............................... Address t ¢ ............................................ Phone No .................. PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block numbers or description according to deed, and show street names and indic whether interior or corner lot. STATE OF NEW,/~'O~I,~,,/, ) S S CO.NT OF above named. He is the ........... .'m?....-.?....-~.....~.'::..~'_.~. ........................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have per{ormed f~e said wor~ and fo ma~e ~ng t this opplicati~n; that all statements cd~d ~is application are true to the best of his knowledge and bell and that the wor~ will be perfor~Bt~"~s~k~ortN in the application filed~rewifN. Swor~ to be e me th s ~ ~ , , F~)~M ~0. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUI~.DING PERMIT Date .~....~...~.....~. ..................... , 19.6..~. 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 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 app~Jca.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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MA:DE 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, alterations, or for removal or demolition, as herein described, The applicant agrees to comply with all applicable lows, ordinances and regulations. ~ ......... iSignature of ;pplica~, or narr~, i~ a cor~)~i~i ......... .......... .................................... (Address of applicant) 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.: . at No.: ......~.....~. ......... Street and Number ....~/...~.~......~...~..z~/~......y...~ ....................... Muni~'ipality 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 ...... X ........ Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................. 4. Estimbted Cost . ~/,/O"~ ooo-~ 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 .../...~. ................. Height ..... /...?...i ............... Number of Stories ..... ~ ........................................ ,. ........................................ f .......... Dime, Jnsions of sam~e structure with alterations or additions: Front ......... .~..~. ................ Rear ........ ~...~ ............. Dept~ .......... ~....'~.. ............. Height ........... /..c.)..i .............. Number of Stories ..... ~ ................. 8. Dimensions of entire new construction: Front .....,/. ....................... Rear ........ J.~. ................. Depth ....~.....~. ............... Height .J. .......................... Number of Stories 9. Size of lot: Front ../.~..~.~..~ ............... Rear .../,.,~....~.~.i ................... Depth .../..~..?. .......... ~ ........,~ ,.~ 10. Date of Purchase ..~/.?....~...[~...~. .......................... Na,m, o! Former Owner .~~ ...... ! I. Zone~ or use district i which prem'ses are situated ....... ~ 12. Does' proposed construction violate any zon'rng ],aW, ordinance or regulation~ ..~~~-- ......................... 13. Name of Owner of preA-nis~s Address ~T¢~i~hone Name of Architect ...J.~,~..- ..~...~ ..... Address ...~..~...J/~..~.~one~'~' ~ / ~ "'~ No~..7.:./.~..~ Name of Contractor .................................................. Address ................................................ Phone No. PLOT DIAGRAM Locat]e clearly and distinctly atl buildings, whether existing or proposed, and indicate all set-back dimensions property lines. Give street and block numbers or description a:ccording to deed, and show street names and indic whether interior or corner lot. STATE OF NEW~',OI~' "~) SS COUNT,,~Y.,?~i~j_.,,~C.~_/jOF .~f~..) ' ' .......... /.[~j~..~.../'.../~:.....~.....'~'..~.?.,.J...~.....~.. ............................ being duly sworn, deposes and says that he is the applic ~ ~{Name of individuo~s?~i,?_~ ~a~pp~,,c~atian) obow, named. He is the ........ ~,-;¢~..:..~¢..~.~. ................................................................................................................. (Contractor, agent, corporate officer, etc.) of said ay/net or owners, and is duly authorized to perform or have performed the said work and to make and file application; that all statements contained, in this application are true to the best of his knowledge and belief; that the work will be performed in the manner set forth in the application filed therewith. __ Sworn to before me this Notary Public ........... ...................