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HomeMy WebLinkAbout2224-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THiS CERTIFIES that the building located at ..~,/...~......~.a.,.~..~....~.~. ...................................... Street Map No. ~.~.~. ............... Block No...~....7.~... .............. Lot No....~..~ ....... ~.O...1].~.~...O.~..~.~.....~......~..,. .................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................. .0.~.~..O.~.c..~:.....~.~. ....... , 1c)..~.,~... pursuant to which Building Permit No....~,~,,,~ dated ....................... 0.C;.~ ....... ].~. ........... , 19..~.., was issued, and conforms to all of the requirements of the eppiicabie provisions of the law. The occupancy for which this certificate is issued is ........ ................................................................................. The certificate is issued to .....]~.~:[~,.~/,..]'~,...~.f~l~.;[.~[8.~ ........................ 0.~[[3.~. ................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FOP~M NO. 2 TOWN OF 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? 2224' Z Date ........................... .Q¢~ ~¢.O]¢.~.~... i .~.... 19...~. Permission is hereby granted to: (}. W. 8mith..&..~on~....A/C.....Da.~&a...DeFr.~.e~ .... ............. S o~e t~ ............................................... to ...,Dui !A.. an..~dcli.~£On., on..~x~...e~,i~.f, ing......l~ui, ld. tzig .................................................... at premises located at ...~.S.....l~i-l~..~t,~'~e.t, ................................................................................... ................................................. Sou.'c. hc~id.,...I~.,..1'. ............................................................................... pursuant to application dated ........................... ~0'11Ob~1~...-.~.~- .......... 19..6,..1., and approved by the Building Inspector Fee $. ~.* .0.0 ............. Building Inspector YOR, M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, iq. Y. Approved t', ,.~...~).~ L~ 2 ........................................ , 19 ........ Permit No. (Building lns¢ctor) Application No, ~..'. ................. APPLICATION FOR BUILDING PERMIT Do e ....................................................... C77 /.7... .............. 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 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 <~pplicant. 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 Sauthold, 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 applicabl/~ laws, ordinances and regulotions~. ~, ,,~ (Signature of applicant, or~ame, if a corporation) 5.~. ................... (Add.fess of'applicant) ' State whether a.~f?Jicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or' builder. ........................ ............................................................................................................................ Name of owner of premises ....... .~... applicant is o corporate, signatq,~ of duly authori~,ed officer. (Name and title of corporate officer) I. Location of land on which proposed work wiU be done. Mop No' . ............. < . Lot No: .~ z_ ......... Street and Number ............................... P..~,.~r...;~......-: ...................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use end occupancy ....~ ~ ~ '~ ~'" ¢~' ~,V,~ b. Intended use and occupancy O ~, ,,~.,~ ~cneck which applicable)' New Building .................. Addition ..... ~.... Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ........................................................... Fee (to be paid on filing this application) 5, If dwelling, number of dwelling units .......... ::-:.,':m.,..-~.. .......... Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify natureand extent of each type of use 7, Dirnensions 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 ........ I..,~...~..,.,/...4,.~.... Rear ............................ Depth Heightl ...... /./~....~ ........... Number of Stories .......... ,/. ..................... 91 Size of! lot: Front ...... ~....,~,,.f! .............. Rear ........ /¢,.,,~...~. ......... Depth ......... ,,'~,..,.~...,~.. .................. 10. Dote of Purchase ....... ~,...,:'.~ .......................... Nome of Former Owner ............. ':............-~. ............................ t 1. Zone or use district in which premises are situated.......~. ................................................................................... proposed construction violate .any zoning law, ' n~/o~r.r~o~n~ .... A(...~. ................. .. ................... 12.13.DOeSNome of Owner of premises~l~..~...~.~.A~rc~i~s~ .~ ........... Phone No.~..,~,.~ ...... Name "'- .__________ .......... hane ........ Architect '"'~', ~~,,1~~ ...... ; .............. '~ ......... Address Name of Contractor/~.,./. ,~..~~.../;.~..Addres, .~~'~'~ ~'~ ............ Phone No.~' '~-- ~.~...0.,,,~..,.~.. ..... PLOT DIAGRAM Locate clearly end distinctly all buildings, whether existing or proposed, end 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 NE~,.YOB~, ) S S --~/.~ .~//..~ ¢~, ~ r/f-COUNTY OF--,'¥~'~9'¢~f~:'" ........... ) ',' (Name of individual signing application) above named. He is th~ ..C,~~ ....................................................................................................................... ontra~ officer etc.) of said owner or owners, and is duly authorized to perform o~ ~ed the sai~o~ and to make and file this application; that dl statements contained in this application are true to the best of his knowledge and belief; and that the work will ~e performed in the manner set forth in, the application fried therewith. ~ ~ Sworn to before me this ~ ~f~ ~,,,.,.~ , · ~ ~ , ~/ * _~ ~ . ~ .o**~.~.u.~,~,.w.~j:.r...~ ......... ~..~.:,~._r,.: .................... /~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......~...~ ...... '.~ 19.~...~.. Approved ..7 ................. !..\ ................ ,19 ........ Permit No...~..;...~..:...~......~....~.'..~ Disapproved a/c ........................................................... (Building Inspector) Application No ............................. APPLICATION FOR BUILDING PERMIT ................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and sabmitted 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 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 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 apphcabIe laws, ordinances and regulations~ ,, ! (Sign.ature'oT applicant, or name, ifa corporation'S' .:.¢...c. (Addp~ss of applicant) State whether app?icant is ~owner, lessee agent architect engineer general 'contractor, electrician, plumber or builder. ........................ . . .~z~,,~. : : / L. ~.'~z. z. .~,. . . ~: . ,,, .......................................................................... : ................................................... <',,.~f~~~,,~,',,:, , ~~1~' If applicant is a corporate, signature of d~uly 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 ........... ~ ~ ............. :.../~.. ................... -%,~.e;~..,,,.../..../.',:~...~.p.~,.....~,,.../. .................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existin~ use ond occupancy ........... ~..~..~.;..(~...~..~ .......................... . .......... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .................. Addition ..... Alteration ............. ReFtair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost .............. 6~....~ ..................................... 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 .............................. ;-~;v:;;-~ ................................................................................................... 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 ....... ,/..~.~'....t..../:~..-.. Rear ............................ Depth ....................... Height ..... ~/..~...z ............ Number of Stories .......... ,/ ...................... 9. Size of lot: Front ...... ~...~...~ ............... Rear ....... ./....q...e. ......... Depth ......... [~..~.~.~ ................... 10. Date of Purchase ........... ~ ...........................Name of Former Owner ............... .~;,.'. ......................... 11. Zone or use district in which premises are situated....~ ............................................................. 12. Do~s proposed construct on voate any zonn, g aw, ordnance_~,/_..~_.._,2, · - . · ..../...,, ..................... ~ .............. Name of Owner of premisesC~..f~,~.~.,Jk~..Address ~~d'. ........... Phone No.,~..~...~... 13. Name of ' ~ ~ ...... Arch,tect ...... :r; ............................................ Address .............. ~ .............. Phone No:'~ .... Name of Contractor/~..~,,d.~ .~.'~ Address ~,~.~ Phone No..'~.~..~..~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exis'ting 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 indk whether interior or corner lot. STATE OF NEt~' YgI~K, /) ) S S . · , ~.Q..J...~. : ............................ being duly sworn, deposes and says that he is the appl,o (Name of individual signaling] application) above named. He is the .~~ ................................................................................................................ -(Contractor; ;;~M c~p~te o~ce~,~ of said owner or owners, and is duly authorized to perform or have performed the said wori4 and to make and f this o.pplic~tion; that all statements contained in t~is application are true to the best of his knowledge and beli and that the work will be performed in the manner ~t f~Lb in the application filed therewith. Sworn to ~efore me this ~ ~ ~,~l~-~t~'-~OWo , _ //, ~.~ ......... .~doy ? ....m~ ................ ~ ........ ~ ~~~ ~ ~~ , -· ......... ........ .........