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HomeMy WebLinkAbout2290-zFOI/~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..~....[9.~, .......... Date ............................. THIS CERTIFIES that the building located at ..... ~[~r/.[].....0~.;[~;~L..~.V~ ........................ Street Map No...;X,~. · ............ Block No.....~ ........... Lot No .....~,~ ....... '~te.~...~.~.~.~tt~ .................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................... X]J~.....~8~,...~.-q-, 196l+... pursuant to which Building Permit No....~.9C~. dated ............................ ~T~L12~,.....~ .......... 19..~.~.., was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ .... l~.i. va.t e...e~e...~.am ~ l.y.. ~we .!...1:ing. ............................................................................................. The certificate is issued to ..P~..~..,~dd.~,~(~g.~;~ll...J~' ........................... 0.~/~1~. ............................ (owner, lessee or tenant) of the aforesaid building. Building Inspect~)r FOP*M NO. ~ 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.° 2290 z Permission is hereby granted to~ aol~.~...W~on..~..,...,., ..................... .................. ~m~.~..~e:}~,,~4 ............................ to ..... ;.Z~]~*..nn,.a~,~o~..°n:.~'~:.e~,~t~,~..,~ve~,~..*,*..: ................. ii ........ , ............. at premises located at .....~/~..~}~e{~...~ ................ ............ ' .................... ........................... ~ ...... ...................... ]...., ....... ; ........... ....~lae~$.,i~.....~,~,. .............................. :...: .................. :. .... pursuant te*o ~cohon ate ....... . ........... ' ................... , Building Inspector 19...~, andapproved bythe Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTME~IT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permi No ...... Disapproved a/c ........ ~~ Application No.......~.....'~.....~...? ..... Date ...... ......... INSTRUCTIONS a. This application must be comp[etely filled in by typewriter or in ink ond submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relotionship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be dra~wn on the diagram which is part of thi,~ 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 opplica~nt. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building sha)l be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the i,s,suonce of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y/5~/k/Iond other applicable Laws, Ordinances or Regulations for the construction of buildings, additions, alterations, or/f~/r/~movcJ oj]de~o~ition, as herein described. :....: 'gn~ ~iJ~/~,orgam ,' ocorpora;ion) '" (A~]dress ~f' a'~'~l.can~) ......................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem.ses' ~.~ .~.~. ~, (~ "3 ~[ ~ ~1..~i~ [~[-' 1. Location of land on which p~roposed work will b~ done. Map No.: ........................................ Lot No.: ...................... Street and Number .~....~..~.~...~...~.[ ....... ~J~!.~.~.'.~., ................................................................................... Municipality 2. State existing use and occupancy of premises and Jntehded use and occupancy of proposed construction. a Existing use and occupancy ..... ,......,...~..Y..O3..,..~ ...... y....C..~...~...,..,..I.. ~ .l..~. ..................... , ................. b. Intended use and occupancy 3. Nat6re of work (check which applicable): New Building .................... Addition .................. Alteration Repciir .................. Remora! .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ~.,....O...~.. ....... 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 bd~siness, commercial or mixed occupancy, specify nature .and extent of each type of use 7. Dimfnsions of existing structures, f any Front ..~.~.. .............. Rear ......... .~...~. .... Depth Height' . ........ [~. ............... I Number of Stories ...........O...~..~ ................................................................................... D,mens,ons of. slame structure w,th alterot,ons or additions: Front .......... ../x/..~.. ............... Rear ......... ~..~..!. Depth ...... -:~...:. .. He ght /.~. NumSer of Star es ....... ~//~ ~6~-L~ 8. Dimensions of entire new construction: Front '-- Rear .......... ~ ............... Depth ig. ht He .............................. Number of Stories .............................. 9. Sizelof lot: Front ....... ~ , ~.~,*~..../:.1. ............ Rear ........... (z~..~.? ................ Depth ......... ..t~....~_~? .......... Dat~ of Purchase ...~..~..i:l..b..~..~,....~.~...~...~'.~..r ................ Nom~ of Former Owner .....0~..~.Z...(~!~.....t...~..~..i~..~ ..... 10. 1 1. Zone or use district in which premises are situated .......... ~...~..~ ............................................................................ 12. Does proposed construction violate any zoning low, ord nonce or ragu at on;~ ~ ~7.C). 13. Name of Owner of premises ..~.~.~.~..(..~.~.~.~..!..~.~....0..~..., ~ttress ..... ~..,:~'.~.:.'.~...~.'.~i~.'.~.. ...... '~'~"~'~.'~i~ Nome of Architect .................................................... Address ................................................ Phone No .............. Name of Contractor ..... .l~..t~..*...~...~.....~...~.. ....................... Address ................................................ Phone No. PLOT DIAGRA~ Loc.a,!e clearly and distinctly ail 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 iriterior or corner lot. STATI-- OF,NEVVC'"YO~,If, h. ) ~_ COUNTY 0F ..~~ ) b:b. ......... ~~:~:':~ ~.~,....., .......................... :~ duly sworn, ~. deposes and says that he is the applica (N ' ' ' s'g lng appl'cation) ~bove nomad, He is the ....... ~.S~J~ .......................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to ~erform or have pert the said work and to make and file application; that all statements contained in this application are tr that the work will be performed in the manner set forth in the Sworn to b~fore me this~ ..... ~'~.~..... ,day__of '~Y.~:,r~ -~ ........... ,~19. ~..~ ........ ". ........... Co ,y FO~H NO. 1 TOWN OF SOUTHOLD BUiLDiNG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ......... .,. ............................ , 19 ..... Approved ........................................ , 19 ........ Permit No. Disapproved a/c ~'~"'~ ~'~ ........... ~;:,~ ............. ~:.Z~:> ..................... ~=:~ .................. .......................................................................... ............ ................... · ......................... Application No ............................. APPLICATION FO~ BUILDING PERMIT Date .....~.:.~..~...a.b..L.~.~..It..~.~ ................ , 19..~...(j 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 Jot 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 m~y 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 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 D~partment for the i,~suanc9 of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y/gf~, and other applicable Laws, Ordinances or Regulations for the construction of buildings, additions, alterations, o/)'¢'r/rerpova~ ~,r/Jemolition as herein described The appNcant agrees to comply with all applicable laws, ordinances ~/r~guJ/atio//.// // ' ......... :::::::::::::::::::::::::::::: ......... (Addre, s of opplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ........................................................ . ....... Name of owner of premises J~.6.~<j~l LJ~c~ ~' ~].~.~;~.~...~[./k...~..~.~. ................................................................................ If applicg~s a ~/orl~o£c~e,/signature of duly authorized officer. ........... ................................................. (N e a~d fltle of corporate officer) '" 1. Location of land on which pro~)~)sed wjork v~ll be done. Map No.: ........................................ Lot No.: ...................... Street and Number .,,,~.~,~f.-~..(.~.L.,,/~/.U:.,.~ ....................................................................... . ............................ Municipality , 2. State existing use and occupancy of premises and in,tended use and occupancy of proposed constructi~p. a. Existing use and occupancy ..... j[.....~...~.:.!?...,]..~.( .~.~. ~ I. ......... r~. l/.~....~.~.~..(.j.?.~...¢~..~ ........... ~ii ................ b. Intended use and occupancy ..... '~L"~i~]'~.-'" '~" ~ ~ .. . """~':' 3. Nature of work (check which applicable): New Building .................... Addition .................. Alteration Repair .................. Remova! .................. Demolition .................. Other Work (Describe) .................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...........I. ................... Number of dwelling units on each floor If garage, number of cars ........... :..-:~... ........................... 6. If b~siness, commercial or mixed occupancy, specify nature a.nd extent of each type of use ...... ~.....~'-. ........ 7. Dirdensions of existing structures, if any: Front ...........~ .............. Rear ......... ..~..?. ........... Depth ....~/~..1~ ............ He~ght'i ...... !.~ .................. ~ Number of Stories D mens OhS of s{ome structure w th o tarot OhS or additions' Front ........ .,t~..?,.,~,, Rear ..... .~ p ........r ...................... ~ ................................ .'~um~er of Stories ................. ~ 8. Dimensions of entire new construction: Front ......... ~ ............... Rear ................. ~ ............ Depth Height .............................. N.umber of Stones .............................. 9. S~ze of lot: Front .............................. Rear .................................. Depth .......... J..~ ........... 10. Date of Purchase ..~.~...YI...'.b.~.,I....~..;~t'~ ....................... Na.me of Former Owner 1 I. Zone or use district in which premises' ~'are situated ............'~...~..,~,. ............. 12. Does proposed construction vi9~.gt~ any zppingiaw, ~rdinance or regulation;~ ...... Nome of Architect .................................................... Address ................................................ Phone No. No~o of Contractor ......... .~.?~..~.~..~...~Z~... ..................... Address ................................................ Phone No. ' PLOT DIAGRAJ~ Locdce clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property !ines. Give street and block numbers or description .according to deed, and show street names and whether interior or corner lot. STATE OF NEW YORK, ) c COUNTY QF ............................ ) .... ......... ]~i~.~..~.M~L~.~..~,.~.~.-~..~ctlTi../...~J..~.-~.~ ......................... being duly sworn, deposes and says that he is the (~ame of individuals!fining application) a,bove na~ed. He is the .....:.~.~.~ ........................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfo~ the said work and to make and file application; that all statement.s contained in this application are tru the best of his knowledge a.nd belief; that the work will be performed in the manner set forth in the Sworn to ~efore me this~ ...... ...................... , ire of applica,nt)