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HomeMy WebLinkAbout2278-zFOF,~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CE:RTIFICAT£ OF' OCCUPANCY No. ............. Date ........................ 0e~el~e.l~.....l.~. ...... 19.~)~. THIS CERTIFIES that the building located at ..]~/.~.....~e,y'...V.:J..e~..~ROP~(]. ........................ Street Map No ..... 3~6&.3 ........ Block No ........... ;F~X..... Lot No..83..~..8l+ ....... Seatho:t~lt...N...~, ......... conforms substantially to the Application for Building Permit heretofore flied in this office doted ................................ J'artl.'~a~..~ ......... 3'"", 19~.... pursuant to which Building Permit No. ~..Z. dated ........................... J'~,1%,.......3 ............. 19.6.~.., 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 ........ ........ P.~.,,~a ~e..ene..ff. em.~,t¥...(l~:e.l.t~.~ ......................................................................................... The certificate is issued to ..l~l~,...E,...Mo~lylg...&..1~4[£e ..................... .0!~'le~'.$ ................................. (owner, !essee or tenat~t) of the aforesaid building. FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE K~PT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 2278 z Permission is hereby granted to: - .W i.~.t~.~m · · {%. · · .l'on~- ............ , ......................... ...... ]~'...~$e~..R~ ............................................... ............. Bou~h~(~ ............................................... et premises located at T~ta..~.~..&..~i+.--.~leoee..~eek..ee~tes .......................................... ', ..... ................................. ~...~$ew...R&..&..Sm$~.h..~rr.-,.g'~ ............................................................. i~ '!" pursuant to application dated .......................... ~'lllltm~/' ....... ~. ........ 196~..., and approved by ith9 Building Inspector Fee $ ~.,..~. .............. FOR. ME NO~ I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..................... ./'. ,~..~,.'~. ....... , 19..~..~ Approved ......................... ~..~..., 19.~.~ermit No....~....'~...~.....?..~J~?' Disapproved a/c ............................................................................................ ................. ............................................................................. (Building Inspector) ~ Application No ........~...?.....~.~ 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 punic 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 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. "~'¢3(Signature of appli ..................................... ............ ........ (Address of applicant) State whether applicant is owner, lessee, a~ent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................................................................................................................................ Name of owner of premises .... . ....................... .~ If applicant is o 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: Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..~..~?..~4¢~:.../.'.r~..~. .................................................................................................... b. ~ntended use and occupancy ................................................................................................................................. 3. Na ure o work (check which applicob e): New Bui ding .................. Addition .................. Alteration ................. Repair ............ ~j... Removal .................... Demolition ....... 2./ .......... Other Work (Describe) ........................ 4, '; ~ O Est.mated Cost ....~...~7..~...~.~..¢. ..................................... Fee ..'.~,,.~.~ ........................................................................... i (to be paid on filing this application),~ 5. If d~velling, 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 .../~..(2/~..~'~. ........... 7. Dimensions of existing structures, if any: Front.._.~..~..f ............ Rear ....~...~..~, .......... Depth ...~....~.,...~. ........... Height ............................ Number of Stories .¢./~...A.]~.~... ................................................................................. Dirdensions of same structure with alterations or additions: Front ....~,..~..% ................... Rear ...~.~..~....f .............. De;th ./¢.~..!.Z..~c..~....f.. Height ................................ Number of Stories ...~..~..~.~.~. ................. 8. Dimensions of entire new construction: Front ................................ Rear .....~....'~...../. ........... Depth ..Z~..../.. ......... Height ............................ Number of Stories....~...~...~.~,~.. .......... 9. Size of lot: Front ,.../,,~..~., .................... Rear ../~...~, .................. Depth ....~...~...1~. ............................ 10. Date of Purchase .....~./~/:'...7./~..0..~. ......................... Nome of Former Owner ..~....~.~r...~.../~./.'.~..~.......~'...~'.~./~.,~ 11. Zode or use district in which premises are situated...~...~¢.¢.~',~....~..(~.'..~..~.~.......¢.~....~ 12. Doe~s proposed construction violate a:ny zoning Iow, ordinance or regulation? 13, Name of Owner of premises 16/~.~..~.<..?.~.~...,A(_C...~....~'!).~ZAddress .(~,4~.~..~/.'./~'~.,..~...~*....~ff..C../!f./.~hone No. Name of Architect ...... ~.¢..,,~//,~. .................................. Address ............................................ Phone No. Name of Contractor .g.~..~,.~...~... ,(~'..~.'.~./~..XC~../f...¢,.~ ....... Address .~..(..~['..~....~...~.~...~.Kfl.~.,~.,¢~./~. Phone No.~..~'.~.~! PLOT DIAGRA,M Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property li',nes. Give street and block numbers or description according to deed, and show street names and indic whether interior or corner lot. t f 't STATE 01~ NEW YO~I</// COUNTY OF~ ..~.) b'b' above named, He is the ............. ~ ................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owper or owners, and is duly authorized to perform or have performed the said work and to make and f this applicbtion; that all statements contained in ~[~rhal~pll~{~on are true to the best of his knowledge and bell and that the work will be performed in the rr~t~r~utSetst~t~ ~t*~Cx application filed therewith. Sworn to b'efore,me this Notaw Publ'~~~ FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................... ~. ....... , 19..~'.....~ Approved ........................ ?.~....~...~......, 19~...~...Permit No ....... ...~......~....'~......~....~.~ Disapproved a/c ............................................................................................ .................. ................. (Building Inspector) (/ Application No ............................. 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 ~ot and of buildings on p remises, 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 port 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 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 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 o~ buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of opp[~ont~ or na~e, if o corporation) ....... (Address of applicant) / State whether applicant' is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................................................................................................................................ Nameof owner of premses ...~.~..~ ~ ~ -~.-.~..~....~. ~...~.~(.. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which p~oposed work will be done. Map No: ../.~.~...~.....;--_ ....................... Lot No: Street and Number ~.~.~r).~.~./~.~r..~..~....~..}/...~.~.~/.~.~..~ .~....~...~.~...~.~/~F~.~.~.~.~.~.~.~ .................. ~.~....~....~....1:..0.....~.~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existlng use ond occupancy ~.. .~. .~?..~ ~. /. ..1~. .~. ............................................................... b. Intended use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition ~ Alteration RePiair ............. (~... Removal ................... Demolition ....... ~/~ ....... Other Work (Describe) ..................... 4. Est imat ed Cost ~..,~..~...(2..~., ~.~. ....................................... Fee . .~..~.~././-~ ....................................................................... (to be paid on filing this application) ,5. If cjwelling, number of dwelling units ....~... ..................... Number of dwelling units on each floor ........ .~..:. ........ J If garage, number of cars ..../~..1~./~.~.. ..................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature.and extent of each type of use ...../~,0./~/t~ ...... . 7. Dimensions of existing structures, if any: Front .................. Rear .................. Depth ...'.~.~. ................ He(ght ............................ Number of Stories ..¢.1~.6J.~-,./~. ................... ~.2:~...~, ........................................... Pin~ensions of same structure with alterations or additions: Front ....(','~..~C.. .................... Rear ...~f. ...................... Del~th .~...~..!Z~....~..~..../... Height ................................ Number of Stories ...~../~...~(.~.t~.. ............... ,Z ./...¢. ................ 8. Dimensions of entire new construction: Front ................................ Rear ...................... Depth Height ............................Number of Stories..~C,...,/.~.. ........... · 0t~ Rea 9. Size of lot: Front ....../.¢ ...... .,I ............ r ..~. ........................ Depth ...~...~....~. ........................... /j 10. DoRe of Purchase .. /.~....7/~....~..~... .................... Name of Former Owner ..~....~....~..t...~./..~......,~...~.())./'~... 11. Zone or use district in which premises are situoted...~.f.~'~.../lJ./~...~.(.C:..... ,~.~:.~.~ ............................................... 12. Do~s proposed construction violate any zoning law, ord nonce or regulation? ............................ 13. Name of Owner of premisesl.~..~), .~....)~,.~..~,~.~.'~.~'~..,Address~..~..~..~'.~i.~...~., ..~...:.,~.~.¢..~4~ Phone No.~.0.~.?..~.,.~ Name of Architect .............. ~./~:..~....~'... ...................... Address ........ ~ .......................... Phone No ................ Name of Contractor ~-~,.~..6./......././..~.~.../~....~. !.Y.f....~.. ......... Add tess/~.~/.Z.6,f. ~...~.~.'~... Phone N o.'-,?..¢.~..~.~ ~.~ / PLOT DIAGRAM Locat~e clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fr property lines. Give street and block numbers or description according to deed, and show street names and indic whether idterior or corner lot. r STATE OI~ NEW~K.,.2Z ) S S COUNTY OF/~....~.. ....... ) ' ' ........... ~.._ ~, v ~..:: ./~.......,~.,....,~ ~ ..................... being duly sworn, deposes and soys that he is the applicc !Nome of indivi~¢l ~,.~Dapplication) abow~ na~ed. He is the ......... ~.~ ................................................................................................................... (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make and this opplidation; that all statements contain~ujpch~pplication are true to the best of his knowledge and bel and that ~he work will be performed i9~:~tb¢ ~es~'inthe application filed therewith. Sworn to Befor~ me this ................ : ........ ..... ............................ ....