Loading...
HomeMy WebLinkAbout2952-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFF~CE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY N~ ..2...3.~.~. ................. Date ............ AI:~,t3,..:L.5 ........................ , 1~ ..... THIS CERTIFIES that the building located at~l~..~.. ................................................ Street Map No ........~ ....... Block No....~ ........... Lot No. '-~"G~,~'~'"~e~..¥o~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ................. .,~:...D.~e=...~ ................. , 19.6~.. pursuant to which Building Permit No.gg~...~... dated ............... ~.e~e~...6. ................, I~5 .....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 ........ ~ddi~on ~o one ~a~ ~e~nce The certificate is issued to~~..~,...~dO~...~O~...~a~..~..~..~.~. .................. (owner, lessee or tena.t) of the aforesaid building. Building Inspector FOI~i~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PEP. MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OE THE WORK AUTHORIZED N? 2952 z Permission is hereby granted to: E~e,d Got.don.... J~..~- ..~a~.~.~.~ ............................. at premises located at ..D?~'~e.~.,,~......~: ....................................................... : ........ ........ : ....... ......... Building Inspector| Building' Inspector Approved .................................... , FO]~M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, 19 ........ Permit No ................................. Application No. ,.~',~,..~('..~..:..~....~. ........ Disapproved a/c ......................................... :.u ......................................... (Building Inspector1 APPLICATION FOR BUILDING PERMIT Date.....~ '.~)..~z--~..~...¢..~-.~....! ............................. , 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 be drawn on the diagram which is part of this location. 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 ova,liable 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 o 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. .. ..... j ~ (Si~/~ture of c/pplicc~nt, q( name, if a corporotioni ......... (~dress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................... .............................................................................................................. Nome of owner of premises.......~.., ...C~-..,.c~;..;...~.~..~.i~:.~...t~...~..~.........~.?..~.../7'~.~..'J...('..2~....~.; ........................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate, officer) Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number .G~,,~..%,~..~,~...~......~./.~.~.~..~. ...... .,~.......~'~.~...~..~..~..'.~...~..(~-~ .................................... i Municipality 2. State existing use and occupancy of,,~m~e~ond intended use and occupancy of proposed construction: o. Existing use and occupancy ... b. intended use and occupancy .......... ..~-..-m~.~.~..~.......~)C)....~ ........................................................................................... 3. Nature of work (check which applicable): New Buildin~l .................... Addition...,/..'~.. ......... Alteration .................... Repair ................. ,~,~J Removal .................... Demolition ...... %~1~""~,' Other Work (Describe) .................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... [ ................ Number of dweIling 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 ....'~....C-.,. ............... Depth ...... ..~-.....~... ...... Height ....... ./...O. ................ Number of Stories ......... f..././..'¢~.. ......................................................................................... Dimensions of sar9~ structure with alterations or additions: Front ...... ---->.~....~?.....~./ ....... Rear ......~..'.~Z .................. Depth .......... ~....~.. ............ Height 8. Dimensions of entire new construction: Front ..... .,~...~-. ............. Rear ....... .... Depth ...::~../... ............... 9. Size of lot: Front ....... .~...~.~.'~. ............. Rear ..... ..~. ................... Depth 10. Dote of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction vi~olate any zoning law, ordinance or regulation? ....... ../~...(~. ........................... Name of Architect ................................................... Address .......................................... Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and 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 corne lot. STATE OF NEW YORK ) S. S, COUNTY OF .......................... ) ................................................................................................. being duly sworn, deposes and soys that he is the applicant (Name of individual signing application) above named. He is the ......................................................................................................................................................... (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 file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the. work will be performed in the manner set forth in the application filed therewith. ........................ day of ........................................ 19 ............ Notary Public, . ......................................................... County (Signature of applicant) FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Exam,ned ...... ....... ...... , Approved .................................... , 19 ........ Permit No. Disapproved a/c .......... ~:~,~( ............. ~;~-,,-~,. ..................................... .......................... ......................... (Building Inspector] Application No. ~>~' ';; · ,L_ APPLICATION FOR BUILDIHG PERMIT 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 prope`rty must be drawn on the diagram which is part of this location. c. The work covered by this application may not be commenced be.fore 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 hove 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. · · - ........... L ._ (l~;t/~oture of ~pplic~nt, q~,,name, if a corporation) ....... ..q., ............................ (~ddre`ss of opplican~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................... ........................................................................................................................ Name of owner of premises...~..x~..~m....C~....?..~)..~...~..;:..~..~.~.~.:~.~.~-.~..!.~.: ........................ :..~.....~..I'~'~' : ........................................................ applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number ................................................. ~ .......................... ~. ..... .........~...-....~ ................................. Municipality 2. State existing use and occupancy of pr~e~mises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... .-::..~...~..t..!...~.t~...~..~.~..w~ ....................................................................................... b. intended use and occupancy ............... ~.>]....k~-~-~ .................................................................................................. 3. Nature of work (check which applicable): New BuildJnf~ .................... Addition.....~ ........Alteration .................... Repair .................... Removal .................... Demolition ......... ~//,..... Other Work (Describe) .................... 4. Estimated Cost ..... ~....~..O...(~..,..¢~..¢~ .............................. Fee ....'.....~.,....O.....~. .................................................................. ~ (to be paid on filing this application) 5. If dw.elling, number of dwelling units ........~ ................. Number of dwelling units on each floor .................................. If garage, number of cars ............................................................................................................................................. 6. If busineSS,ofCOmmercial or mixedif occupancy, spgci~yZ.L nature andReareXtent......~...../,~..of each type of use.....~....~..i .................... 7. Dimensions e~sting structures, any: Front....;.)uj/...~.'.}y .......... ............... Depth .................... Height ....... (...O.. ............... Number of Stories ..../.../....%d.. ............................................................................................... Dimensions of same structure with alterations or additions: Front ........ ~ ......... , ..... Rear .....~.....(-~.. ................... Depth ......... ,..TTI ................ Height ....... J. ...................... Number of Stories ........../..?~... .............. 8. Dimensions of entire new construction: Front ...... ~..~.~.. ............. Rear ...... ~..~.. ............. Depth ,C,~, /~ Height ...... !..O.. ................. Number of Stories ......... !.~..~ ............ 9. Size of lot: Front ...... ..F-j'...~.. ............ Rear ....... ~...~.. ............ Depth ...... J...O....~.'....j. ........ 10. Date of Purchase ........................................................ Na,,a~e~.of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ .k..~...~.~.c~...J..~.L~..L~....~.~....~... .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ..L~....~..: ................................... 13. Name of Owner of premise~ .~')...~...~..~......?.-..t.D.!:l...l~..Address ...~.~..I~.~..'.~..¢~:..~..T.~ ........... Phone NO ..................... Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor .:.~....:....-.~..:...,....~..4~.~..(..~.....O...O..~..~. ............... Address .~-.~.~.~..I..~...~.O..(..L.~..'i'. ........ Phone NO.~....~..!?.7.!.~?:~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicote whether interior or corner lot. STATE OF NEW YORK ) COUNTY OF .......................... ) ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ...................................................................................................... ' ................................................... (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 file this application; that ail statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of ........................................ 19 ............ Notary Public, . ......................................................... County (Signature of applicant)