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HomeMy WebLinkAbout3210-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ~..31.~/ ............. Date ....... z~lJ.t...27~ ......................... , 19~6~... THIS CERTIFIES that the building located at ....... LI~JI..D~,i,V.~ ....................................... Street Map No ...................... Black No ...................... Lot No ....... ~oldr..~..~k .................... conforms substantially to the Application for Building Permit heretofore filed m this office dated ...................... ~~=..~ ............... , ]9.~.6.. pursuant to which Building Permif Ho ...52[~..~ d~ted ........... ~e~.~...~ ............ , ]~..~.6., w~s msued, ~nd conforms to ~11 o~ fhe requirements of the ~pp]ic~ble prowsions of ~e lew. The occupancy for which th~s certificete is issued is ........ ..... ~v~..o~..~tLy..~l~ ...................................................................................... The certificate is issued to ..~~...~.. ~ ................................................................ (o~er, [essee or tenant) of the aforesaid building. FOl~V~ ~0. ~ 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? 32i0 Z Date ~..~. t,,ll~r 6 1~...~..... Permission is hereby granted to: ~,..~.~r.....~...~.....~..z.~~..~ ...... at premises located at ..~.~..~....~.~..I~1....,~...~.~.1~. ....................................................................................... ........................................ ~.~t~:~.~.~ ..... .~..,.~.: ..................................................................................... pursuant to application dated ............................ ~.t,.. ........~. ............. 1 .9~......., and approved by the Building Inspector Fee $~..?...~... .............. Building Inspector/ FORM NO. 1 TOWN O~ SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ....... ........... ^~o~ ......................... ~. ........... . ~..~ .... ~,~ ~o..~../..~..? ...................... ...... '("~';;;i ................................. APPLICATION FOR BUILDING PERMIT Date S ~J~/~. INSTRUCTIONS a. This application must be completely filled ~n by typewriter or in Ink and submitted in duplicate to the Bu~ldin Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises ar pubhc streets · areas, and g~ving a detailed description of layout of property must be drawn on the d~agram which is part of th~s applicotio, c The work covered by th~s apphcat~on may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector w~ll ~ssue a Building Permit to the applicant. Such perm 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 Occupanc shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of o Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demohtion, as hereto describe; The applicant agrees to comply w~th all applicable lows, ordinances, building code and regulations. (Signature of a ant, or name, if a corporation) ..~.~ ...... ~....-.....G~.~.:~..: ................ (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done Map No · . .................................... Lot No.: ..................... Street and Number ..... .~....~....~...~. ....... ..D...~..J...~...~.. ............................................ ~..6...q.?...N...O..?....~.. ..................................... Municipality 2. State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction o. Existing use and occupancy .......... .~....~../._~..~...L../..~....~.. ............................................................................................. b. Intended use and occupancy ............................................................................................................................. 3. Nature of work (check which applicable): New Budding .................. Addition /"/ Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ....~.....¢~.. ................................................ Fee ....................................................................................... (to be paid on filing th~s 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. Dimens,ons of existing structures, if any: Front ...... ............ Rear ......... ...............Depth ......~...~.." ....... t Height ./..~.. ................. Number of Stories ...... ./. ................................................... 7 ...................................... ;' ......... alterat~9ns or additions Front ........ ~ Rear .~.~ D~mensions of same structure with ............................................. Depth ...~..o.. ....................... Height .... [.~ ................... Number of Stones .... 8 Dimensions of entire new construction: Front ........ .~...~ ...................... Rear ....... ..(¢ .................. Depth ....~.~ .............. Height .....~....~..~.. ....... Number of Stories .... ~ ............ ; ............................................. .~ .................................. 9. Size of lot: Front ...... ff..o..'..,~...~ .......... Rear .......... ./...q.'-.~. ................. Depth ....... ..~....~..?. ............ 10. Date of Purchase ....................................................... Name of Former Owner ....................................................... 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation:) .~..a. ................................................. t3 Name of Owner of premises~.Z..~.~..A.,j'//~:/? ~'/P/~ Address ..................................................... r. ........................... Phone No ..... ..-z ............ Name of Architect ...................................................... Address ............................................ Phone No ................. Name of Contractor ...~...:,/~.:..~....Y...~...~...~.. ...................... Address .~.'~?.~...~.~.h..~ ...... .O.~/..~...W..~,...N.,..>( Phone No~. ~.~...'.~..~..~.~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fron property lines. Give street and block number or description according to deed, and show street names and ind~cat. whether interior or corner lot. STATE OF NE~W ~'0~, ~ ~ c ¢ ...... ........... : ........ ~.~¢..~.~...~. ............................. be ng duly worn, deposes and says that he is the apphcor (Name of individual si~j~ing application) /, above named He is the ......... ~4k4..~....:...~<t,-.~ ..................................................................................... (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 fil this application; that all statements contained m th~s application are true to the best of his knowledge and belief; an that the work will be performed in the manner set forth in the application filed therewith Sworn t~,before me this ~ _ ~ -~-" ' 19..~....~......~ Notary Public, ...~,~.~¥...~.~.......ff/..~...~.~... .....County (Signature"'~:""{"~"~of applicant) ...............................