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HomeMy WebLinkAbout3542-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No.....Z.....3..[..,9.~, .......... Date ......... A~gtl,~t,..2.7., ....................... , 196B... THIS CERTIFIES that the building located at ..C~cla~..JDJ'.:Lv~ ......................................... Street Map Nc~lV~.t,;~J;'.U,~l~:... Block No ....................... Lot No.],.7.,~,8,.~.~.....~..~..~.~.~...~..~...~.~....~..~...~.....~.0..~..~.. Deve3.opment: Co. conform~ substantially to the Application for Building Permit heretofore filed in this office dated ............... ~.t~.~....~., ................................ , 19..~..?... pursuant to which Building Permit No..~.5...~.~...~. dated .....~lZ.%y...[3., ............................... , 19..6.7.., 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 ........ ..... l~.;Lv.a f~a,. ~a r. ag~ ...(a,~ce,~so~.y...b~ild~ng.) ........................................................................ The certificate is issued to .....J~...$..~.....~.;~..~t!II~..~,...~;~.~JL...(D.~] ............................................. (owner, lessee or tenant) of the aforesaid building. ......................... ~ii~;n~ Inspector / FOF,~ NO. 2 TOWN O!: SOUTHOLD BUILDING DI:P~RT~ENT 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? 3542 Z Permission is hereby granted to: .......... ~.~..~...,..~:.'. ..................... . ........... / ................ to ...~j,~. ~.. ~,~t~. #,~ ................................................................................................ at premises l~cated'at .~.f~:~.:.,.~.~.;J~.~.~..~....; ......... ~....;: ........ i....'..~...i.'i'.i ............ J .......... .................................... ~..~. ......... pursuant to Opplication.'dated , . ...J ..~.~..;....~., ....... , ]0..~.~..., and approv,ed by the Building Inspector. , Building InspectOr ',~.,; %: ' FOEM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~ ~9.)..'.... Permit No..~...>~ Approved ........................................ , .......................... Application No. (Building Im~pector) APPLICATION FOR BUILDING PERMIT )ote .............. ............ , ..... 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 coveFed 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 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 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, building code and, regulations.., ~ ~ .................... :~ ................... :~/.~ ............... ,.....~.~-:Z..~,...~.~'T .................... (Signature of applicant, or name, if a corporation) ........ ....... /~ , ' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a 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,~./~.J./.~'.~?..c.~.u..¢./?/..~/?.~.:.~/.~.(.~,. Lot No.: ..../...7...'.~../.~..?..~.. Street and Number ...................... ..~....~.~.~...~....~. ......... .~...'~.../..~.~.'. ............................... ~..~.~..~.(../.~...~'..~..,~......./..u'.~'. ............... Municipality 2. State existing use and occupancy of premises and intended use ond occupancy of proposed construction; a. Existing use and occupancy .............../.Z.°.../..~-~ ..................................................................................................... b. Intended use and occupancy ......... ..~..~).//Z~./~..~'.~.. ................................................................................................ 3. Nat~Ure of work (check which applicable): New Building .................. Addition .................. Alteration Repbir .................. Removal .................. Demolition .................. Other Work (Describe) 4. Est,~nated Cost ....~..../.. ......... : ...................................... Fee ............................. I (to be paid on filing this application) / 5. If al. welling, number of dwelling units ............................ Number of dwelling units on each floor If gJarage, number of cars ................... ~/ 6. If ~?usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dir6ensions of existing structures, if any: Front ............ 3.~. ......... Rear .......... ,.~./../. ............. Depth Hei~lht ........ ./..~.. ........... Number of Stories Dimensions of same structure with alterations or additions: Front .................................... Rear M Del[th ................................ Height ............................ Number of Stories ................................ 8. D,r~ens,ons of entire new construction: Front ........... /..~...~ ............... Rear ....... Z~.~i./. ............ Depth .....~....~../..~ Heibht ...../.3. ......... Number of Stories ............/.. 9. Siz~Fof lot: Front ..........~...~.r. ......... Rear ........... ..2%~.~./. .............. Depth ............. ./....F~....~ .......... 10. Dat"e of Purchase ........................................................ Name of Former Owner 11. Zor~e or use district Jn which premises are situated J 12. Does proposed construction violate any zoning law, ordinance or regulation? 13. No'ne of Owner of premises~..~..J...../:g.~.....~/......~..~../.~.~.. ....... Address .~.~...~..~....~...~.~ '~..~.~.~.'.¢Phone No. Na~ne of Architect ...................................................... Address ............................................ Phone No. Na~e of Contractor .................................................... Address ............................................ Phone No. PLOT DIAGRAM I_ocat,le clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lines. Give street and block number or description according to deed, end show street names and whether in~'erior or corner lot. ~.~¢/ STATE al NEW YORK, COUNTY~OF ................................ ' ~"~ ~'~ ................ I ................................................................................ being duly sworn, deposes and says that he is the appli¢ i(Name of individual signing application) above na~ed. He is the of said o~ this appli~ that the ~ Sworn to t afore me this ............ day of ....... ......................... , Notary Pu~lic,~.~¢~...~....~..~.~~6k(~o~?~'''. ." (Signature of applicant) [. ,,,r,,,.--~ ~tate of New C/ .0~'~;~~u '- ..... (Contractor, agent, corporate officer, otc,) ,her or owners, and is duly authorized to perform or have performed the said work and to make and :arian; that all statements contained in this application are true to the best of his knowledge end belief; ork will be performed in the manner set forth in the application flied therewith. FOI~M NO. 1 Examined ....!;~7. ................. ] ............ , 19 ........ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................. Disapproved a/c ....,..,,.,,~ ............... ~,~,,.,.~ ....................... ~,,,~.~.~:.....~..:~,~,~,,,,,~,.~.~,~.. -,-,~ ,~.,~ ~., Application No ............................. APPLICATION FOR BUILDING PERMIT ,,'\ ~,~ , Dote ................ (~?.,'...: ...................................... J. , 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 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 premis, es 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 of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code and regulations. ...................... ................... (Signature of applicant, or name, if a corporation) ...... ....... ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of lend on which proposed work will be done..Map No.: ........................................ Lot No.: Street and Number ..... ] .............. ~]~.~ ....... ~..~- ........................................... ~.~....~ ............... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... ~ ..................................................................................................................... b. Intended use andoccupancy ..... g~.~.~ ......................................................................................................... 3. Nature of work (check which applicable): New Building ...~........ Addition .................. Alteration Rep~air .................. Removal .................. Demolition .... Other Work (Describe) Esh~ated t~'/O~'~ O 6rP .............. 4. ' Cos ....~ ........... ~ ............................................ 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 ............ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 7. D~mens~ons of ex.sting structures, ~f any. Front ............ ~....~.. ........ Rear ................................ Depth Heij;ht ........ ./..~. ............ Number of Stories DiMensions of same structure with o.lterotions or additions: Front ....................................Rear De~th ................................ Height ............................ Number of Stories ................................ DJ :ensiGns of ntire new construction' Front Hei'ght ....... ..3. .......... Number of Stories / 9. Siz~ of lot: Front ........ ~ .............. Rear .......... .~..~.o. .................. Depth ................................ 10. Do(e of Purchase ........................................................ Nome of Former Owner 11. Zor~e or use district in which premises are situated ]2. Do~s proposed construction violate any zoning law, ordinance or regulation? 13. Na~e' of Owner of premises .....~..~.~.;....~...~,....~'....~.7'..~....Address ...~<'~Z~....~.C..~,...~.~'.7.'?/.~..r.~Phono~ No. No'ne of Architect ...................................................... Address ............................................ Phone No. Loca! property I whether i'n ne of Contractor .................................................... Address ............................................ Phone No. PLOT DIAGRAM clearly and distinctly oll buildings, whether existing or proposed, and indicate all set-back dimensions nas. Give street and block number or description according to deed, and show street names and ~erior or corner lot. / STATE O1: NEW YORK, [ ¢ ¢ COUNTY OF ................................ ~ °"~' ............................................................................................... being duly sworn, deposes and says that he is the.applk [(Name of individual signing application) above named. 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 application; that all statements contained in this application are true to the best of his knowledge and belief; that 'the ~¢ork will be performed in the manner set forth in the application filed therewith. Sworn to'l~fore me this ,~ ~ ........... ....... ........ ..................... : ..... Notary Pqbli ~ ..... County (Signature of applicant) V MARION A. REGENT NOTARY PUBLIC, State o! NOW Yor,k No. 52-3233120 Suffolk GoMIR¥ Term Expires March 30. ],9,~;_~