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HomeMy WebLinkAbout5877-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi icnte Occupnncy THIS CERTIFIES that the building located at ~.~....~..~...R..O~.. ............ Street Map No. ~ .......... Block No....g~. ...... Lot No. ]l~r~... M~;tit~lllMl:~. II,ge ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ... Ma~. 2 &.14a]~ .2.~.., 19 .~I~. pursuant to which Building Permit No. ~ .~..~.. & dated .. Ma~. 2. & .l~l&~..~.6 .... , 19. ~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . B~Rle~.z .bl~.lJ, d~g .-...~.~r..o.~, &. ~ .~l~..~.~..1~., ~l~.a..~., .~...$~., .fea.~.s., (..a.~]~ The certificate is issued to ~.oyd L~dsalr & ~£~ o~ner~ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .lq,R, ............................. UNDERWRITERS CERTIFICATE No... ~.~..~.~..J-~.g ...................................... HOUSE NUMBER..~.~.~0 ...... Street .......~&~lJ~ .l~$&.~ ............................... FOEM NO. ~ TOWN OF $OUTHOI. D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) lq.° 5722 Z Dote ........................... J~J~lJl~ ...... .~ ....... , 19.~11~.. Permission is hereby granted to: at premises located at ...~.~.....J~j~..jjljjl~i ......... Jl~l.~t'J;~'Jl~'"'JJ~ ...................................... pursuon¢ to oppli¢ofion doted .............................. ~.~....~ ............... , 19q'~..., ond opprov~l by the Building Inspector. Fee $...~J~.Oi~ ......... TOWN OF SOUTHOLD BUILDING DE.P2RTMENT T~N CLERKS OFFICE SOUTHOLD, N. Y. .................. '.'. ....... ........... . APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ~.arch 2 19..7...2. ...... a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspect6r. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is part of this application. The work covered by this application may not be commenced before issuance of Building Permit. c. 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 Deportment 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, housing code, and regulations. (Signature of applicant, or name, if a corporation) New Suffolk, N.Y7 ....................... oT iigg6) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. general contractor If cant is a corporat , sig atur of duly authorized officer. -~_ ~1~ ~ ...................... - (Nar~ and title of corporate officer) I~ '1 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ........................ 'l Street and Number ....................................................................................................................... , ............................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy vacanl: b. Intended use and occupancy ............ ..~..~..o...17.e.. ....................................................................................................... 3. Nature of work (check which applicable): New Building .~ ...... Addition Iteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... ..$..]:.5..t..0...0..0.?...0..0. .............................. Fee $~)~O~- ~'..~'c ~ (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 s~..o..~........., ....... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height Number of Stories Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front 6~0 t Rear ......~..0...t'. ................ Depth /-tO t Height ].6 t Number of Stories ]' ... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 19. Does proposed construction violate any zoning law, ordinance or regulation> 13. Name of Owner of premises ........ ~.~.o.~.~....~.~.~..~..~.Address ~w~.~.~...,qg...~..~. ..................... Phone No..2....~....'..~.?.,0.9.. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~..e...,,~.o.?...t[..o..~.....~.....S...o.~..,~. ............. Address ......,,l~,..~......~...~...~..o....]~.. ............. Phone No. 756"6552 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y.4DRK ,_ ~ COUNTY Of ...~,,~-~.~.~. ........... Ge~-,~ Lo Horton ,. ............................................................................................. Demg duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the corporate officer (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 ore true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application, filed therewith. Sworn to before..~~~~lf,~me this . ...... ~~"~"'"~"'~~~t~' 2.nd March 72 NOTARY PUBLIC, State of N~w York No. 52-8125850, Suffolk Cou,~ T~rm Expires M~rch 30, 19~ I~ORM NO, 2 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? 5877 Z Permission is hereby granted to: ........ ~1~ ...... w~.~ ................................. at premises located at ...~l~..!~'~3t''~l~lL'('''l~&~t~''&lll~''~l~'~ ............................... pursuant to applicotion dated .......................... ~ ....... ~1' .......... , 19~ .... and approved by the Building Inspector. Fee $~1~ ........... ........ Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPAR. TMEN'I TOWN CLERK'S OFFICE SOUTHOLD, N. Y. O sapproved o/c .... ....... / .............. ~'*'"'~'~-'~ ..................... ~2-~ ............. ~'~z'"'" ................... INSTRUCTIONS o. This opplic~tion must be completel~ filled in by typowriter or in ink ond submitted in duplicote to the Buildin~ Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to ad oJnJng premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue g 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 o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New ~ork, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or f~or removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (S~gnatur~ apphcant, or name, ~f a~rporation) ...................... : ........ .............................. 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.: ...;. ........... L....,.: ............... Lot No ........'~... .............. Muni~flSolity 2. State existing use and occupancy of premises and intended use and:occ, upancy of proposed construction: b. Intended use and occupancy ...................................................... ~ ......................................................................... 3. N(~ture al~ work (check which OlicabJe): New Building .................................... Alteration ........ ~.,.~_ ... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..: ......... 4. Estimated Cost ........ .?..~.~ ................................... Fee .......................................................................................... f (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. Dimensions o,f existing structures, if any: Front ............... .'.~.....~. ..... Rear .......... ~.~.....~ .............. Depth ...~.~ Height ......./~.~...~...... Number of Stories // Dimensions of ~ame structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ ]0. Date of Purchase ........................................................Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate ony zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Jot. STATE OF NEW YORK, ................. .~.~...r.,~:...~.~.~~ ............. being duly sworn, deposes and says that he is the applicant (Nam~./6f individual signing applicatj~K) above named. He is the ......................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of soid 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 applic~ion filed th~ewith. Sworn ta,befor~ me this ............. .................................... Notary Publ~ ~~o. unty (Signature o , ©OR 51