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HomeMy WebLinkAbout4-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SO/FTHOLD, N. Y. C, EHTIFICATE OF' OCCUPANCY No .......... ~...7~.~.. Date ................................. ~t1~..21 ......... 19.~D- THIS CERTIFIES that the building located al ~l~e%s .~lec]~..]gd..,...c~%eY~g~te... Street _Map No. ~.~ .........~.. Block No ......... ~e.~....Lot N~ ........................................................................... conforms substantially to the Application for Buildiug Permit heretofore filed in this office dated ............. ..~,~..~....4.. .................... 1~...?.... pursuant to which Building Permit No ......... ~.,,4 ........ ~ated ....... ~..,4 ..................... 19~?..., 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 ~R~VAT~ 0~: FAmilY DWE~IN(~ This certificate is issued to ............ .07'..O.h.lit..07~....~.~.Sl/illl~...J~.,.,....ol~.tte= ......................................... (owner, lessee or tenant) of the aforesaid building, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL PULL COMf~LETION OF THE WORK AUTHORIZED) pursuant to application dated .... ~..:~ ~/~' ...... ~' ............ 19 ...... _S i~ and ap,proved by the Building inspector, ,../ ................... Building Inspector FOR~I NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .................. -- "'J.~). ........ (T.( ....... 19...~.'~..?Permit No .......... ~......~.... ..... Disapproved e/c ............................................................................................ Application No ........ .'.~.....~. -. .......... APPL[CAT[O~ FOR BUILDING P~RMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the ~uii~ing 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 descriptio~ of layout of property must be drawn on the diagram which is par~ of ~his location. c. The work covered by this appJicotion 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 permff 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 far removal ar demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ........ .... '~' '/"¢~" '~'"'"'/~Add re~ oi~'~a"r t)~'~' '~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. /~ . Name of owner of premises....~ .............................................................................................................................. 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 ................................... Block ...~,~ .......................... Street and Number ...................................................................................................................................................... 2. State existing use and occupancy of premieses and in~'ended use and occupancy oF proposed construction: a. Existing use and occupancy .............. ~.~ .................................................................................................. b, Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... qt~er Work (Describe) .................... 4 Estimated Cost ..... ..~....~. ...................... 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, commerical or mixed occupancy, specify nature and extent of each type of use ................................ 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 ................................ ~..~,,~,.. ~...~...~.~ .~ Ho[~ht ~.....~. Mumber of Stories ...... t~ ............ 10. Zone or use district in which premises ore situated ...................... ~Zk ......... ~.._~..~.~.....~ .............................. 1 1. Does ........ proposed construch~ wolate any zomna law, ordinance or regulahon? ................... ~.~. ............................ 12, Name of Owner of premises....~~.~...... Address ''~.~....~.~hone NO. ~:,,~ Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor .................................................... 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 corner lot. STATE OF NEV~ YO/RI~.,. ~, ~ ) COUNTY OF ~,.~,,.,~.....) S S.' ., ..(~, .'l~...l~. :,,,~:.....~.......' ............................. being ~/ (NaMe of Xndividual' signing application) duly sworn, deposes and says that he is the applicant 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. Sworn to before me this .....'.'~.....~.. ........... day of ...... ~...c.~....~ ................ 19...~....?.... FOP~M NO. t TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ......... ......... .......... ~isopproved o/c ............................................................................................ Application No....~.~......~.~.. ............ APPLICATION FOR I~UILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter oF 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 drown 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 available for inspection throughout the progress of the work. e. No building shall be occupied or used in whale 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 and regulations. .//.. (Ad'dress of applicant) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. ....................... ~:~,~,L...~c~. u,/'./ ....................................................................................................................................................... Name of owner of premises ....... ~ ............................................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work willbe¢, don,,e. ~Map No.,. ...... Street and Number ~.'~.~ ~-~'~ ~'~ .... ~'" ...~.¢.~ .............................................................................. ~ ................ ,...,..~;~, ¥ .......................................... 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~ .................................................................................................. b, Intended use ond occupancy ..................................................................... 3. Nature of work (check which app~icaNe): New Building ....... ~.....Addition .................... Alter)~tion .................... Repair .................... Rem?.val .................... Demolition .................. ;~ther Work (Describe) .............{......, / (to be paid on filing this ~,~plication) 5. If dwelling, number of dwelling units ...... ~ .......... Number of dwelling units on each floor.,..~r~ .............. If garage, number of cars ........................................................................................................................................ 6. If business, commericol or mixed occupancy, specify nature and extent o¢ each type of use ................................ 7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories .............................................................................................................. Dimensions of some structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions^ , ~.~e/~of entire, ew constructlon'. Front ....... ,-~..O...A..i ...... Rear .. ~.~.~ ....... .... Depth .. ~...,~./~,~--~ ..... Heigh~,,,//~.. Number of Stories ..... ~ ............ 9. ~' ' T _~ Size of lot: Front ...... ~..~.. ....... Rear ..~:~.~.....__ ........ Depth~ ~'"'/~-' ...... 10. Zone or use d,strict in which premises are situated ...................... z~....~.z......~ ........................................ il. Does proposed constructio~ ~e any zoning law, ordinance or regulation? ......... ~ 12. Name '~ f ~.~. ~ ................ : .............. of Owner of premises.~~ ........... Address/Z~ ... :....Phone NO~:.~;.~ Name of Architect ............... ~.T_~ ........ Y ..................... Address .................. ~ ......................... Phone NO ..................... Name of Contractor .................................................... 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 corner lot. STATE OF NEW_YORK, S S.' COUNTY OF ~..~'.:..~,~_~:..:.~....,:...:....::....~ ............... being duly sworn, deposes and says that he is the applicant L/ u',~me o'f' malwaual signing 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. Sworn to before me this ...... ...... ..................... Notary Public~..~.....~ /!