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HomeMy WebLinkAbout83-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at W/~..~O~:N~431;L~f...d~.;~ .................... Street Map No. ~J.t,...~,~. ............. Block No ..................................... , Lot No.613t61t~t..J~t~,,t~;llelrlll. J. conforms substantially to the Application for Building Permit heretofore filed in this office dated .................... ~11l~t~....?1 ........... 19~....., pursuant to which Building Permit No ..... ~..83 ............. , dated .................... ~....~. ........... lC~....., 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 ............ This certificate is issued to ...~.~t, Ol~..L,...~lglll~O~ ............... (~3~i1~.) ................. i ..................... (owner, lessee or tenant) of the aforesaid building. Building Inspector/ FORM l~O. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES APPROVED PLANS AND SPECIFICATIONS UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) No ....... .~....{~ ...... Date ........................... ~'"~'I .......... 19.~... Permission is hereby granted to: O~t ~v Llndluu,~%.....~.¢....~1..1.t,o~...T~no~peo~ ................. · -.~ho~'a~.~.....~,.~., .............................................. to ...... ~kt~.~d...new.. dwett.!m~ .......................................................................................................... at premises located et ..~foo~]~t.ia.f..~l_.ve ....................................................................................... ............................................. (....Weet...V4ew...~.... ~t.t~,tuck.,.....~l.~, ......................................... pursuant to application dated ................ /--T~,I~..~.[ ........................... I~K...., and approved by the Building Inspector. Fee $.~0,,00 ............ Building Inspector/ FO]~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved o/c ........................ ~. ............................ ...................................... ......... ....... ...... .......... (Building Inspector) \ Application No ........~ ........... APPLICATION FOR B~!LDING PERMIT J '. .Date .................. ..~.....'~......':~ .......................... 19.'ff.....Ir..... 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 available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpdse 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. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, _agent,. architect, ~ngineer, general contractor, electriCan, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) tocat on of and on wh ch groposed work w I be done /~op No ~i~'L~L } J%-Li.,d B ack '-~-'- i. Street and Number .. ,~.,/.-..~., ....... ~ ........... ~...~..~....i: .......~ ....... ...~......-~...:.. Stat exlstln use on occu ancv of oremiese[ a~d ~nt 2. e ' ' g d p cy p em'e es and ' ended use and occupancy of proposed construction: . a. Existing use and occupancy ...................... 7...:~. ........................................... ';.. ......................................................... b. Intended use end occupancy ................................................................................... Nature of work (check which applicable): New BuilcJing .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition. .............. "...Other Work (Describe) .................... 4. Estimated Cost ...~:..l.?/J~.~:~ .............. Fee ./..., ................................................ (to be paid on filing this application) ' FEES: 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 ................................ 8. D mansions of entire new construction' Front '.~...3 Rear ...... . .~.......~. ............ Depth ...~.~......~. ............... Height .......~....J. ............ Number of S;ories ..iii'Z.'.~iiiiiii- 9. Size of lot: Front ..~..'..~..~..../. ........... Rear .....~.....'~'..../.. ............ Depth ..../.....~.....O. ............. or use district in which premises are situated.....~J:......~..~. ......... ~ .............................. 10. Zone 11. Does proposed constructic~n violate any zoning law, ordinance or regulation? .......... ...~....~ ............................... Name of Owner of prem ses.~.....~r-'~ Address .~....? .... ~'"-~' Phone NO 12. · ........................ i.-.~...~ .~ ............... :.~.:...::;;~,,_~_. ................ one NO ..................... Name of Archtect ~'~ 1.~,-~-~)~_--- .................... Address~" ....... ~' ........... ( ............... Ph ................ ; .... Name of Contractor.....~..~ ....... i.....i~ddress ...~ ............ : ............ 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 STATE OF NEW'}YORK, ) COUNTY OF-~.) S S.' (Name of individual signing application) ab°Ve 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 oll 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 .......... ........... Nato. Pub ic ............. County (Singature of ap~,licant) FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~ppraved ........................................ 19...~.....Permit :~o ................................. Application No C~ -~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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 port 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 P~rmit 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 o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 Lows, 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 lows, ordinances and regulations. (Signature of. applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, og,,ent, architect, engineer, general contractor, electrican, plumber or builder. Nome of owner of premises ............... .~,. ............................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of'~rpprote officer) 1. Locotionof andonwhch roposedworkw bedone Mo No ~ ..~..~ -- .n~ · ~.P ...............................Block ..................... ~. ........... Street and Number .~../'~...:...~~)...~ .......... .~.... ~.¢.~. ~.. ........ ..~.....~ .~...,... 2. State existing use and occupancy of premiese~ a~d intended use and occupancy of proposed construction: o. Existing use and occupancy ...................... ~ ....................................................... b. ntended use and occupancy '~k~ ~ ~- (~ ~ ............... 3. Nature of work (check which a~plicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ....~:..!.~....0~..~ ............. Fee Z~ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ................ ' ~....~...~mber of dwelling units on each floor ............................ If garage, number of cars ......... ~ ................................................................................................. 6. If business, commericol or mixed occupancy, specify nature and extent of each type of use ...... ~.. .................... .'.. 7. Dimensions of existing structures, if any~Fr.~on, t..~--¢....~....~. Rear,.:.~ .............. Depth ............................ Height ............................ Number o Sto~i~s T_...~... ..................................................................................................... Dimensions of same structure with alte/atJons or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ Dimensions of entire new construction' Front "7 ~ Rear '7 ~ Depth ~ 7 8. Height ..... ...~...J ............... Number of S~ories ..iiii~ii~'iiiiii .......................................................... 9. Size of lot: Front ....~.......~....~ .......... Rear .....~......~.....J. ............ Depth ...~..~....?. ............ 10. Zone or use district in which premises are situated ...... Z~ ................................................................................ ~ ~ l l. Does proposed construction viola}e onyx._ zoning law, ordinance or regulation? ........... ~...~. .............................. 12. Name of Owner of premises ~ . ~.~...~... Address~ ............... Phone NO .................... of Arch tect (~ ' ~ ~ c~ ~ .~,~ ....... ~.~ ~ . Name ' . ............................. ~ ................. 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 NEWnYORK, ~ ) S S., . (Nome of individual 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 da of ~,-~"'1 , 19 ..~ (Singoture of applicant)