HomeMy WebLinkAbout192-zTOWN OF SOUTHOI. D
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the budding located at .ll~/.~.....~...&~r~,~..~_.~te~t,J. QZ~ Street
Map No (C~...O&~e31) ......... Block No ............................... , Lot No
conforms substant,a{ly to the Apphcat,on for Budding Perm,t heretofore filed ~n this office dated
.................... ])P~(~l~ml:~t....~.C). ..... 19~.., pursuant to which Bu,lding Perm,t No ...~..~.C)~, ............ ,
dated ................. ]~.o...~l..c)m .......... 19.. 27', was issued, and conforms to al{ of the requirements
of the applicable provisions of the {aw The occupancy for which this certificate is issued is ............
................................................ ~RI~rATE....DWELLI~O ....................................................................
This certificate is ~ssued to ...T['ezl.~. .~[g. zz~e~.lto. ............... ~...o:~n~t.~) ................................ (owner, Iessee or tenant)
of the aforesaid budd,ng
Building Inspector
FORM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES V~I~c,~T,(~
~l~9~:~l~l~j~l~?~l~-~l~if)~6~ UNTIL FULL COMPLETION
OF THE WORK AUTHORIZED)
Permission is hereby granted to
~uscon Con~.t~.ti~ ... ~J'(~...R~.
........ .l~.thex' Lo, ne .........................
........ ~t. ~.er..h.e.a..d..,... ~.. ~:. .....................
to ...l~d N,~ ~%;el!lr~g ............................................................................
at premises located at .W,/~ 0_~.~/1:1 ,~VI~ .....................................
...................................... .s..o...u..t...h..o.Z..d. ,... ~,.~,. .........................................................................
pursuant to apphcat,on dated ......... ~.ec~ml~ ~ ......... 19~.~.... , and approved by the
Budding Inspector
Fee $.~..0.?..0...0. ...........
Budding Inspector
FO/tM NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ........................................ 19 ........ Permit No ...............................
D,sapproved a/c ~~.~.~.~,w:,.~''~-
Application No...../....~...~ ..........
(Building Inspector) /
APPLICATION FOR BUILDING PERMIT
Date i ./.~'.//~ ]9'~
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 coYered 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 a Iterations, 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, engineer, general contractor, electrician, plumber or builder.
............................. ........................................................................................
Nome of owner of premises ...........................................................
If applicant is a corporate, signature of dulv authorized officer.
................. (N~r~;"~nd title of corpor~¥~' ~'i~;;'i '"
]. Locat on of and on which, proposed work will be done. Map No: .............. ; ............................. Lot No: ....................
Street and Number ....~,. ,,/,~.~..,. ,~~., ...~.'""~'"'?' '~'' ~' · '~'''' '"~'l~'?'" '' '~''t': ,,'~.,,w~,., ,~ ,,(,~...~ ........
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a, Existing use and occupancy .................. ,.,~,.,,.,~,...cT~,..~ .................................................................................
b, Intended use and occupancy .....................................................
3. Nature of work (check which applicable): New Bui d ng ................ Addition .............. Alteration ....................
Repair .................... Rem, oval .................... Demolition .................... Other Work (Describe) ....................
4. Estimated ..... F~ · u
(to be paid on filing this application)
5. If dwelling, number of dwelling units .............. !.....~ ........... Number of dwelling units on each floor ...... ~;'~..~.ii;~ .........
If garage, number Of cars ...............................................................................................................................
6. If business, commercial 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. Dimensions of entire new construction: Front ....... ;;..f ................ Rear ......... ..~ ............. Depth
Height .....~.:: ................... Number of Stories ........ : ...................
9. Size of lot: Front /" Rear Depth ~" ~
10. Date of Purchase ............L..[...~....1 ............................. Name~ ~°f Former Owner .;h;.,M-,f,~ .................................
1L Zone or use district in which premises are situated ............ ~....~...'
12. Does proposed construction violate any zoning law, ordinance or regulation? ........ j.;;,:;~ ...............................
13. Name of Owner of premises ........................................ Address r
· .:..~,;~ ;~,~ :~ul, ~,,*;~/.., ............. Phone
Name o Arch tect .:;:..~....; ................... Address ...j;~':;Z{....~.%(.'2'~ ............ Phone ~'~
.9 ,. '"";""7 .......... ·
Name of Contractor. J~z;J.¢;L:.~''' k~"* E~ '": Address ' ~
..~.;.....,,; x:.:~..:'.:.~ ................. Phone
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,)~)RI~,~_ ) S
CLO~NTY OF ~-¢~.~ ......... ). S.
............................................................ ;J~L;9........~:...;..;; ........ .~...being duly sworn, deposes and says that he is the applicant
(Name of individual signing application) t
above named. He is .................................................. :::~ ~ .... ;H;.. ~.. . ...........
(Contractor, agar, carporate officer etc.)
of said owner or owners, and is duly authorized t~o~e~rformed the said work and to make and file
this application; that all statements contained in this appfication are~rue to the ~st of his knowledge and belief;
and that the work will be performed in the manner set forth in the applicat~n file4 therewith, r
Sworn to before me this ~. /~,. ~ ~
~ ~ EL01SE B WD ~ --
...... [~ ....... day of .....~..; ....................,19...~.Z... ,~ot, ry ~,,,c. st~ ~e of applicant) J
Not~ Public ....... ~.[.~.7~,z.. Coud~ . ..... ~o. ?-~57~30 ~