HomeMy WebLinkAbout16-zFOItM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, iN. Y.
UPDATED
Certificate Of Occupancy
No. Z709.1 ....... Date ............ J.~.me.. 48 ...... , 19. "~6
THIS CERTIFIES that the building located at . .N/S. Dound- .View..Ave ..... Street
Map No.. x~ ........ Block No...xx ....... Lot No, x.:zx · .. Go~tkotcl. · .N ,Y', .........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............. ~t.e:y.. 3'1', 19. ~"7' pursuant to which Building Permit No..1.6Z ....
dated ............ June.-t"', 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 . P~.ivate..onef~mity .dwe~..ti~g ........................................
The certificate is issued to . .Nic.h~la~..Nal,tesos...t~o, Ka-t.he~ine~ .Pan, o- a-l.~s · .' owner
(owner, lessee or tenant~
of the aforesaid building.
Suffolk County Department of Health Approval .N .R.., .1.9~.7. ........................
UNDERWRITERS CERTIFICATE No. N, R.., -19 ~? ..................................
HOUSE NUMBER .... 20.36~ .... Street ... Soulful. ,V.~,ew..Ave ..... Sou2ho.ld. .......
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOL~D, N. Y.
CERTIFICATE OF OCCUPANCY
,~'~ne :L,~ 60
No...,................,....~' 6'/3 Date ........................................................ , 19 ........
THIS CERTIFIES that the, building located at ~..~./..@.~.~...~...1~'..~.~..V..~...~..~..~.~..~.~.G..*.~.~...~..~...~..~.~eet
Map No ............. .~...~.,e...... Block No ...... ,~.~ .~. ............ Lot No ........................... ~.~,,.e..~ ..............................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
........................... J~y...~l~l, ............... 19.~.7..., pursu~='nt to which Building Permit No ........ ~...],.~ ...........
dated ................. ..~. ....... ..J..~.~.e.....1. ............ 19.....~.?was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupo, ncy for which this certificate is issued is ................
PRIVATE OITI~ FAMILY DWELLING
This certificate is issued to .....~l..~.~.~t~..~.~.,....~.~'. ........................................................
(owner, lessee or tenant)
of the aforesaid, building.
i
FOP, M NO. 2
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 FULL COMPLETION
OF THE WORK AUTHORIZED)
Date
Permission is hereby granted to:
..~.$.~?...~.. ~....~ .........................................
............ ~.~?.....~ .......................................
l~ew Yo~'k~ IT~.
to...~:.~.~.~?.~.z..z..t.~.~.~.~.z..~.~.~.~.~.~.e.~ ....................................
at premises located
pursuant to application dated ................................................................ 19 ........ , and approved by the
Building Inspector.
Fee $..~.~. ,.0.~.....~.~.~
FORi~ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined.....f<] m ~. :r.=. .................... 19
Approved ................ ~. ....... /. .............. 19...~...]Permit No..~,.4....~.. ...............
Disapproved a/c .......................................... ! ..........................................
..... .......... ...................................
(Building Inspector)
^pp'cation No
APPLICATION FOR BUILDING PERMIT
Date .......................................
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 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 regulatloqs.
(Signature of ap,plicar'/t, or 4¢'me, if a corporation)
....... .......
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder.
Name of owner of premises ......... ......... ~..y.t..~..~.J.....m.~...u~. ....................................................................
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 Cone. Map No ................................... Block ..................................
Street and Number ~.'..~...~. ...... ~.f(~......'.~...~.....~ ............. ~'~...~...~.~.. ..............................
State existing, u~e .and. occupancy of premieses and intended use and occupancy of proposed construction:
a, Existing use and occupancy ..................................................................................................................................
b. Intended use and occupancy ....... .~.~.~...¢...-~.'..(i~¥.;,.% ........................................................................
3. Nature of work (check which applicable): New Building. ................... Addition .................... Alteration ....................
Repair ..... Removal ........ Demolition ........ Other Work (Descr be) .................
4. Est mated Cost ~...~.....~.. Fee..../...0. .................................................
(to be paid on filing this application)
If dwelllng, number of dwelling units ........... L .............. Number 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: 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.....~.../..'....~.. .......... Rear ...... .~.../.:...~.. ........... Depth ,~t,~' ~
Height ......... ~...~...'. ........... Number of Stories ....... ! ....................
9. Size of lot: Front ....... 7.....~. ............ Rear ..... .~...~......' ........ Depth .....~..~...~.. ............
10. Zone or use district in which premises ore situated .......... /..~..~..~.. .... ~.1,.~. ...............................................
t 1. Does proposed constructio~ violate any zoning law, ordinance or regulation? ............... ..~....~ ............................
12. Name ~'
of Owner of premises.....; .................................. Address ............................................ Phone NO .....................
Name of Architect..'~.~:.~ ..................... Address .. ~.~ ~ ~,~z~, A/~'
(~...! ....~..~Z~. ............... (~.Phone NO...~.~....~,.~.7.~
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 ~ames and indicate
whether interior or corner lat.
STATE OF NEW YORK, )
(Nome of individu*l signing (f~pplicationj
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 ........... ~ ........... 19...~..~.. ....
(Singature of applicant)
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined..~~....../ .......... 19...~...)
Approved ........................................U/ 19 ...... .~.Permit mo.....r ...........................
Disapproved a/c .................... .._~....~....~......~,,~,:....../.../ ........
(Building Inspector)
Application No...~.?... 'Z ........
APPLICATION FOR BUILDING PERMIT
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 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.
(Signature of applicant, ~,~ name, if a corporation)
........ ..........
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricen, plumber or builder.
Name of owner of premises .................. ~ ...LC.,,: t, ..~.~ ......... ~..~...~...~.~. ...........................................................
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 ..... ~v~.~......~e~.....~..~ ....... ~ .......... ~.4 .........................
2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction:
a. Existing use and occupancy.....-[~r:,:~:~.~,~:c~ .......... , .............
b. Intended use and occupancy....~[C~..~.~.!.)~...~...~k~....C-...~..
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....................
Repair .................... Removal,. .................. Demolition .................... O, ther Work (Describe) ....................
4. Estimated Cost ...... ..~......Z..r.O....O.....O.. ........................... 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. I~ business, commerical or mixed occupancy, spedfy nature and extent of each type of use
7. Dimensions of existing structures, if any: Front ............................ Rear ............. .Ti.[ .......... Depth ............................
Height ......... T. ................. Number of Stories ................. --.. ...........................................................................................
Dimensions of same structure with alterations or additions: Front ........... .":: .................. Rear ...:T.' ..........................
Depth .... Height ................. ~..:: ........ Number of Stories ......... .-rz ...................
8. Dimensions of entire new construction: Front.......zll..!...~..~ ......... Rear ............................ Depth ............................
Height .......... ~..~..~..~. ...... Number of Stories ........ ! ...................
9. Size of lot: Front ..... ../..~....q..~¢. ....... Rear ....... ....... Depth ............................
'A
10. Zone or use district in which premises are situated .......... L.~...~.~.(..O..~..!.O....C...~......~. ....... ~ .................................
! h Does proposed constructlc~n violate any zoning law~ ordinance or regulation? ............. ~ ..............................
12. Name of Owner of premises..: ..................................... Address .......................................... ,.Phone NO.j ..................
Name
of
Name of Contractor .................................................... Address ............................................ Phone NO .....................
PLOT DIAGRAM
Locate cteaHy and distinctly all buildings, whether existing or proposed~ and indicate all set-back dimensions from
property lines. Give street and block numbers or description a~.cording to deed, and show street names and indicate
whether interior or corner 1at.
I
ss..
.......
...... ............................... wom,
(Name of indKvidual signing application)
above named. He is the ............................. ~ ....................................................................................................
(Contractor, agent, corporate o:ricer, etc.)
of said owner or owners, and is duly authorized to perform or have performe( the said work and to make and file
this epplJcation; that all statements contained in this application are true to he best of his knowledge and belief;
and that the work will be performed in the manner set forth Jn the application i/ed fherewffh.
Sworn to before me this
.......... ...'~..../.....'~... day of .............. ~..~ ........ 19..-,-?~..~.....
/
(Sir
gature of ap~licant~