HomeMy WebLinkAbout21-z TOWN OF SOUTNOLD
TOW~ CL~RK'S OFFICE
OF' OCCUPANCY
No ..... -~....9~,~ ...... Date .............. NOV~tltb 6~:r..-2.~ ................ , ~l!~0...
THIS CERTIFIES that the building located ~/~/..R~',I~' ..i~.-..14atlt~.it~l~k ............. Street
Map No ....... *.ia ........Block No....~.....~,.....~,.Lot No ...... .~,......~......~ .................................................. .' ....
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ..............~tl~..6 ................ , 19~.']... pursuaut to which Building Permit No..g...21~ ............
-lated .............. ~.~l{le..{~ ................... 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
............................................................ BUS t.t~StiL..Bt, I~)~.N~ ......................................................... : ............
This certificaie is issued to ..... I:l~,.l~.O.l.d R~ ..R~.~t~.,,...~,...ancl...~.e-hel~ite...~wne~rs ..............
(owner, lessee or tenant)
of the aforesaid building. '~
FO~I~I NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOLITHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF
APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMP. LETION
OF THE WORK AUTHORIZED)
Permission is hereby granted to:
~old..L..~e~..&.~o~.....~.C....~o~.~,..~e~e ~r, ~
........ ~..~.:....(.~,.~S,...~ou~o..2~) .............
.............. ~i~u~k~-...~ ...................................
to ...~.X~.~..~t~$~..~ ..................................................................................................
pursuant to application dated ............................ J~'"'6~"'"~9~ ........ 19 ........ , and ap.proved by the
Building Inspector.
Fee $' ~,0';00' ......... ~:IA
Building Inspector
FORM NO. 4
TOWN OF SGUTNOLD
BUILDING DEPARTMENT
TOWN CL[RK'$ OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at ............................ ~L.~..~],, ................... Street
Map No ..................................... Block No ..................................... , Lot No .....................................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
......................... ~Tt~q.e...6.t ............... 19.....~.~/, pursuant to which Buitding Permit No ..E~,iiL ....... :~.. ........ ,
dated .......... ..~ ................... J~e...8.~ ........ 19.~$7..., was issued, and conforms to all of the requirements
of the appliclable provisions of the law. The occupancy for which this certificate is issued is ............
............................................... I~.J..net~ ..............................................................................................
This certificate is issued to ..... ~.~o.l~..~...~eeve..~z,~..~..~).t,~et.z'~ ............................................
(bwner, lessee or tenant)
of the aforesaid building.
Building Inspector /
FORM NO. 1
TOWN OF $OUTHOI. D
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
m' d.....f./..z.......... .................. 19 ........
Approved.....i'.~. ......... ~.: .......... ...~.......19.~?..Permit No....~.~.......~.~.....( ............
D isapp roved a/c ........................... ~,,.~,::-:.:.: ...... , .~..~..~. ~.~.~-i~i .~.. ......... :.':Z: ..........
........ ...................
(Building Inspector)
Application No......~.....~.~ ......
FOR I~OILDING PERMIT
Date..~..'~...~.. ........ ~ .......................... 19...~..T.~...
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 p,urpose whatever until a Certificate of Occupanc~
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 [aws, ordinances and regulations.
(Signature of applicant, or name, if a corporation)
Z.,.......z.,../... .........................................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder.
........................................................................................................................
N a me of owner of pre raises..../...~..~.., .~, .~,.../?,- ~~. ~ ........ ~....~ ~ ..................................
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 ..~.~/-~'~..~...~.,~.~.....~?~'.,~.../.~ .,~..Z~..~....2~.~....~..~~.~'~
2. State existing use and occgponcy of premieses and intended 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. ................... Other Work (Describe) ....................
4. Estimated Cost ............................................................ Fee ......... .~...~..,...~?.~. ....................................................................
(to be paid on filing this application)
~ .~ FEES:
~] 5].'..l~,dweU~ng, number of dwelling units ............................ Number of dwelling units on each floor ............................
If garage, number of cars ........................................................................................................ ~,~F,,~';'".~'~I~'
6. If business, commerical or mixed occupancy, specify nature and extent of each type of use~'.,,...~.~.~..~i~'~.
7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................
Height ............................ Number of Stories ..............................................................................................................
Dimensions of same structure with alterations or additions: Fro~ ................................ 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 ...... ~Z.Z.
10. Zone or use district in which premises are situated..~~ ..............................................................
11. Does proposed constructia~ violate any zoning, law,,ordj~nce or regu[atio?......~ .....................................
12. Name of Owner atp remises.~.~.~..~CC~...~~.~..Phone N~.~
Name of A rchi tect ~. ~ ~Z~.. ~dd res s ~~ ~ .~ ......... P h one N~'~ ~M. ~
Name of Contractor~Z~.~.~~.~ress .~~.. ............. 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 numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
STA'r'E OF NEd YO~I~/]~ )
COUNTY OF"'~..~...) S S.'
.................... being duly sworn, deposes and
(Name of individual signing application)
(Contractor, agent, corporate officer, etc.)
of sa~d 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 beIJef;
and that the work will be performed in the manner set forth in the appIication filed therewith.
Sworn ~before me this --
~otory Pub~c.~~ ........ County
FORI~I NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUT.O,D, N.
ami ed ...... ~...~.. ....... . ........
·
pproved ........................................ ] 9 ........ Permit ..........................
Disapproved a/c
(Building Inspector)
Application No...~ .................
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, end giving e 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 o 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 pursuc~nt to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the consf'i'uction 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 appliconh or name, if a corporation)
......................................
(Address of applicant)
State whether appl;nt is owner, lessee, agent, architect, engineer, general contractor, e(ectrican, plumber or builder.
........ ...............................................................................................................
Name of owner of premises...~....~..~../~......~.~.~L~-..~..e~......~..~.. ....... ~..,~..........~...~.~..~ff.,.~. ..............
If applicant is a corporate, signature of duly authorized officer.
]. kocotion of land on which praposed work will be done. Mop No ................................... Block ...............................
Street and Numbe "~"/'~ .......... Y ....... "~'"'~'"~" ..... '//~'~-~-~"~"'c~.!
2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: '~'
o. [xistin~ use *nd occu~oncy ..... ~ .............................................
b. Intended use ond occuponcy ................................................................................................................................
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....................
Repair .................... Removal .................... Demofifion . ................... Other Work (Describe) ....................
4. Estimated Cost ............................................................ Fee ....... Z..4~...~.~. .....................................................................
(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 ~;~.~;~/.,
6. If business, commerical or mixed occupancy, specify nature and extent of each type of us ..
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 ........ ~..~..,.~.....¢...
Height ............................ Number of Stories ............................
9. Size of lot: Front .............. Z..~.....~..r: Rear ............. ../....~...~'....'. Depth ......... '~' ~'~ "" '.,~...~'.,.~........-
10. Zone or use district in which premises are situated....~..i-ff.,.~./.'~..~'..,~.,~. ...........................................................
11. Does proposed constructiorn violate any zoning kjw, _o,f~Jnance or regulation?..~.. .......................................
12. Name of Owne r of p rem ises.~.,./~,..~;~1/~.~....¢..~...~... Address ......../~. ~.~. 4 ............. Phon e N O./..~_~. ~..~. ~'~
Name of Architect..~,..~..,.~./f.~,~-.,~,-.'"ff_,~_.,~, ~) ............ Address~.. ?.~¢. ,~;. ,~,~l.j~.~. ......... Phone
Name of Contractor~'~,../.,(.,,~.~.~.~.l~....~.....~..~,./~..~... Address ~/.~~'~. ............... Phone NO .....
PLOT DIAGRAM
Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate all set~bock 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 NE~)YO~I~ ^,"~ )
COUNTY OF~ S S.'
.... Z.~.~..~.C.~....~...~,__~K'fL~.~.~_,.~.~.. .......................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
(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 applicatjon/~,~,~,~filed~,therewi~b.
L~ROY S. REEVE No. S2.8520900
l~totar¥ Public iR tho Stlte of Now ¥o~k
Suffolk Cmlnty