HomeMy WebLinkAbout52-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No....~...1.73 ......... Date ..................... ,0,~.~ S.~....~1,~. ............ 19...~.
THIS CERTIFIES that the building located at ....
Map No ........,~XJf,;. ................... Block No ..................
conforms substantially to the Application for Building Permit heretofore flied in this office dated
.................... ~LI.~,I~.'...~ ................... 19.~?..., pursuant to which Building Permit No ....~..~'~, .............. ,
dated ............. ~.....~lt,l,~.'...,1.~ .................... 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 ............
.............................. P. tt IItAT~..l~,!~ I,L,~.~6 ............................................................................................
t
This certificate is issued o ..~tl~4ta~.¢~l...~....iVtallo~.y ........ (...~.~zl~.} .............................................
(owner, lessee or tenant)
of the aforesaid building.
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 WITH ONE SET OF
APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION
OF THE WORK AUTHORIZED)
Permission is hereby granted to:
tlr e}~,. z~..!. ,,.,.,.,~:L~,.O.Z~ ................................................
....... ~ u,.L.,;5.~ ...........................................................
............ ~...j~.~,, ~]~ ~-...J.,.,~,., ..........................
t o ...D~t:L i{t.. ~g~.. ~ ~3, ~,;L~3~ .............................................................................................................
................................................. ~! ~,1~,, ~.:~.~>,~,,, ,,~,~,~.~ .................................................................
pursuont to opplicoHon do~ed ........................... ~.~,.,,.~,~t~. ............... 19~'~,,.~ ond ~p,proved by
Building Inspector,
Fee ....... QQ ........ :. -'~
..................... ~ JJ~Jing i~]~'ector [ .......
FOI~I NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
Approved ...................... :~. ............... 19 ........ Permit No .......................
Disapproved a/c ............................................................................................
(Building ~nspector)
Application No....~..~..~....~..~ ..............
APPLICATION FOR BUlL, DING PERMIT
INSTRUCTIONS
o. This application must be completely fi[~ed 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.
~. The work covered by t~his application may not be commenced before issuance of Bbilding 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 app cable Laws, Ordinances or
Regular ons, for the construchon of buildings, additions or alterations, or for remora or demo t on, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
'g app '"cant, or name, if a corporat~
....... s. ......... ........
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder.
....... ............................................................................................
Name of owner of premise ..'/. . ....... ....... ............. :"
!
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Location of land on which proposed work will be done. Mop No ................................... Block ..................................
Street and Number ~``~.~`.~.s~.~:~.~.~5.~j}~j.i~f~.~:~`.~.`.~"~5~(<.~
State existing use and occupancy of premieses and intended use and occupancy of proposed con,f ruction:
a. Existing use and occupancy ........................ ~ .......................................................... .............
b. ntended use and occupancy .......................... ~---~'~ ~;~.~.~ .....................................................................
3. Nature of work (check which applicable): New Building ...... ..~..........Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition. ................... Other Work (Describe) ....................
...... Fee/...0.
4. Est/mated Cost .....................................................................................................
(to be paid on filing this application)
FEES: ~9,,~ ~_
If dwelling, 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 ................................
property lines. Give street and block numbers or description
7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................
Height ............................ Number of Stories ..............................................................................................................
Dimensions oE same structure wi;~h alterations or additions: Front ................................ Rear ................................
Depth ...~..,....~,.,,~ ............ Height .............................. Number of Stories ................................
8. Dimensions of entire new construction: Front ...... ..~..~. ............... Rear ...... .~.~...../. ........... Depth ....~...7.. ................
Height ...l~ .....~ ......... Number of Stories ...........
9. Size of lot: Front .I..~:~ .................. Rear .~.~..~ .................. Depth ~.~..~ .................
]0. Zone or use district in which premises are situated ..........
11. Does proposed constructi~ violate any zoning law, ordinance or regulation? ............. ~..~ .............................
~. N,me of Own~ of p~s~.~.~.~.~.,~Z~dd~ 5.~..~e~ ......... Pho,~ ~O.~..~.:~.~Z
Nome of Architect.~.L.%g..t.~ .............................. Aadr*s~*t.~/~..~t.~.Phone
p~lc
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existinc or proposed, and indicate all se~-back dimensions from
~cording to deed, and s~ow street names and indicate
whether interior or corner lot.
STATE OF NEW YORK, )
COUNTY OF ~...) S S..
(N~e of individual signing application)
duly sworn, deposes and says that he is the applicant
above named. He is the ..................... .~..:.~L..~'T...:.'ZT....~.. ..............................................................................................................
(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.
Swo'rn to before me this
...... ........... day of ........ ................
(Singature of applicant)
FORi~ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved......~.... ..............~.~. ............ ] c)..... [.Permit No '~ ~"~ ~
.................. :'.:.::!::.::5...?..:.. ...... ..........
~ ' (Building Inspector)
Application
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This applicatior~ 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 o 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 antir a Certificate of Occupancy
shalt 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, Ordi~nances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein d~scribed.
The applicant agrees to comply with oil applicable laws, ordinances and regulations.
.......... ........ P..,g,..
(Address of applicant) ~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder.
Name of owner of premises.. .¢..~ ............ /k..~..~.. ........ ~...~.. .......... ~ ...... /). .....................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Location of land on which proposed work will be done. Map No ................................... Block ..................................
Street and Number .....~.~.~-t.i ..... [~ ..... ~ ......... :-~......~ff,.f//~....~'.~..~.....~..~..~......z~...~. ...... ~.~...~..~'...~....~.~.//~..
State existing use and occupancy of premieses and intended use and occupancy of proposed construction:
a. Existing use and occupancy ........................... ~ ....................................................................................................
b. ntended use and occupancy .~..'.-t~- ~(~'~'~ '
3. Nature of work (check which applicable): New Building ....~.....Addition .................... Alteration ....................
Repair .................... Remo, v~J4 .................... Demolition .................... Other Work (Describe) ....................
4. Est mated Cost ...~..L ~> .o...o. ~ .......... Fee ./..~.:......O...? .......................................................
(to be paid on filing this application)
FEES: ~/~)-'~-. Q
If dwelling, number of dwelling units ........ I ................... 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....~...~...I. ............... Rear .....~....'~.. ............... Depth ...~....~.../.. ...........
Height ...~...~...~....~..~ .~.~... Number of Stories',~..ZX~..~?..~..e'./....
9. Size of lot: Front 41 ~. { . m . m~ ............... Rear { . ~4 .O{ mO . . ~{ ........... Depth ..L.~...~.. .............
]0. 7one or use district in which premises are situeted ..................... ~ ....................................
11. Does proposed construetior~ violate any zoning law, ordinance or regu[ation?......,~.....~. ......................................
· n o,q (, .......
12. Name of Owner of prem,ses~lZ~.~....O....MZ/).,/.0. KX/Addre,~'.....'.~..~. ...............~..~,..~/~.Phone ~../
Name of Architect~ .~.dL.~.~.~.~t~ ...... j~.~.K~..~..,~. ...... ~.Address/..~./..~//~.~.¢.~)~'.e..(Jy:]~.Phone'-#'~' NO~£..~...'.~/.,~
Name of Contracto'~>~.,~.~ ...... ~.~..~..~..-.,q .......... Address.Y}l./~.~.l/~./~x'..,4~...~/J.~.F¢q4..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
whetber interior or corner lot.
ST^T OF ) s
s.,
CQUNTY
.~..r~,f~.-~/~.~z.-yf.,~......//..7.:..../6/.z~..~.<~.L~.....~. .................... being duly deposes and says that he is the applicant
~,]Name of individual signing app~6tion) sworn,
above named. He is the ..................... ..~.~.~¥..~.'.;..~m...~.....-mm.. ............................................................................................................
(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 Jn this application are true to the best of his knowledge and belief;
and that tbe work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
..... /..~ ............. day of ...... ~ .................... 19..-~...%...
[LOISE ~IOWDEN
(Singature of applicant)