HomeMy WebLinkAbout84-zFORi~ NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No ........ Z..,1, .~.~ ..... Dote .................... ~.~l,~t.....1~. .................. 19...~}~.
THIS CERTIFIES that the building located at ...... W~.....D~.ep...}]~ol~..D~.~,.~.e ............ Street
Mop No. ,.X~.,~',X. ........................ Block No .......... ~ ................., ~,t~T~ ...~a.t~t,~,t, kl,~,k~.....J~*~Z*
conforms substantially to the Application for Building Permit heretofore filed in this. office dated
........................ ~U~:t~s.t~.-..-~..'l. ....... 19..~8..., pursuant to which Building Permit No ...... ~,..:8)~ ............ ,
dated ............................. Al.lf~l~St,.....~:~...19...~., was issued, and conforms to all of thefrequirements
of the applicable provisions of the law. The occupancy for.which this certificate is iss,?ed is ............
........................................................ P~I~A~;~.. ~D~ ~ZJ,I ][~.f& .......................................... ¢..~. ....................
This certificate is issued to ........... .Wl~,,...l~'.,...}~l,],14~.......-.(~Wt~e~.) ............... : ............ ] ......................
(owner, lessee or tenant)
of the aforesaid building.
FOI~M NO. 2
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES ,~J~bI~SjF~]T~-
~6PPROVE P S ~ T.~ UNTIL COMPLETION
OF THE WORK AUTHORIZED)
No . .Z.....SA .......... Date .................... ~,~g.8.~...~ .1 ................. 19. ,~.7...
Permission is hereby granted to:
........ t 5~.. ~..2.6....;~,I~..~ e .............................
............ ~&~..~l.r~g. ~... ·..~ ~. ·...~.,.%, ....................
at premises located of ..W/G.....D.e. eD...~al.a..D~l?ze. ..........................................................................
pursuant to application dated ..................... ~,~b~......~] ................... 19..~.., and apDroved by the
Building Inspector.
Fee $.],Cy.,.O~...,/.~, ~
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERI~'S OFFICE
SOU'THOLD, N, Y.
Approved ......................... .~.Ic ............ 19 ........ Permit No ................................
Disapproved a/c ~-" -~' -'
...................... ......................................................
(Building inspector) I
Application No ............................
APPLICATION FOR BUILDING PERMIT
ate ........... ~ ...................... 19.~ ..........
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 diagrom 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 shah 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 altero.t~Lo~or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordin,afCce~/~'nd regulations. ,~
..........
(Signature of applicant, or name, if a corporation)
........ ........ ........
(Address of appll~ant~~ ~ ~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder.
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. ~;,~'_,'.r~.~/rJE~..!.~.:~jff~B~-4'~r~.~..?. ...........................
Street and Number .................... ~ ..........................................................................................................
State existing use and occupancy 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. E'stimated Cost ...................................................... tee .../.~ ..................................................................................
(to be paid on filing this application)
FEES:
5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................
tf garage, number of cars ............... ~i ......i..N~'.. ......................................................................................................
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
9. Size of lot: Front ........ ..~.. .............. Rear ............................ Depth
]0. Zone or use district in which premises are situateo.,.~...~.: ......................~..: .......................................................
[[. Does proposed constructic,n viatate any zoning Iow, ordinance or regulation? ...... .~......C~ ..................................
Name of Architect ...................................................... 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.
ST~E~OF NEW'~ YORK, . )
_
a...,.~~....~_...~~.... .......................... being duly sworn, deposes and says that he is the applicant
(Name of [ndiv[d6~l signing application)
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 be[ore me this
......... ~./. ....... day of ...... ~.: ................. ,l 9..~'..Z,.
Notary Pc~blic,... ,~.~ ............ t,Coun y
g,ature of applicant)
FOI',,~I NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLER[('S OFFICE
SOUTHOLD, N. Y.
......Q ...................
Examined ~.i~ 19.
Approved ........................................ 19 ........ Permit No ................... , .............
Disapproved a/c ............ .. ...............................................................................
......... ....
............... l' ...............
Application 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 a~te~ or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordiqa/nc, c,c/~nd regulations.
(-
..........
(Signature of a~plicant, or no, m~,if a corporation)
....... ?_~..~....... .~..f~....../...&: .......... ~..~f.,¥~. ......... ~. .......... :.
(Address of app~cant,)~7-J'~/f.~/~"t-'~'~/~ ~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder.
Name of owner of premises ...... ,'%. .'],,z~..~r .-~,-~-,w.., ...........................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
i. Location of land on wh ch proposed workwil be done Map No~. ~
Street and Number ..,~../.~ ......q ~¢~.~,,...~-~.,~,&~,,,~.~.~/.....~..,~.~.r,,¢~,.~,~..~.~.~,~<~,, ..............
2. State existing use ond occupancy of premieses ond intended use and occuponcy of proposed construction:
a. Existing use and occupancy .................... '......~..~i..-~...~ ...............................................
~ccu~nc, ~_'~ ~ ~',~.
b. Intended use and ~ ~,,~ y ................................................ .\ ..............................................................................
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition . ................... Other Work (Describe) ....................
4. Estimated Cost ..~r..~...~...~.: ........ .~.~ ... Fee
(to be paid on filing this application)
FEES:
If dwelling, number of dwelling units ........... / .............. Number of dwelling units on each floor ............................
If garage, number of cars ................ ~ ....... ~ ......................................................................................................
6. If business, commerical ar 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 ....... .,~l..~. ............. Rear ..~..~. ................... Depth~J .......................
or use district in which premises are situated...~..:...~'~t~.~ .......... .~.~.~ .............................................
Zone
1 1. Does proposed construction violate any zoning law, ordinance or regulation? ...... '~'"..O ..................................
12. Name of Owner of premises...~........~.,.~..4~...Address ............................................Phone NO .....................
Name of Architect ...................................................... 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
corner lot. r~ --
ST~'~'~ OF NEM/ YORK, )
...... 1
..//~~/.~J,../~ ............................. being duly sworn, deposes and says that he is the applicant
(Name of indiv~d'q61 signing application)
above named. He s the ...................................... ~~ ....................................................................................
(Contractor, agent, cor~rate 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 ail 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 flied therewith.
Sworn to before me this
........ ~,....( ........ day of ...... .~..~. ............ . 19...~...2..
~'~'~/~/g, ot u r e ~o f appJicant)~4,~