HomeMy WebLinkAbout134-zFOI'~I NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, hi. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at$/~..~.~...~e~J~..]~O~ ........... t ...... : ..... Street
Map No...O~o.o~...Park ..... Block No ..................................... , Lot No., ........... , .........................
the App cat on for Bu ding Permit heretafare ~ed [n this office dated
conforms
substantially
to
doted ...... 0~...~ ............................19~ .... w~s issued, ond confolms to n~l of the requirements
o{ the ~pp[icoble provisions o~ the I~w. The occuponcy for which this certificate i~ issBed is
town er, lessee or ~enanr)
of the aforesaid building.
/
r ' Bud ng'-~pector ~ ' J
NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
(THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF
*************
~]~D~,VF~tI~NfZA~B~GI~I~t~T,~(~, UNTIL FULL COMPLETION
OF THE WORK AUTHORIZED)
Permission is hereby granted to:
Geo. W. ~mith..&..~on~.....A/C.....L~ui.s..Es~ne~ ...........
He&n-.t~ead. ...........................................................
........ Se'a.t, heI..d, r .....~.,.~., ....................................
to ....... Mui, ld...new.. ~wel.llmg .........................................................................................................
at premises located at 8/S...pi~e...}~eek.,.Road...&..O~kwood...Drtve ...........................................
.................................................. So~ho ~6 ~.....~ ~. ..........................................................................
pursuant to application dated ~ 19 and approved by the
................... Oe~'='"'3 ..................... FF'"',
Building Inspector.
Fee $.10, O0.....pe, id
FORM NO. IL
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ........................................ 19 ........ PermJ~ No .................................
Disapproved a/c ............................................................................................
(Buildin0 Inspector)
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 adioining 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. Up.on approval of this application, lhe Building Inspector will issue o 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 hove 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 oil 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, electrican, plumber or builder.
........................ ..............................................................................................
Name of owner of premises .............. '.....T: :....~...~r......~<..~-~,r~,f,~-,~,,,¢, .......................................................................
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. ~ .................................. ~.r.~. ......... ,../...~../~...
Street and Number ~2;D~z~cc...:~... 'fr.,~.~.....~../.~.~
tat ex~shn use and occu anc ofraremteses and ~ntended use an o
2. S e ' ' g p y p ' ' d ccupancy of proposed construction:
a. Existing use and occupancy......%~~... ...................................................................................................
3. l~!atl.lre of work (check which applicable): New BuJld~ng ....... ~...Adclltl ....................... Alt .... i .......................
Repair ....................Remg~al .................... Demolition .................... Other Work (Describe) ....................
~7~/~--'~ ~ Fee [0~-~
4. Estimated Cost ..¢...~.+~... ........................................................................................................................................
(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 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 .......... t.~.~.....~..~.~.. Rear ............................ Depth ..~..~....~.....~... ......
Height..,~rr.....'~.,..~...7~.. ........ Number of Stories ..../.. .....................
9. Size of lot: Front ...... .~..~...Z.~. Rear .~....)zc...~'.~..: .~....~... Depth ...~..~....~....Z.~......
10. Zone or use district in which premises are situated ....... ~ ..........................................
11. Does proposed construction violate any zoning law, ordinance or regulation? ....... '.~.~ ................................
12. Name of Owner of premise~..~Address ~.~., ..~.~.l~..*.....Phone NO.'..:.;..~ ......
Name '
c~ CA~?:ta~.;~..:~..:~~~AA~i~...~.fCDt_..~...Phone--.~..~ ....... ,~.~ ....... Phone NO.~...c,).,.,.f.:~.,~../~..~.,~ NO'¢4 ...................
Name
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. ~,,,-'7~"' ~
\
STATE OF NEV~,~ YORK,
.............. ~..c¢~.,: ............................ g duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
(Contractor, agent, corgorate 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 ali 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 fn the application filed therewith.
Sworn to before me this
......... ~ ......... doy of ......... ,~,,..,~,..~ .................. 1 9.,.':~,../..,
E/OIS~
~ot~l,~ public, State of New York
Residing in Suffolk County
No. 52-0367800
My Commiss~o~ £xp~rcs fJ~rc:t
(Singature of applicant)
FO~NI NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ............................... {. ....... 19 ........
Approved ........................................ 19 ........ Permit ma .................... .~ ............
Disapproved o/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, 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, or name, if a corporation)
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)
Locat on of and on wh ch proposed war < w be done ~ ' . =e-k:rcrd..'f...-~... ..... ~ .
Street and Number .~/,~,/~r~r.......~.....~...~~..~....,~......~...~%~..~..~...¢.....~...~...,?.....~..z ~
n o u n f--i s te
2. State existing use a d cc po cy o prem'e es and in nded use and occupancy of proposed construction:
o. Existing use and occupancy ..................................................................................................................................
b. Intended use and occupancy ...............................................................................................
3. Nature of work (check which applicable): New Bui'lding ....... ~,,~m....Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost .~..~f~,~....i~ ........................... Fee
(to be paid on filing this application)
FEES:
5. If dwelling, number of dwelling units ........... Z ............ Number of dwelling units on each floor ........................ . ....
If garage, number of cars ............ ~ .......................................................................................................................
6. If business, commerical or mixed occupancy, specify nature an~l 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 ...................... i ....... Number of Stories ................................
8. Dimensions of entire new construction: Front ......... .~..~.....~. ~/~,... Rear ............................ Depth .~..~...~..~.T ........
Height ..~. ......... /7../.. ......... Number of Stories ...,/ ......................
9. Size of lot: Front /..'Z Z Z..:/.-.~. Rear .~.;...%:....~.'['....,~...Z;.. Depth../...~..~... '~...'.~......
10. Zone or use district in which premises are situated ....... ~f..L.f.n/~r..'~,..~.~¢...~.i~'.~..~.(:~.~.. ...........................................
11. Does proposed construction violate any zoning law, ordinance or regulation? ....... ..'~...~.:t2 ................................
12.
Name
of
Owner of premise~.d.;,,,,f,....,.%~',..L,z,w~...~.Address ./zJ.,Z~:~.'~..~.~..f~(~..,ff:',~'.':....Phone NO. ~.~ ......
//
Name of Architect ............................... Y~,.~ ~xC'(,*,V"' ................... Address .................................. "7" ""~-/' ,)/~ '"'F¢"Ph°ne ~,ir~NO' L ........... ~. ~ .......
Name of Contractor~:J..A/..j,,:..~i,z,[,;.-...,.....~....,.,;,..~/;~Address ... Cf,
PLOT DIAGRAM
~ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
prop(.rty lines. Give street and block numbers or description according to deed( and show street names and indicate
whether interior or corner lot. ~'2:__~?. ~ ..
Sworn to before me this
....... '~F"" ........ day of ......... ~: .................. 1 9...~....~...
ELOISE BOWDEN
[~Ot~y Public, State of New York
Residing in Suffolk County
No. 52-0367800
My Commission Expffes M~rch
(Singature of applicant)
STATEOF NE~YORK, -, )
COUNTY OF~..~...~SS''
............... ~....,¢¢~'..~ .......................... being duly sworn, deposes and soys that he is the applicant
(Name of individual signing application)
obove homed. He is the ............................................. c~..~.....~..... .......................................................................
(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.