The URL can be used to link to this page

Home My WebLink About155-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OC;C;UPANCY No..Z.....1,'~0. ........ Dote ..................... ~.~-'¢ze.. lO ........... .' ........ 19.~.8... THIS CERTIFIES that the building Iocoted at ,~,~,~,~J~,,~O,Q~,.,,~:..gz;L'l:;;.t,,6t~.,~. .... Street Map No, ~.O.~.~hl~/~.Q~l. .............. Block No ..................................... , Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office' dated ......................... .0. g.!~..O..1.).~'. ....... .,~..19.~'.~..., pursuant to which Building Permit No .:~...~.~. .............. , dated ................... ..0..q.~...O..~...e.?..,....~.~ .......... 19.~.~..., was issued, and conforms to all 0f the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ............ ................................................. .P. ~ .~ ~'.tj~.....1)..~.L~ ~T~ i?l'f}. ...................................................................... This certificate is issued to ..... ~..o..~...a.~...~.~....8,.e..9.~ ........ .(...g.~,~'.). ................................................. (owner, lessee or tenant) of the aforesaid building. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON ]-HE PREMISES ~g~(~¥~,~,~:e~aJ~,~)~eT~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No ...... Z...1-~..~ ....... Dote ............. October.....>-.~ .................. 1 c~. .... Permission is hereby granted to: ...Donald..Seo.tt ................................................ ....................... Sa~t~old ...................................... to ..... l~a$1~...New..Dwett.i, ng ........................................................................................................... at premises located ot .......~uO~'"~3 .......~O~l~'h:WOO~ ....................................................... : ................ ........................................... ,~ou. the-l-d.~.-..-N..-g.o ................................................................................. pursuant to c~pplicotion dated ........................ 0~>~...--~..~ ............. 19~.~...., and approved by the Building Inspector. Fee $'~0~00 ........... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ ~9 ........ Permlt Na .................. Disapproved a/c ........................................................ ........................... ..... ......................... ....... ..................... (Building Inspector) Application No ......L..~..i.~.: ........... APPLICATION FOR BUILDING PERMIT Date ............ ~... ~..'./..'~'. .......... i~/~. ............ 19...'~'..Z... INSTRUCTIONS o. 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 dj&gram 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, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspectiori 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 afxplicant, 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 rem ses ~ ~ c~c° ~' e 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 ~ ......... (~ .................. Bfo~k .................................. Street and Number ...C.~./.../.'~...'./.~,..~Z~'~.-/.~..../--~.......~..~../9....~C~. ....... ..~.. ...... d~-~~.:..~..,...,..~...~Z .......... State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... t'.._I:7:..~,K-Z.K .................................................................................................... 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: 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 and extent of each type of use ....... ~ ........................ 7. Dimensions of existing structures, if any: Front ............................ Rear ............................ DeDth ............................ Height ............................ Number of Stories .............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ d' ' 8. Dimensions of entire new construction: Front ....... .~. .................. Rear .......... ........ Depth ...:........ ................ Height ......... ,Y..~,.. ........... Number of Stories ...... ./..~.'.~.?... /_.C'~ ~2~ ,~/,~.7-~ 9. Size of lot: Front /..i/· ,~ ~ Rear ./...~...~.: ~ ~*/ Depth ..../...~:....~..?......c~ 101 Zone or use district in which premises are situated ........... ...~....~.C...~.....~?Z....~...?'..'?.~ ...................................... 11. Does 12. Name of O~,ner of premises.....~.,..~...~..~..~.~...~?~ress,/( "~ ~.,.~..~./~..~ Phone NO Name of ~?..~........../~..:.....~...~.~.?...~...~.~.~. ........ Address ..~.....~'...~...~.~ .......... Phone NO ..................... Name of Contractor...~.~..f)~.~..~..~/......~....~....z~..~Address ..... ~.~.~.~....~:.....~m.. ........ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and Mock numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW./~'O~.,, ) S S cou N' _Y OFFS....) .......... ~.....i ................... ~ ..................... be,rig duly sworn~ doposo~ o~d soys thor Be ~s tho oppll*ont (~omo of individual sionin~ oppl~cotion) obove n~mod. He is tho ........ ~ ....................................... ...... (Contractor, o~ent~ cor~rote offlcer, etc.) o~ solB owner or ownors~ ~nd is duly outhorized to perform or hove performed the s~id work ond to m~ke ~nd file this opplicotion~ thor oll statements contoined in this ~pplicotion are true to the best of his knowledge ond be~ief~ ond thot tho work will be porformed in the monnor ~ot {orth in the opplic~tbn {Ued thorewith. (S[n~otur, o~ opplic~nt) Notory Public,..~.......~ ........ County FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examned ....... Approved ........................................ 19 ........ Permit No. ~r. ...................... Disapproved a/c ............... (Building Inspector) 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 BuiMing Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit sholl be kept on the premises available for inspecti~on throughout the progress of the work. e. No buiMing 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 far the issuance of a ~ui~ding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other ~pplicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described~x. The applicant agrees to comply with all applicable laws, ordinances and regulations. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. ........... ............................................................................................................................................... Name of owner of premises ....... ¢ ............. '..,~ ................................................... ~ ................ ~.. applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. kocation of land on wh ch proposed wor< w bedone Mo ~) Street and Number . .~..,~../...~.~-../~"~..~........ .~...../~....~...~.... ...... ~ ................................. ~..'..~.. ....... d.~...~.~... ............ 2. State existing use and occupancy of pre~qieses and intended use and occupancy of proposed construction: a. £xisting use and occupancy ......... .~.~...~.,.../~.....~....~ .......... ...~.....~?. ............................................................ b. Intended use and occupancy ......... ../~...~./.~..~ .2..--~ ..~.~..~..~G.~.~.~..~..,~-",,'u/~-~-~'- 3. Nature of work (check which applicable): New Building .................... Add tion .................... Alteration ...... Repair .................... Re~l~Yal y .......... ~;;Demolition . ................... Other Work, (Describe) .................... 4 Est mated Cost .... ./..~/~...~...~..~.. Fee ..................................... (to be paid on filing this application) FEES: Number of dwelling units on each floor If dwelling, numb~er of dwelling units:.~, If gara~ib, 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 ~'~tire new construction: Front ....... 2..,~-.~...i'~/~ ....... Rear ...... .~...~...".f. .......... Depth .....~.....)~..~..--/' ............ 10. Zone or use district in which premises are situated ............ ~.~.~~ 11. Does proposed construction violate any zoning law, ordinance or regulation? ......... ~ ............................ 12. Name of O~ner of p~se~,~.~ Ad~ress ~~..~,.~ .......... Phone Name of~g~...X¢.....~~*~.~. Address .~ ~ Phone NO ................. Name of Contractor~~.~.....~~Address ...~,~.~ ......... Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all 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 at. 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 oil statements contained in this appllcotion are true to the best of his knowledge end belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to befgre me this ........................ aay/e~ ........................................ ~'....../ .... / ,~ /'- (Singafure of applicant) Notory Publ' ~ .............................. ount~ ST^T OF s c .........-,,, ..... ~~::..~..~ ........................... being (Name of individual signing application) doty sworn, deposes and soys that he is the applicant