HomeMy WebLinkAbout166-zFORM NO. 4[
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at ...1~'/.~......~]-~...19.Qa~ .......................... Street
Map No ............ ~X,~, ................. Block No ............. ~ ................. , ~]:~ ..... Pe~O~'(~'t'"'"~'~'~'*
conforms substantially to the Application for Building Permit heretofore filed in this office dated
........................ ~.~'.e/~]~.,~,~...~. ....... 19.~'~...., pursuant to which Building Permit No ...... ~].6~ ............ ,
dated ..................... .~..~.~.~.~..e.:~...~ ........... 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 ............
........................................... Private...d.~elling. ..............................................................................
This certificate is issued to ....~]'l~.~.'~....~,~a~'.~l. ............. (...~W'~]} ...............................................
(owner, lessee or tenant)
of the aforesaid building.
FORM
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, H. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES '~'~T~T~.~:
~,~PP, I~(~¥E~&~,~,N~&t~I~,.~T~I~JJNTIL FULL COMPLETION
OF THE WORK AUTHORIZED)
No....21.....;]66 ...... Date ................... No'~embe~.-.-6 ............. 19_.5:7.
Permission is hereby granted to:
Cb. ester Or .le~sk..t......A/(].. ·. (~hes.t, er. · .Sk~m~"~. .............
........... xiTa~.t, ehe§ .t~e ,~......~ ,..~.~ ...............................
to ..... .]B~.Z. cl...ne~..<t~re~.~.r,§ ...........................................................................................................
at premises located at ...~/e.];:l~..~OS~ ..................................................................................................
................................................... ~.eeo~e ~.....~.,.~.,. ............................................................................
pursuant to application dated ...................... ~i~veIit13er.....~. ............... 19~.~..., and approved by the
Building Inspector.
Fee $.10, O0. ..........
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ........................................ 19 ........ Permit No ...............................
Disapproved a/c ..............................................................................................
(Building Inspector)
Application No. I ~ ("
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 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 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 Iterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all appllcable laws, ordinances and regulations.
....... · .......... .......................
~nature of appficant, or nome, if a corporation)
.................... ..................
(Addross ~f o~lic~nt)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pJumber or builder.
......... :.-,,~¢~.~'~.,,~-.'~.... .l~<;~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 No: ................ :T.: ........................ Lot No: ........'~'~. ...........
~ -- ~.....~-..~.~_~c~ .,~ .~.: ...........................................
Street end Number ....~.~.,,~ ~....~.. ..................................................... "~
Mu~icipal.ity
2. State existing use and occupancy of pr,emises and intended use and occupancy of proposed construction:
Ex st ng use and occupancy....,~,~-/.¥..,.~...-<~,. ......... ~ ...................... '~ ....... ~....~ ...............................
b. Intended use and occupancy.....l,~.,..-~....'~........,,:~..~'...'~....,~..~.:.~..:.~...~ ..................................
3. Nature of work (check which applicable): New Building ........ ..~. ......... Addition .................... Alteration ....................
Repair ............... ~Removal~_ __ .................... Demolition .................... Otherz,. __ Work (Describe) ....................
(to be paid on filing this application)
5. If dwelling, number of dwelling units .............. .J. ................ Number of dwelling units on each floor....../. .....................
If garage, number of cars .............. ;z.~n:.~. .....................................................................................................................
6. If business, commercial 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 ...... ..~..(o ............... Rear ..... ~.. ~ r
Height .......... .{.i.6.]..r. ........ Number of Stories .....J.. .....................
9. Size of lot: Front ..../. ..................... Rear .....J.. .................... Depth ...............................
11. Zone or use district in which premises are s.tuated..._....___:~............. ............... r. .........................
12. Does proposed construction violate any zoning law, ordinance or regulation? ...../'~/......~ .......................................
Name of Architect ........................................................ Address ............................................ Phone NO
PLOT DIAGRAM
Locate c[eerly and distinctly all buildings, whether existing or proposed, and indicate all set-beck 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 NEW YQR, K,. # ) S S
(Name of individual sioning 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 before me this __w ~~~ ' ' " ~.~'
........ ~. ............ day of .~..' ....................... 1'9"~"~/'""'' ~~P~y~t~'~'~-¥,~-' -' plicant)
' /0~ No. 52-03~7800
Notary Public, ..."~,....~ ............. ~ Residing in Suffolk County
My ¢~mmmsmn Expires ~larch 30, 19
FOR1YI NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD', N. Y.
...............
Appraved ........................................ 19 ........ Permit No ...............................
Disapproved o/c ............................ .,~,.,~:.;~ ......................................... ~,,..~.....L
......... ................
(Building Inspector)
Application No ........!..~...g'. ...........
APPLICATION FOR BUILDING PERMIT
Date ...... .......... : ............................... ....
INSTRUCTIONS
a. This application must be completely filled in by typewriter or Jn 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 cowered 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 issuonoe of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or
Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, os herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
]Signature of applicant, or name, if a corporation)
....................
.............................. ~',~ddr~s of applicant) /
State w,h, eth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~/'~ -' 0 r~ '~m- ¢~.~...
Name of owner of premises .............. ~ .........................................................
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: ............................................ Lot No: ....................
Street and Number ....'..~....~.....~...s......~.~..: ........ .~...?m..,f,~.:;.-z:~...z....J.L.:...~..: ........................................................... Municipality /
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
Existing' ' use and occuponcy.....~¢.~ ........... ~..'~.~.' ....................................................... ~- ~'
b. Intended use and occuponcy...t.~.~;..~!..~..~....~.:.~...~.:~..'~.:.....~.'...'~.. .................................
3. Nature of work (check which applica'ble): New Building ~x . Addition .................... Alteration
P, epair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost .......... /..~.....~ ........................... Fee ./...~. ! .~ ........................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ............ t/..' .................. Number of dw~elling units on each floor ........ ....................
ar, age, number of cars ...........
6. If bu'siness, commercial or mixed occupancy, specifyU 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 ...... 7...(~. ............. Rear ........ ~....~ ............. Depth .....~....~.. .................
Height ....../....~ .............. Number of Stories .......... / ................
9. Size of lot: Front .../....~....7. ............. Rear ...... /...~..-~. ............ Depth ...~....,~...q ................
10. F)ate of Purchase ..... .~..~:.M~...., '~..../.../....,~.'....~.-- ........... Name of Former Owner ..~...~..:-~~~' -4'- ( ~'
/.
situated,...~..,~.. ,.~ ....~,,~.,,-,,,,,, ,,~,,~~.....~J~ ........ : .......
11. Zone or use district in which premises ore
12. Does proposed construct on vj,q ate any zen ng law, ordinance or regulation? ...... ~,Zz~m.....: ..............................
13. Name of Owner of pram ses..'~...~.....~....~...Address ..... NO.t~.~..=/~..O...~.
Nome of Architect .......~ ............................................... Address ............................................ Phone NO .....................
Phone- ~
Name of Contractor Address ~......~. 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.
/
/ ¢-u
STATE OF NEV~ YQI~K,. ,! ) S S
COUNTY OF ~ ...... ) '
,,..~...:....~¢(,.~,~c~.~/,~4,..~'..~..,'~./,~,~ ........................... being duly sworn, deposes and says that he is the applicant
..... (Name of infO'ual 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 gppiication filed therewith.
Sworn to before me this
.... ................
Nm. p~, Stat[(~ t~ of applicant)
My Commission Expires March 30,