HomeMy WebLinkAbout397-zTOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No...~.....3...~..8..4.. ............ Date .......... AUgUaLt..22., ...................... , 19.68...
THIS CERTIFIES that the building located at ...Zn].e.t,..~ll~:LlZe. ........................................ Street
Map No. ~.~.~..~.~.~...... Block No ....................... Lot No. 97fl~ ..........................................................
K:l. dd
conform~ substantially to the Application for Building Permit heretofore filed in this office dated
........................... .~.~.~....2...8.~ ................... , 19..~..8... pursuant to which Building Permit No.~....399. .....
dated ................. .~,..~.~.....2..8..e .................. , 19....5..8.., 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 ........
..... .........................................................................................
The certificate is issued to ..... .~....c~...~.~...cl,...~...e.~...~..e..~..o.....(.l:~.l~.~.:[c..) ...........................................................
(owner, lessee or tenant)
of the aforesaid buiJding.
TOWN OF $OUTHOLD
BUILDING DEPAgTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 397, Z
pore .................... ,Z.u%:~..~ ..................... ~9~..8....
Permission is hereby granted to:
Irwt~ T~ t hi i i.... ~..~...F,~.w~...~e.r.t..e.~.~ ................................
....... Y~a ~.t i.~uek ~.....;~{,.~. ....................................
to .. make., an...~ lte~.a.tf on...-.... ~udd& ~&o ~...~a.. mn...exi s& i Pg.. dw..e..~ ~.'.x.D~ ..........................
at premises located at ..~-'~...~x~.i.v~ ................................................................................................
................................................ Ca.p.t,....K.i~.~..~.Ca.te$ ......................................................................
.............................................................. t4a-tt ~-%uek.~.,...-N~ .~. ~.. ...........................................................
pursuant to application dated ................................. ,~-t~2~. .. 2_8 .............. l C~...., and approved by the
Building Inspector
Fee $.-..~:~,. O0 ...........
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
A proved s/ ~t ' 19 ~ Permit No. ~-~ 3 ~ 7
Disapproved
(Building Inspector) /
APPLICATION FOR BUILDING PERMIT
Dote .......... ~.;,¢.............~, ............................... 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 o detailed description of layout of property must be drown on the diagram whlch is port of this location.
c. The work covered by this epplicotion 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 pukpose 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 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, electrician, plumber or builder.
........................................................ ~:..~.X .~d; ;.:.;::5~ .......................
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: ..~.t./..~...~.C:!C....../..~..:'~...~..,. Lot No: ....................
Street and Number ..0~:*..~."~..~..~.':: ........ :~..~'.~...~..~..~/..~,.~.~ ......................................................................................
Municipality
2. State existing use and occupancy of premise~ond intended use and occupancy of proposed construction:
-~-
o, Existing use and occupancy ...................................................... : ..............................................................................
b. Intended use and occupancy ........................ ,~t,,a,~,;.::.,: ........... ~ ...........................................................................
3. Nature of work (check which applicable): New Building .................... Addition ..... ~....Alteration ../,,~.. ............
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
5-0
4. Estimated Cost ...... ~ .................................................... Fee .~.. .....................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ................................ Number of dwelling units on each floor ............................
If garage, number of cars .............................................................................................................................................
6. If business, commercial or mixed occupancy, specify n~ture 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 ......... '...'~...~.{. ......... Depth .....L..'~... ...............
Height ............................ Number of Stories ~
9. Size of lot: Front ............................ Rear ............................ Depth ............................
10. Date of Purchase ........................................................ Name of FormerFD\wner ........................................................
tl. Zone or use district in which premises are situated .............. /~..:.....~..~.!.~--- .......................................................
12. Does proposed construction violate any Z:oni/gg_law, ordinance or regulation? ........... ~..~....~ ...............................
13. Name of Owner of premises...~.~ ......................... Address ............................................ Phone NO .....................
Name of Architect .......~. ........... ;~.......~:..;.,..i....Address, tA. ~,.), ............................................ Phone NO .....................
Name of Contractor...~ ................................. Address ............................................ Phone NO .....................
PLOT DIAGRAM
Locate dearly 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.
STATE OF NEW~..~. ) S S
COUNTY OF ......... ?~r.<,[x. ........... ) .~...,
./....~...,-------~ i ,~..~.....~:,.~, be ng du y sworn, deposes and says that he s the app cant
(Name of indiwUual signing appliF, Rtion)
above named. He is the .................................~ v v-----~-- · ....~'"~ '~'"~',~'~'~' ........... i .......................... : ........................................
(Contractor, agen ,TT-corporote officer, etc.1
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 tortbe best of his knowledge and belief;
and that the work will be performed in the manner set forth in the application[lied therewith.
.
Sworn to before me this ~ -
of ..... .............
~ , k/ ~
Notdry Pub[ c, .~...(.~...Z~..Cddnty
TOWN OF SOUTHOLD
BUILDING DEPARTI, AENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ...... ...~...... 19.?..~.
Approved...../.. ................................. 17 ........ Permit No ...................
Disapproved a/c ...I......./~ ................ ~.'..~ ............... ,,,~ .............. ~:~ ................
..............................
.......... ...... ..........
(Building Inspector)
Application No. ~ ¢ ?
APPLICATION FOR BUILDING PERMIT
Date .......... .,(..~ ...........~.~. ............................... 19 ............
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and su~omitted 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 port 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
Buil~ling 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 applicable laws, ordinances and regulations.
(Signature of applicant, or name, if o corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, 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. Ma[~ No: ..... ?..~:.¢. .. Lot No: ~.'.~.~.?..~,. ....
Street and Number ..r~.¢:.....'...; ............... ..~:.....,.-.......-"~'~"¢~. ......................................................................................
Municipality
2. State existing use and occupancy of p~emise~nd i. ntended use and occupancy of proposed construction:
o. Existing use and occupancy .....................................................................................................................................
b. Intended use and occupancy ........................ ~'...~;. .................. ~, ...........................................................................
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ..,.~C'... .............
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost......f~...-~......~.......'~.. ................................... Fee ..~. .......................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ................................ Number of dwelling units on each floor ............................
If garage, number of cars ............................................................................................................................................
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 ......... .~...~ ........Rear ........ ,.'~......~.. .......... Depth
Height ............................ Number of Stories
9. Size of lot: Front ............................ Rear ............................ Depth ............................
10. Date of Purchase ........................................................ Name of Former~wner ........................................................
11. Zone or use district in which premises are situated .............. /...~. ..............................................................................
..... p /kJ~'
12. Does proposed construct.on wolate any zoning law, ordinance or regular.on ........... ¢..~... ...................................
ame ner of ~emfses ~'~ ~ Address
13. N of Ow p' ,.,' . ................................................................................ Phone NO .....................
....... Address ............................................ Phone NO .....................
Name of Architect .......~.. ......... ~_.~i~.~.~.]
Name of Contractor..~......~~....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.
S AT,: O. N,W R i_ ) s s
................................... ~..'~....¢~.:::~:..~........~::,~,,,,beln~ duly swarn~ deposes ,and says that he is the applicant
(Name of indiv~rual signing applic~ion?~__
above named. He is the ......................................................................... · ........................................................................
(Contractor, age,t, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or hove performed the said work and ~o make and file
this application; that all statements contained in this application are true t~he best of his knowledge and belief;
and that t~e work will be performed in the manner ~. forth in the appllcatib~ filed ~herewifh, ~
Sworn to before me this ~ ~ ~ ~ ~W~ ~ ~ ~ ~Z~ /
..... ........
Nota~ Pubhc, ~.1.~ ............... Cou~t~ ,.,,:, ~, ,~ ,~ ~