HomeMy WebLinkAbout400-zI~OP~FI ~0. 4
TOWN OF 50UTHOLD
BUILDING DEPARTMENT
'I"OWN C~-ERK'S OFFICE
SOUTHOLD, N, Y,
CERTIFICATE OF OCCUPANCY
TH]IS CERTIFIES that the building located at W.~.~.~..~.~....~.~..~ ~...~a..~.~.l...~.~.~Street
Map No ............ ..?..e.?.... Block No ....... .e..?.~ .......... Lot No ...... ~.~. ........................................................
conforms ,~ubstantially to the Application for Building Permit heretofore filed in this office
dated .................. ~.~.~y....2..~ ............... 19..5..8.._ pursuant to which t~uilding Permit No ........
dated ................ ~.~..~....~.~.. ............... 19.~.~.-, was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
~ssued is ............ ~l~ ~*V~I'I~...O~.. ~.~4X ~-~f..D]~ ~.(~ .....................................................................
This certificate is issued to .......... 1~.~....~.~...~.~....O.~. ..................................
(owner, lessee or tenant)
of the afo~'esaid building.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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? 400, Z
Dote .................... ;[ul~.....2~. .................. ]9.~.~...
Permission is hereby granted to:
~eo T ay lo~..... A~/.C..... ~.~... (;~ec~..,~&~. ...................... ...................... Ma.tt i.t~e.k .....................................
..................................... FI.;.~.~ ...................................
~o ~T~buT]:d~.~an~a~]~t~;r~.~u~`~ad~i~i~n~n~a~e:~i~s~.i~ng~.~e.l~.i~g .................
........................ (...emclo~e...po~.c~.~..~.i~..~ermi~en.t .. ~o~stmuction.). ...............................
at premises located at ..-.Wes~ph.a~..l.a.....~Rea~ ..................................................................................
.............................................................. M-a~:~.tt~c~ ~' u'""Fi';'~'~ ..........................................................
pursuant to application dated ..................... ~T~.~.~..~,~ .......................... 19.~,~.., and approved by the
Building Inspector
Fee $..~,00 ..............
FOI~i~ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
....... 19.5
Approved.......k~.. ............................. 19 ........ Permit No ...............................
Disapproved a/c "'~'"-'~u .......~ .......... ~ ........... 7~ ...........~ .......
............................. (zL .z: ........ ........
.................... ............ 'T' ................
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 coYered 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 pu.~pose 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 appj~ant, or name, if o corporation)
~ ................. ..~.~..~ ~ ..... ......... ...................
(Address of applicant)
State wheth,er applicant is owner, ,e~s~, a?ent~architect, ~gineer, general contractor, electriizian, plumber or builder·
Name of owner of premlses......~..~. .............................................. ~t' .....................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which,proposed work~w 11 be., done Map No: ....................................... ~... L.~ I~1o: ..>~ ................
Street and Number ...~<..~:......~.~...~.-.[/. .................. ~ ................................... .Z..%.......;' ...... ~ ............................ ' ....................
~ Municipality
2. State existing use and occupancy of premises ~nd intended use and occupancy of proposed construction:
a. Existing use and occupancy ....................... ~.~:...~.....~.....'~...~..~.r~ ......................................................................
b. Intended use and occupancy ................................................................................................................................
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)
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....: .................. i.... Rear ............................ Depth ............................
Height ............................ Number of Stories .............................................................................................................
Dimensions of same structure with alterations or additions: Front ............................ :... Rear ................................
Depth .............................. Height .............................. Ngmber 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 Farine,r, Owner ..~. ....................................................
11. Zone or use district in which premises ore situated ....... ~...~.~..~.:~ ................................................
]2. Does proposed construct'~on violate any zoning law, ordinance or regulation? ....................................................
13.
Name of Owner of premises.../,k1~.~....~..'r~......r..".~......xz~Address
Name of Architect ........................................................ Address
Name of Contractor....,~ ...... ~..~...~'z~..:..Address
PLOT DIAGRAM
............. : ~I~...~. ............ Phone NO .....................
............................................ Phone NO .....................
.....~.x~...f~~: ........ Phone NO .....................
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.
I OM ~ ,
STATE OF NEN4~-iFg~<, ,/~<j ) S S
............................... ~.~......~. ......... being duly swqrnl deposes a'nd says that he is the applicant
(Name of individual signing'~pplicotion) ' ~,, '
obove nomod. Ho ~s the ..............................................................................................................
(Controctor, ooent, corporate officer, etc.)
of s~id owner or ownors, ond is duly outhorized 1o perform .or h6vo por{ormod the said work ~nd to moke ~nd file
this opplicotion~ thor oli stotements contolnod in thi~ ,p~lic*tlon oro truo to tho best of his knowlod~o
and thor the work will be performod in the manner ~t forth in tho opplico~ion filed thorewith.
Sworn to bofore me this ~ D ~ ~n-
.......... ~"~ .....~ "f"'"~F'~ ...... ~ ............. ~ '~ ,~ ,,?r ..
_~.~WoN OF SOUTHOLD
~D~G DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD~.~.~
Examined ...... .~....? ......19....( ....
Approved ......................... .k. ............. 19 ........ Permit No. ~"~'~( ~ C5
Disapproved a/c ................. ~ .................. ~..~ ..............
....................... ............. ':: ....
APPLICATION FOR BUILDING PERMIT
I NSTRUCTIOF¢~
o. This application ~ust be complmtmly filled in by typmwrit~ ~n~ x ~t~d in dup, licot~ 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 ~ayout of property must be drawn on the diagram which is part of th~s ~ocation.
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 in throughout the ress of the work.
e. No building shall be occupied or used in whole
shall have been gra~ted by the Building Inspector.
APPLICATION IS .HEREBY MADE to the Building
Building Zone Ordinance of the Town of Southold, Suf
Regulations, for the construction of buildings,
The applicant agrees to comply with all applicable
.art for any
Certificate of Occupancy
of o Building Permit pursuant to the
~d other applicable Laws, Ordinances or
or demolition, as herein described.
t (Signa or name, if a corporation)
(Address of c
State whether applicant is owner, I~s~)e,( ~..~.~',x~_ ,,.ag~. a~?te~_?~gi~eer~,.~.x~,.,~...~g..~e~al contractor, el , lumber or builder.
If ~pplic~nt is ~ ~orpo~te, signature o~ duly ~ut~ e ffi~er. ~
............... ~ ~' ~[' ~"~'~';~'~';~'/~'~ ........
1. kocotion of Iond on which~propos~d wor~will be. done. Mop ~o: ..... ~~. o: ....................
Street ~.d N.~be~ ..,.,~ ..... .~...~...;r.:.:Z.~...,~:~i~:z ........................... , ........................
2. State existing use and occupancy of p~emises ~d intended use and occupancy of proposed construction:
~. Exmtmg use and occupancy ............................. ~ ........... 7.....; ...... ~.? ......................................................................
b. ~.t. nd~¢ ~',~,~:~,~ ............ ~.~ ................................................. ~ ............ : ................................................
3. Nature of work (check which applicable): New Building .................... Addition ........... ~..AIteration .'CT......... ..........
Repair ............. v~....Removal .: .................. Demolition .................... Other Work (Describe) ....................
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 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 O'-Iz--~.--,
9. Size of lot: Front ............................ Rear ............................ Depth ............................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
11. Zone or use district in which premises are situated ........ ~..c....~~ ............................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ........... ~ ............
13. f r ~/~" ' "-~"~'"r-'~ ~"'~ ......................
Name of Owner o p emises~J~f.~...~.~..-~.....~.~,~t<~. ...... Address ............................................ Phone NO .....................
Name of Architect ............... ~ ............ ;? ....... ..,....~ .......... Address ............................................ Phone NO .....................
Nome of Contractor ...................... Address ............................................ Phone ~0 .....................
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.
STATE OF NEV(-"~OI~,I~,, ~j~. ) S S
(Name of individual signing~'F ~ti 'alb'plication) ~ ~_~
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 containe~,~i,t~l~/~pplication are true to the best of his .k. nowledge and belief;
and that the work will be performed in the~ mo~,~,~.'~f~/~in the application filed therewith./'/
Sworn to before me th,s ,~, ~ ,.r~,,~ .%' ?,~'.:
Not .. .