HomeMy WebLinkAbout429-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 .~a.y..L~c~...Da.~,.k..~r~.l. gt~y.~...~%~a~t~Le~e~
Map k No ......................... Lot No.
conforms substantially to the Application for Building Parmit heratofore filed in this affice dated
Septe~er 3 19..~.~., pursuant to which Building Permit No. Z ~.29
d , Saptem'ber 4 "
area .......................... ' ....... ~ ...................]9..~..,wa~s ;ssued, and conforms to all of the requiFements
of the applicable provisions of the law. The occuponcy ~or which this certificate is issued is ................
................................................................................................. '.~T~.. D... ~;LL~.~. .......................
This certificate is issued to ~arl VaJ. l~ owner
(own~L lessee or tenant)
of the aforesaid building.
Building Inspector
FOBM NO. ~
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.o 129 Z
Date ........................ ~ai;;~l~.....ll, .... 19...1~.
Permission is hereby granted to:
D~uglas B~geJ~s.....bY~.G.-..4'~r.l..'V'atj. ...................................
................... ~.~.~.-~i.~zz ...................................
at premises located at ....fi/.~;...etx~.j..~f....FiT.l.¥&i~e..¥~J~l. .................................................................
.................................................. ~"'i~ke'"?~x~ ...............................................................................
pursuant to application dated .......................... ~o~p%.....;~. ..................... 19.~,l~.., and approved by the
Bui{ding Inspector
Fee $ '~, ~,~)C~ .............
Building Inspector
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLO, N. Y.
...........
Approved ........................................ ]9 ........ Permit No.
........................ i'l~'uil'"'~i ng In'"'"'"~¢~';~;i ....... / .......................
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 p art for any purpose whatever until c Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of o 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.
(Signatu[e'of ap, plicant, or name,.j,f'~a corporation)
............... ...................
(Address of applicant)
State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
............. ./'.~/.¢¢,~,¢¢: ~ ,~.. ~. ...... ~.~.*Z. ¢..~./,'.¢. :'. .,~ ..............................................................................................................................
Name of owner of premises .......... ~.f~.....:~..~;~...'~.~-~.¢~Z~.'.:. ....................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Nome and title of corporate officer)
1. Location of land on which proposed work will be done. Map No: ...~ ......... ~ ................. ~ .......... Lot No: ....................
Street and Number .................... ~/_...r..¢~.~¢.~.~.....¢ .......................................................................... Municipality ,¢/ : ...............
2. State existing use and occupancy of pr, emises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ......... ~r~c,c.~j/2¢~¢= .......................................................................
b. Intended .se and occupancy ............. .....................................................................................
3. Nature of work (check which applicable): New Building .................... Addition ....4S~-............Alteration ....................
Repair .................. ;.~emoval .................... 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 ....~,.7.'~<......~. ........
Hefght ......~ ................. Number of Stories ....... ¢;?q~.~ ..........................................................................................
Dimensions of same. structure with alterations or additions: Front ...... :...~__x~.. ............... Rear ..... .. ,,~..., ...................
Depth ........ ..~...~.~. ............. Height .......... .~...~ ............... Number of Stories ........ ~-. ..........
8. Dimensions of entire new construction: Front ......... ~,~.. ............ Rear ........ ./...~.. ............. Depth ..'.z~..i..C~. ..................
Height ......,~'...~ ............... Number of Stories ! ........¢;~'..."~. -.¢, .....
9. Size of lot: Front ...... ,cI'..~¢, ........... Rear ........ .~r~...O....~....~i ..... Depth .........~.....~..~.'..~...~..
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
11. Zone or use district in which premises are situated ................................................................................................
12. Does proposed construction violate,~ /,,'/~/--,,'/an~ zoning law, ordinance,-~ r---~'/~,,--°r regulation? ........ ,~......~..~..'. ...........................
13. Name of Owner of premises....~".~....x~./.4~..~ ...... Address ....~-~.~.~..~?4~...:.Phone NO .....................
Name of Architect ........................................................ Address ............................................ Phone NO .....................
Name of Contractor .................................................... Address ............................................ Phone NO .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sbt-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 ~4DP-,~.~,¢~'~ ) S q
COUNTY OF ...~. ~.~...v/..~...) - ~. .
'~/~--z~ ~ e du n de oses a s th th '~s
..................... ~ ............... ~.~~ ..................... b 'ng y swot , p ,, nd say a e ' the applicant
(~me~ individual sig~g application) ' '
above named. He ~s 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 wJ[I be performed in the manner set f~rth Jn the application~iled therewith. ~
Sworn to b~ore me this ~ c, ~,,,, ~tu,~, ,, 7/~, ~/~ ~
FORI~I NO. 1
TOWN OF SOUTHOI. D
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTNO].D', N. Y.
Exomined....~....*-./. ............. 19...~...~..
,, . ........
Approved ........................................ 19 ........ Permit No.
(Building Inspector)
Application No....?..~......'~....~ ..........
APPLICATION FOR BUILDING PERMIT
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 adioining 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 o 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 applicable lows, ordinances and regulations.
....................
...... iSig~turex~plicont, or n~e, if a corporation)
............... ....................
(Address of applicant)
State wheth,er oppl~ant is owner, lessee, ~gent, architect, engineer, general contractor, electrician, plumber or builder.
.................. ........................................
.............................................................................................
Nome of owner of p m* , ........
If applicant is a corporate, signature of duly authorized o~ficer.
(Name and title of corporate officer)
1. Location of Ic~nd on which proposed wor~¢ will be done. ~Map No: ............................................ Lot No: ....................
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .......... ~/.~..~.~L.....~ ......................................................................
b. Intended use and occupancy: ............. ~-~,,-,~.~.. ......................................................................................
3. Nature of work (check which applicable): New Buildlng .................... Addition ...~r.."~.................AlteratJon ....................
Repair .................. .~,emoval .................... 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 ..............................
' ~' Rear
7.
Dimensions of exbt/ing structures, if any: Front....~... .................... .....-. ...................... Depth ............................
Height ......../..~.. ............... Number of Stories ...~...~-,:. ........................................................................................
Dimensions of same structure with alterations ,or additions: Front .......... .'7~../... ............. Rear ......7.../... .................
Depth ......... . .~...~-~ ............ Height ......... /.~. ............... Number of Stories ........
8. Dimensions of entire new construction: Front ....... .~..7.. .............. Rear ........ /..?. ............. Depth ...../'....~.~, .................
Height ........... .~..~. ........... Number of Stories ......... q.~ ......
9. Size of lot: Front .....~....~...~..~. ......... Rear ....~....O...~....~. ........... Depth ........ ,~..~.....~....~?,.."
10. Dote of Purchase ........................................................ Name of Former Owner ........................................................
11. Zone or use district in which premises are situated .............. ' ...................................................................................
12. Does proposed construction violate any zoning law,. ordinance or re~ulation? ............ ~...'~.. .............................
er of re . Z.~..~/.
13. Name of Own p m'ses ......... ~..... ;./~.f...;...Address ........ ~..'~.~.~/~,t~..Phone' "NO .....................
Name of Architect ........................................................ 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-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~..Y~¥~,,~C ) S S
.................... ~'~'~"...~.~...~.,...,.~--~ .................. being duly sworn, depbses and says that he is the applicant
~ame ~ individual signi~ 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 wJ[I be performed Jn the m,an~[~e~'~g~th in the application find therewith.
Sworn to before me th~s '~
~ day of ~~ ~1~9~.E~./? C'o~ ~yror~ ~a~re of app ca~'
..................... .' ........ ...................... / - / --