HomeMy WebLinkAbout445-zFORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CI:RTIFI£$ that the building located atlr/~....J~.!.~,.~¢~.~. ................................... Street
Map No ......................... Block. No ......................... lot No ...................... lle%t,~,f~t~el~....l{v~.., ...............
conforms substantially to the ^pplicatJon for Building Permit heretofore filed in this office dated
............................... Se.~t,,..~. ......... ,1~ ...... pursuant to which Building Permit No....9...~1~ ...............
dated .............................. $o~,~,....~, ........ , 19r~...., was issued, and comforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ..............
.................... .....................................................................................
This certificate is issued to ....,T~....~,~r,£ ......... ~z~e~'.~) ..........................................................
(owner, lessee or tenant)
of the aforesaid building.
/
..... /.k:~-.~', ~-~.; .~.... ' .~' ....... ~ - .';~ .......... ~ .......................
' Building Inspector
FOI~M NO. 2
TOWN OF $OUTHOLD
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.° 445 Z
Date .................. ~2~t,l~;~.~{~...~. .......... 19.~.~...
Permission is hereby granted to:
Joha ..A~...W.~ l~eusk~. .........................................
.......... ~,~i~..~ .....................................................
................ I~u~.i.~......~,,~., ..................................
to ............... l/~ul?.d..~e.w..d.weJ, ling. .................................................................................................
at premises located at ..... /~/~l,,.pJ.f~...HOad. .............................................................................................
................................................................. bla.t,t.~.t~r....~,.Zo .........................................................
pursuant to application dated ........................ ~l~t~,....l~ ........ 19.~t..., and approved by the
Bui{ding Inspector
Fee
Bui{ding Inspector
FORi~ NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
Approved ..................... (..! ............... 19..../....Permit No. Z ~'~//-z/~
Disapproved a/ c ..~~~/,
........ .......................
(Building Inspector) /
Application No..?.~..~../.'..~.')i..'~. ..........
INSTRUCTIONS
a. This application must be completely filled Jn by typewriter or in ink and su~)mitted 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 issu,ance 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 puFpose 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 applic,able laws, ordinances and regulations.
(Address of applicant)
State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder,
Name of owner of premises ............. ..~....e.{~.....~.. ...... ../~.f: ....... .~.¢..L~.C~:.~.g.' .................................................................
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 "~' .... ~"~unici~ali~ ............... ................ --'""~ ............................
2. State existing U~e and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .....................................................................................................................................
b. Intended' use and occupancy ......................~..o..o.)~.,..~...~.....~...E-. ...... ~.~.~?~..E..~ ......................................................
3. Nature of work (check which applicable): New Building ............ Addition .................... Alteration ....................
Repair .................... Removal .................... DemolltJon ........ ~.........Other Work (Describe) ....................
4. Estimated Cost ................... ~...~..q...,.,h.'~.O..O ....................... 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, Jf 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 .......J..~/..~.: ............ Rear /6'~0 Depth ......~.ff...O. ...............
10. Date of Purchase '~2.'~-- ,~F'O~..~.. /~,J.'..~. ......... Name of Former Owner /?,~d~
]]. Zone or use district in which premises ore s~tuated ................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ........ {.l..O. .....................................
NO. ,?t~.:.q.:r.~.,f.R.~.'"'
13. Name of Owner of premises.~.o.~z.¢.r~.~,.,~..¢,C~h/,~,~...Address
Name of Architect ..........~.'.~..~.fk,~.~r...&.~.o..~.*. ............... Address
............................................ Phone NO....,~f?.':.~..~ ....
Name of Contractor..'.~.~.?./.',q.....0.;..../..:?.~.f'..:../.( ......... Address .~"?:.'C./5.~::..~.......~.~,~.r.......'Y.,G. Phone NO..~.~.t?:..:'?::.~.~.~
PLOT DIAGRAM
Locate clearly end 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 S S.
COUNTY.., .~, OF
........ ;.~.;..,.,~,.,,,.-w~ ,,,~. .......... being duly sworn, deposes and says that he is the applicant
L~ (Name of ndividual signing application)
above named. He is the .............................................................................................................................................................
(Contractor, agent, corporate officer, etc.)
· ~ 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
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUT,OLO, N. ¥.
Examined ......... ~....~...../~...~z.. ....... 19..~..~~.
" lO ~ Per ,t ~y~'5
Approved ................................................. m' No ...............................
.......... ................
(Building Inspector) I
Application No....~....~_/.'..0. ...............
APPLICATION FOR BUILDING PERMIT
IJote ............ ~.....,.;.,... :.:.,...T; ......................... 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 fo 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 I~ept 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 puFpose whatever until .a Certificot, e of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Soufhold, 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 applic.able laws, ordinances and regulations.
........ .................
(Jignature of applicant, or nome, if a c~rporation)'
(Address of applicant)
State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ............
If applicant is a corporate, signature of duly authorized officer,
(Name and title of corporate officer)
1. Location of and on which proposed wor~k will be done. Map No: ............................................ Lot No: ....................
Street and Number ........ t.~.~. [~J~.~. ............................ ~ .~..~('],.~,. t' t]!)..~;.~-!~]).q'~..~.-~., J~. ~.~., j.X.(: ........................... ,~.
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occu onc
occu onc
b. Intended use and p y .............................................................................. ' .................................................
3. Nature of work (check which applicable): New Building ............. Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition ....... .~ .......... Other Work (Describe)
4. Estimated Cost ............... ~-- --/...~./....~..~.~....0. ......................... Fee ~.J...~. ....................................................................................
(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 ........ ~.r. ........... 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 ............ x[.~:./. ...... Rear ........ ~j~,~?....r. .......... Depth .......)..~' .................
Height ............................ Number of Stories /
9. Size of lot: Front ....... ../..~..,?.;..i.' ....... Rear ...... /(?...~....~i .......... Depth ....~..~.,,~. ...............
............. ~/7. ........ .~.,.~,~...4¢......: ........
10. Date of Purchase ..~..G .......~...~.)....~.. ....... ./. .................. Name of Former Owner ~,~ ,~ ~
11. Zone or use district in which premises are situated ........ ~....~.!. .....................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ....................................................
13. Name of Owner of premises.. /f~...J.C.:...~../.%/.C;~..~..4.~(...Address ~./.~:!~¢..~¢;~,..k.~?..~..C~...~.:.¥',....Phone NO./~;.~.~.~..~..I.
.................................... NO. ~.&...l ........
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 S S.
)F
g duly sworn, deposes and says that he is the appllcan'
~me of individual signing application)
above named. He is the ............................................................................................................................................................
(Contractor, agent, corporate officer, etc.)
,ef-~4~.owner or owners, and is duly authorized to perform or have performed the said work and to make and fil~
this application; that all statements contained Jn 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. ~ s~.s¢~¢~
Sworn to before me this ~ . ~ '--"~' s ~?~'ot~,,,. ~
"' ~" m aa~'~ ~0. t~
....... ~../ .......... day of2...A,¢~¢-.~.% .......... 1~...~...~,, ~=;~ ¢~at,~ro or ~,r::~¢;,¢
Notaw PuNic, ........ ~f~,'~:C~:~ ................ County ~' '¢ ~ .... ~ ~..'¢"'