HomeMy WebLinkAbout446-z~OB~ ~0,. 4
TOWN OF ~OUYHOLD
BUILDING DEPARTMENT
TOWN CLEHK'S OFFICE
SOUTHOLD, N.
CERTIFICATE OF OCCUPANCY
No ........ Z...~.3fi .... Date ........... ~.O..V..~..~.,.~..~.. 26 , 19..~.0
q'HIS CEI~TIFIES that the building located at ..]~.&r~ ..~...~.g~.~..t ..~,.~...~.~t~l~et
~ap .~o ........ t~ ......... $~ock ~o....~..*...*. ............. ~ot ~,ro. ?*.. .............................................................
conforms substantially to the Application for Building, Permit heretofore filed in this office
dated ................. ~l~,.~.~..l~q~'....1..~., 195...~.... pursuant to which Building Permit No...~....4~.6 ......
dated ............... .~.~.1~.};.~.1I~..~.~..~]..., 19.~.., was issued, and conforms to all of the requive~
ments of the applicable provisions of the law. The 0ecupancy for which this certificate is
issued is ....... ~RIVATE ONE FAMIL~ DWELLIN~
This certificate is issued to ..... rr_a...l~......D.?.;[?~.:...,~.t~,,...,o~,,~?,.~. ............................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
FOB~M 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.° 446 z
Date ............ ~p~ll~l~l~ .....,1~1 ............... l~r~ ....
Permission is hereby granted to:
Mm. K~ause .-.~G..-.t~,m~k...l)r~e~..~ ...............................
............. ~t~t. tuek .................... .........................
............................ 1I;~'~' ...........................................
t o ........ 11~' ~'~:' ~d ;t~ionll'"on"atl" ~x:l.~ t:13~" dl~t '].t ng ......................................................
at premises located at t~k,..8t...]L~te~t4~i~ ...................................................................................
.................................................................... l~tt,~tuekr.-.#,~.. .............. ~. .......................................
pursuant to application dated ........................ ~0-~t~1~1~-....~1. · ........ 19~J~'~..., and approved by the
Building Inspector
Building Inspector /
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town C .ER,'S omcE
SOUT.O,D,, N. v.
Exomined......~.../...~ .......... 19.....~...~-
Approved ........................................ 19.....t...Permit No...~..?..c~.'....~. ......
Disapproved a/c ...~.~~. .......... ~ .... .~ ..........
Application No..?....~...f~ ...............
APPLICATION FOR BUILDING PERMIT
Date ........ L~..~. ...... ./......~. ............. 19....~...?....
INSTRUCTIONS
a. This application must be complet, ely 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 part for any pui'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 issuanae 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, ordlnances and regulations.
............ .............................
(Signature of applicant, or name, if o corporation)
................... ................
(Address of applicant)
State wheth,er applicant is owner, I~?s~e, agent, architect, engineer, generaJ contractor, electrician, plumber or builder.
................................... ........................................................................................
owner remises P~'~ ~.~. ~ ' . .
Name of of p ............ r ........................ ~ ....................................................................................
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: ................. ~.~Z~...~'T. .............. Lot No: .........--'-T. ..........
Street and Number ..././.z~..~.~...C...%...'.~....~. ....... ~.~.~....: ...................... ~..~~~.-. ..........................
Municipality
2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction:
b. Intended use and occupancy ...................................................................................... t .........................................
3. Nature of work (check which applicable): New Building .................... Addition ....~ ...... Alteration ....................
Repair ............. ,~....Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost.'.,~.¥.~...l~...?~'- ~ ......................................... 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 ............................ ep .........~. .................
Height ............................ Number of btories ..... .k~_..."T..'~.....'t~'.......,~¢... ..............................................................................
Dimensions of same structure with alterations or additions: Front ................................ Rear ................................
Depth .............................. Height .............................. Number of Stories ................................
8. Dimensions of entire new construction: Front../~.../~......../...~.-- - ...... Rear ....... '~/..~'/..../...~.. ....... Depth ./...'~..Z..,~....'~.....~ .....
Height ............................ Number of Stories .....f~ .....
9. Size of lot: Front .......... ..-:~......(R'. ......... Rear ............................ Depth ....../....~'....~......?.....
10. Date of Purchase ........................................................ Name of Form~ O..wn~r ........................................................
11. Zone or use district in which premises are situated ........... Z~. .......................................................................... ~.~..
12. Does proposed construction v~late~ J..~ ,-/any zoning law, ordinance~)/l,~ ~jLQr regulation,? ........ ~ ...................................
13. Name of Owner of premises...~K'~&~...h~(,,~.~.~...~....:Address ...../....r..~..~./. ......... Phone NO .....................
Name of Architect ........... ~ .......................................... Address ................. ~..~...~ ................... Phone NO .....................
Name of Contractor...~.~L.~...~ ................ Address .....:..4~...i~.~.'~.~...~..~.....i~:~...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 NE~,~_~//~ ) S S
COUNTY OF .~,~,...-..._ J.~'~) ._'
...............................~ ~/'~ ~-~..;.'~.~..'~......~."" ~.,4u-'~ ................................... be ng duly sworn, deposes and says that he is the applicant
(Name of individual signing apj~cation)~ _.L:.~ , ,.,_.~
above named. He is the ............................ ~...~...:.;:...~ ........ i...-'J~. ...............................................................................................
(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 app cation; that oil statements contained in :t~is~ application are true to the best of his knowledge and belief;
and that the work will be performed n the r~anp~/:~t J~r,t.b,. n the application filed therewith.
Sworn to before me th~s
/ '~--~J Hay of .~..-:T~.....%~..'...~.., A1~) ;,~...,~0u.~¥ ~!~ ,~ (S gnature of app icant)
Notary PubJic,~~:~~. ~ounty ,~,
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOI. D, N. Y.
Exammed ................... 19.
.......... !~ ...................... 19.h.....Permit No. ~"~ ~Z~r:Z~&
Approved ...................................
(Building Inspector)
Application No. ~?/6/~.
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 adioining premises or public streets
or areas, and giving a detailed description of layout of property must be drown 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 port 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 alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with ail applicable laws, ordinances and regulations.
:~?~,,~ . IX. I' /~ '~-' ~ ~
(Signature of applicant, or nome, if a corporotion)
(Ada~ess of applicant)
State whether applicant is owner, I~s~e, agent, archite~ct, engineer, general contractor, electrician, plumber or builder.
Name of owner of prem~ses...L ...... ;::.:..;..;...~.....:~Z~:.;~:¢:;;...';'...,~; ......................................................................................
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 .... t.',..:;.¥.-..~.-.,~:.~.: ....... ::::f':,~:;: ...... ;'....,: .............................................. ~.~L.,.:b':~ .......................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
o. Existing use end occuponcy ............................ z.......,.~'~.:.....~ ..:'. .............. .~ ....................................................................
b. Intended use ond occupancy ................................................................................................................................
3. Nature of work (check which applicable): New Building .................... Addition ......~T......' ...... Alteration ....................
Repair ............ ~(2....Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost..~:~.:~..O...§:.~...~.."~ ,~ .,, ,~ ........................................ Fee .~. ....................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ......... :; ..................... ~umDer 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 ....................... 7"' Rear ............................ Dep h ............................
Height ............................ Number of ~ones ....... ~ .................. ~ ...............................................................................
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 ........... ~.~...f~ ........ Rear ............................ Depth .....L..~'...?~ .......
10. Date of Purchase ........................................................ Name of Form~ Qwn~r ........................................................
1 1. Zone or use district in which premises are situated ............ ~.J ...... ~ZZ.Z;~.T.;. ...........................................................
12. Does proposed construction violate any zgning law, ordinance ~ regulat~n~ ..~......~ ...................................
]3. Name of Owner of prem ses.,,),,,~,,:,,: ......;~,~&,~-~;;',z,~TL~Qdress ...... ~ .......... ~ .......................... Ynone iN~ .....................
............: ............... ............................................ .....................
.................... ...... .....................
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 NEW,.-yo,~, ~ ) S S
COUNTY OF ....~,..,,~.G.;....)
~'/~,F~'t'~ ,/~,?'> ~~ be n~ duly sworn, deposes and says that he is the applicant
(Name of individual signing appl~tio~)
above named. He is the .................. ~: ..... : ........... ; ........... :r;~ .................................................................................
(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 app cat on; that al statements contained i~t~lic~tion are true to the best of his knowledge and belief;
and that the work will be performed in the mann~,¢~t~;,,~[~}~the application filed therewith.
Sworn to before me this
Notary P.biic,'~~ ................. ~Y'