HomeMy WebLinkAbout478-zFORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. Z :~02 -.- ~T~.t 1, 1~.?. .....
........................ LJoTe ..........................................................
Map No.~..1..*....~..?.?.v..?. ...... Block No ......................... Lot NO
conforms substantially to the Application for Building Permit heretofore filed in this office doted
............................ .O...~..t..e..b..e..~.....~. ...... 1~..8. ...... pursuant to which Building Permit No ......... ?.....A.,*~.. .........
doted ............................ .O..c.~.o..b..e.~.....2.~...., 19..5.~..., was issued, and conforms to all of the requirements
of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ..............
Private one family dwelling (var~anoe sranted by Board of Az,peals)
t~Charle. Abrahams (owaer)
This certificate is issued
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
FO~M NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL F:ULL
COMPLETION OF: THE WORK AUTHORIZED)
N.°:~t78 Z
P~rmission is hereby/~/)ted to:
' c~..~.....~..~..~ ................
...~ r....r.~...:...~....~...~ .........
.............. ...~.......~~~...~. ....... ~..:~.: ....
,o...4 .....¢.......~ .................... .~ ............................ .: ..............................................
.......
............ . .......................................... .~...~..~.~..~:Z~ ..............................................................
Building Inspector
ui ding Inspector /
NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
NOTICE OF DISAPPROVAL
To ......... J~o.b~Z: .~...'D. a~. %...a,/..~.. C.~l[~.;F. ~ 5_ .Ah$' ahams
.......... ~ ~:.%Y.~ }:~... ~.~ ~,,(~ ~...~f~.~... ~.~:~.fi ...~[~ Z~ ]Lane
.......... ~.~.t~ ~k~..~...~.q~'~ ..................
PLEASE TAKE NOTICE that your application dated ............. ~.~.~...~.~.. 19.J'~..
for permit to construct ~,~.~$~ ....................... at the premises located at Y f/.a..~'.~..~.6~'Zq .......
.......... Street
Map ........................................ Block ............................................ Lot ............................................ is
]~}~e~[t~z~disapproved on the following grounds ............................................................
................................ .xz.(~Z~.~LLqn...off...~,kc&e. LTZ~...~s.c..3OD, .,~]z~, ~ ~ ...........................
........................... ,~...}0~ 30~ 3~6 amd...$a8 ...............................................................
Fz'onta~ze Zess than ~00 ?t,~ front xard set~ek less
t~.an 3) ?~-~ corner Zot requ:~rzng 3~ Ft. on eams szde, rear Faz'~
].ess than a~ ft. ' ' ~
Building Inspector
FORI~ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ........................................ I ~ ........
Approved ........................................ 19...L...Perm~t No ...............................
D sapproved o/c ........ · ...... ~,. · ......... ~
............. ...............
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ........ ~....~......., .~.......~c ' .................. 19.......~..~...5-
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 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
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 laws, ordinances and regulations.
......Ch^Rk=£ i'...' .............. '.....Z. ...................... A 13 2BA b, .'. ................. ' ..........
(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.
~ame of owner of premises.....~.g.~.?......~~;..°;~..: ..............................................................
If applicant is a corporate, signature of duly authorized officer.
1. Location of land on which proposed work will be¢one. Map No: ...~v:~'~...c~.......?....~....c:..~...°~... Lot No: ....... .............
Street ond Number ..v.......' .4................~ · ...... ~,g...~ ...... ~..-~ ..........
Municipality
2. Stqte existing use ~nd occupancy of p~emises ond intended use ~nd occupancy of proposed construction:
o. [xisdno uso ond occuponcy ................. ¢.~ .................................................................................
b. Intended use ond occupancy ............... ~¥ .........................................................
~A
3. Nature of work (check which applica'ble): New Building .................... ddition .................... 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, if any: Front ............................ Rear ............................ De'pth ............................
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 .......... ..~....~.....O...,A~... Rear ...... .~......~. .............. Depth .~..~.....O.r..A.:. ..........
Height ............................ Number of Stories ~...~.. ..........
9. Size of lot: Front ...~-... ................ Rear .~.¢./....~..'.~...¢...T~C..~Depth ./.?.:~..?../..../.~..
10. Date of Purchase../.~.....~....~....~..Z.~'...~.Z.~.. ................ Name of Former Owner ........................................................
1 1. Zone or use district in which premises ore situated .................. : ...........................................................
12.
Does
proposed construction viol~e anvj~oning law, ordinance or regcllation.....~'...: ...........................................
13. Name of Owner of ............. Phone NO .....................
Nome of Architect ........................................................ Address ............................................ 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 NEV~C~K~,P/~ ) S S
COUNTY OF ..~.~)......) '^ .
................................ ].L~.....~~..being duly sworn, deposes and soys that he is the app, icant
(Name of individual signing 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 oil 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 ~efore me this ~ x~ ~O;s~ ~0' ~ [2 x~ ~ ~ ~
~ ~ . ', st~t. or ~ ~ ~
............... A .... o, ......... ........... ,,,,.
. ' · '~;~' :~'u367800 -
Notary Publ,c,~...J~.~....~. ~ ~xp,res ~re~ ~, i~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
Examined .......... . ..~..~..~....~........ 19.. r..~...~
Approved ........................................ 19 ........ Permit No ................
Disapproved a/c ..... .~. ................................ : ....................................................
Application No ........~..~...?...~ ......
APPLICATION FOR BUILDING PERMIT
Dote ........ ~.~.~....~.....~-...~ ~; ~2 .................. ! 9.......~.~'' ¢~ ....
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 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 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 issuanoe 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 nome, if a corporation)
......... ........... ..........
(Address of applicant)
State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. ......................................................................................................
.................................................... ................. ......... l ' .......
Name of owner of prem~ses....~ ............................ ~ ...................................................................................................
If applicant is o 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: ...~;:,(.~:...'~ ...... ./...(-.'.'i~:~.~.~":.~.'..~, Lot No: ...... , .............
Street and Number ....................:'.:'..; .......................................................................... ;' ......... ""~ ........
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .................~. :¥~'.~. Z?. · .'~ · · .~. · ../..~:?. · .q · · · · :, .................................................................................
b. Intended use and occupancy .......... ~......,~. ............... ~ ...................... ~ ........ ~ ..........................................................
4.
5.
6.
10.
11.
12.
13.
j I
Nature of work (check which applicable): New Building .................... Addition .................... Alteration 't ..................
/
Repair .................... Remo~l ~ ................... Demolition .................... Other Work (Describe) .................... /
Estimated Cost .............................................................. Fee .........................................................................................
(to be paid on filing this application)]
If dwelling, number of dwelling units ............ ~': ...... Number of dwelling units on each floor ... I .....
If garage, number of cars ............................................................................................................................................
If business commercial or mixed occupancy, specify nature and extent of each type of use .................
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 ............................. ..~umber¢~ (5:) C)A°f Stories ................................
Dimensions of entire new construchon: Front ............................ Rear ....... ;~..: ................ Depth ........................
Height ............................ Number of StorJe~ ....... ~-~ ..................
Date of Purchase
...................................................... ame of Former Owner .......................................................
. ....... ..........................................................
Zone or use district in which p~emises are s~tuated ............ ~ ~
Does proposed construction vloJ~e a~ zon~gg Jaw, ord nonce or reauJat~on. ....~ ...........................................
Name of Architect ........................................................ Address ............................................ Phone ~0 .....................
~ome of Controctor .................................................... Address ............................................ Phone ~0..., ..................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dime~
property lines. Give street and block numbers or description according to deed, and show street names a~
whether interior or corner lot.
isions from
STATE OF NEW~.Y0~JK, /) ) S S
COUNTY OF .~.(~.....) '
................................ !1. ,~, .~.~,z,,~ ,~,~ ,~..... g..,'~-,'.,, r '..:L. ,.,.~.~,.. being
(Name of in~vi~lual signing app ication)
~d indicate
duly sworn, deposes ~nd says that he is th~ applicant
above named. He is the ................................. f"~...×.~,¢~.~ ........................................................................... i ................
'--' -" (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 fife
this application; that all statements contained in this application are true to the best of his knowledge 6nd belief;
and that the work will be performed in the manner s~,,f~xth in the application filed therewith, j
Sworn to before me this ~ ~/Ic~t~
· · ,-" sidi I~ ,I ~t Yo."l~ ,
· e2~,~ day of ....... /':]:.:~"~,~.~,,.,,,¢:,.~lv.~,19..~..~,c".,~,~,.,u~ty~°'/~ Co ~' (~[gnatqret off apl?h,cant),' - ' (
Notary Pu bi lc, ~z-,~t,~ ../.~.~ ~...~u nty aO,