HomeMy WebLinkAbout493-zFORi~I NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No.g... 66 ............. Date ..............................
THIS CERTIFIES that the building located at g/.g..R.~t~.l~..RO&0. ..................................... Street
Map ~.~.~..,.K..:i:~..~!!~..g Block No ...... ~ .............. Lot No. ,~,00..~ ........ l~t~;.:~t,~,OtC~......}~,.~r, ........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
......................... OO¢~Z'......~,.-.-, 19.~'~.., pursuant to which Building Permit No..~...~C),,~ .............
dated ......................... O0.t, otl~Z~.....~.. 19.~8..., was issued, and conforms to all of the requirements
of the applicable provisions of the Iow. The occupo.ncy for which this certificate is issued is ................
..................... P~'~.v~te..~me..~.~y...dwet-~.~.ng ...........................................................................
of the aforesaid building.
Building Inspector
FO~FI NO. 2
TOWN OF SOUTHOLD
I]U~LDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS F~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 193, Z
Date ..................0. g.~ .0...b.~ :~.,,,,..~.~. ............... 19..~..
Permission is hereby granted to:
.............. ~.~,.~m~U~.s.t ~.....~ ....................................
to ........ 'B~:~:t~"new"d~e']:~i~g ........................................................................................................
~t premises located ~t ....~O.~...~....,C~,..,Jl.i~d...~&g~.~ ...................................................
pursuont to oppJic~tion d~ted ..................... OD.~.~.,...~.~ ................. ]9...~, ~nd epproved by the
Building Inspector
Fee $......~0~C0(~ ......
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ....... .~..~.~....~....~.. ......... 19..~.'...~..
Approved ........................................ 19 ........ Permit No ...............................
Disapproved a/~.~.:~ .......................................................................................
.................................... ~.'.' ......... ~ r.'~. ;:Z.~ ............................................................
........... ..............................
(Building Inspector)
Application No. ~-/~ ~
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 port 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 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 o Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk Counfy, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, os herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
~(Si nature o Opp ci'~~oraf"(~ ~ '~ 't ~'~'-~ i~ n)
...... ,~,g~re ~o:'"i~; ~. ....... ................ ........... ~ ~"'~ ............
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nome of owner of premises ........... t.~-~-.--.-..~. ..................................................................................
If applicant is o corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work wjII be done. Map No: ~..?.~.~.~.. Lot No: ..~...~...: .....
Street and Number ~' 0 iD .~ ~ ...... ~~'..~.~ .....................................................
Municipality
2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction:
a. Existing use and occupancy........~...~.~.--.....~ ................................................................................
b. Intended use and occupancy .......... ~~ ........ ~-~..-~,~...~t~.:Z~: ..........................·
3. Nature of work (check which applicable): New Building ...... .¢~..... ...... Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
(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 .............; .................. ~
Height ............................ Number of Stories ....~..../.~. .........
]]. Zone or use district in which premises ore situated....:.~~? ...........................................................
12. Does proposed construction violate any xoning Iow, ordinance or regulation? ....................................................
13. Name of Owner of premlses,..~...~ddress ............................................ Phone NO
Name of Contractor ......... ~~ ....... ~u~'~w'X'~ '~ '?~'.,..~..~ddress ............................................ 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 strdet names and indicate
whether interior or corner lot.
STATE OF NE'kI~.Y.~K,,~.,~ ) S S
/--
......................... .~, ..................................................................... be ng duly sworn, deposes ond says that he is the opplicant
(Nome of individual signing opplicatlon)
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 will be performed in the manner set f~r~;Jz in the application filed therewith.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S O~:FiCE
SOUTHOLD, N. Y,
Exam,ned ....... ........ 19...5
Approved ........................................ ]9 ........ Permit ~o ...............................
Disapproved ~/c .................................... ~ .....................................................
..............................
..................
{¢uildinfl Inspector) ~
Application No..~./..?..'..~. ................
APPLICATION FOR BUILDING PERMIT
Date.... ~./..~.: ................ .~. ............................. 19.. :/....~.%...
INSTRUCTIONS
o. This application must be completely filled in by typewriter or in ink and su~amitted 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 pu~'pose whatever until .ct Certificot~ 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 Lows, 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. ~.~ , ~
....
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
/!! '
Name of owner of premises ........... ,~,,.~ .............. ~/ ............. ~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 wjII be done. Mop No: Lf~/j~:..~g.~.z~....~ Lot No: ~¢..~*..~ ........
Street and Number .............................. : ................ ~ .................................................................................................
Municipolity
2. Store existin0 use ond occupancy o{ premises *nd intended use and occuponcy of proposed construction:
o. Existing use and occupancy.**...~.3~ffJ:~..~- ........ :~=**~ ...................................................................................
b. Intended use ond occuponcy ......... ~.~ .................. ~ ............ :~:......~~ .............................................
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....................
Repair ................ ,..Removal .................... Demolition ....... :¢;:,~ ~.... O~er Work (Describe) ....................
4. Estimated Cost....~....Z.~...~..¢...¢...¢.!...¢.~. ............................... Fee ..~..~:. ................................................................................
(to be paid on filing this application)
5. if d~velling, 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 ...................... :~.~¢~.u~ber of Stories ...~.~.~--.'2 .............. ~-
8. Dimensions of entire new construction: Front.....~¢~,,,..../. .......... Rear ............................ Depth
Height ............................ 10¢2, NumberE) of Stories .,;/;¢~t~¢ .......
9. Size of 'o,: Front .... },.¢.~-~ ............ Rear ............................ Depth ..................
10. Date of Purchase ........................................................ Name of Former Owner'. .......................................................
1 1. Zone or use district in which premises ore s~tuoted ....... ~ ....................................................................
12. Does proposed construction violate ony ~oning 19w~ ordinance or regulation? ....................................................
13. Name of Owner of premises ........... ......¢....>~t~ddress ............................................ Phone NO .....................
Name of Architect ............... ~:..'~..~.......'...~.~ddress ............................................ Phone NO .....................
Name of Contractor ......... .~.~.....¢. ...... .'.%--..'::~ddress ............................................ Phone NO .....................
PLOT DIAGRAM
Locate clearly and distinctly all buddings, 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
......................... /. ..................................................................... being duly sworn, deposes and says that he is the applicant
(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 all statements contained in this application are true to the best of his knowledge and bef'ief;
and that the work will be performed in the manner se~ forth in the application filed therewith.