HomeMy WebLinkAbout502-zFOEM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at ...W/.~.....}{ai~e~..~8.~.e. ........................ Street
Map No ....... ~.~..~...~. .................. Block No .......... ~.~.;¢. ..............., L;~(Y~ffq~...~..~...~.~..~.~..~..q.~..t......t.%T.,*..~~'o
conforms substantially to the Application for Building Permit heretofore filed in this office doted
..................... .0.q.l~.O.~P¢.~......,~.9. ........ 19..~., pursuant to which Building Permit No .....~....~..O..2.. ............. ,
doted ..................... 0.g..~O~.eI'......~9 .........19..~'.~.., was issued, and conforms 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~..~.~[ ...............................................................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspec~ror /
FOI~M NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
N:
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
502' Z
Permission is hereby granted to:
at premises located at ...~.../..~.......~...~..~..d...Q.~.........L~...fl...~. ..................................................................................
.............................................................. .1~ .~.t.~ .~Uc~k, ..... ~1, ~:, ............................................................
pursuant to application dated ..................... .0.1~.'~.1~.11~.~......~ ................. 1~'~....., and approved by the
Buiiding Inspector
Fee $.~.......0~.. ..............
A. RE:ILLY & SONS, INC.
MATTITUCK, LONG ISLAND
NEW YORK
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ........ .C.~ :~;..~......4.. ~i! ......... 19...~.'..~..~
Approved ........................................ 19 ........ Permit No ...............................
Disappr°ved /lc ~r '~ ....... ...... ~
........................ 'i ;) ........ .........
Application No ..... Z...~...~ .....
APPLICATION FOR BUILDING PERMIT
Date ......... ...~....~ ........ ~..7 ................. 19..?'....~.~....
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and sctbmitted 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 Buitding 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 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.
State whether applicant is owner, le~sssee, agent, architect, engineer, general contractor, electrician, plumber or builder.
premises ~..b~.
Name of owner of ...................................... '[ ............................................................
If applicant is a corporate, signature of duly authorized officer.
................... '('~'~'rne and title of ~;'r'~'~'r'~¥~";;¢¥'i~;;;~ ..........
1. Location of land on which proposed work will be done. Map No: .................. Lot No: ....................
Street and Number ....~./~..:.....~.,..~'.'(.~.~...~"~,- ........... ~,.~...~"~' ';~';':"~'~ ........................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
o. Existing use and occupancy ............................................
b. Intended use and occupancy ........................................ ~ ...... : .........................................................................
3. Nature of work (check which applicabTe): New Building .................... Addition ......... ~..Alteration ..~ ...........
Repair ............. .w,,..Removal .................... 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 ar 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 ................................
8. Dimensions of entire new construction: Front ............ ~,...( ........ Rear ......... ~.....~.. .......... Depth ...../.,.~ ............
Height ............................ Number of Stories ...,.O~', .~ .......
9. Size of lot: Front .~../..../....~.. ........ Rear ............................ Depth .~....~. .........
10. Date of Purchase .................................................. Name of Former ~wner ..................................
] 1. Zone or use district in which premises are situoted .......................................................................
13. Name of Owner of premises../.~'..'.J.(..~..,~ .......... Address ............................................ Phone NO .....................
Name of Architect ........................................................ Address ............................................ Phone NO .....................
Name of Contractor,~.:...~.~..g.~'~ ^ ............. Address ............................................ Phone NO
PLOT DIAGRAM
Locate dearly end distinctly ail 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.
LA,
STATE OF NEV~ YQ. RJ(, OJ ) S S
..................... ~~~--~L ....................................... being duly sworn, deposes .and soys that he is the applicant
(Nome of individual signihg applic.~tion) ,
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 application; that all statements contained in this application ore true to the best of his knowledge and belief;
and that the work will be performed in the m.ar~,c s~o~[erth in the application filed therewit~n.
'-,?.fy p~ '~,~ BO
Sworn.to before me this ,,~ .~ Rf~ddl..blle' Sta, ~0£N ~. I /~,-§~
.................. ........
.... .. :.. .. ]
Notary yuguc, . ............... ~.~.~...~ ........ ~ounty 30, ~ ~
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ........................................ 19 ........
Approved ........................................ 19 ........ Permit No. ~'~ ..... ~ o ~
Disapproved a/c .............. '~. ....... :.~.~ ..............................................
/~.~ ,,?~-. ~ ..... ~,~,,~, / ~..-~.. -~
....................... ....................... ........
Application No ..... .~....~)....~ .....
APPLICATION FOR BUILDING PERMIT
Date ......... ........ .................
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildinf~
Inspector.
b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or punic 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 aDplicafion 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
I~uilding 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.
..... .~.. ......... :...:~ ...... 2'..: ..........................................................
(Signature of applicant, or name, if a corporation)
................ (Address of appli~Yant)
State whether applicant is owner, le_ssee, agent, architect, engineer, general contractor, electrician, plumber or builder.
....................................................... k..,,~.:~..~:::~;2:' ::(;: :.x,. ..................................................................................................
Nome of owner of premises ...... z._..,,:',..'.; ................. '~ ........... ':....~ ....... .f ..................................................................................
If applicant is a corporate, signature of duly authorized officer.
1. Location of land on which proposed work will be done. Map No: ................ Lot No:
Street and Number ....~:'. ...... ~.1......,...~-.,¢... ~:,~ ............... J .......... ~.-~.~ ....................................................
Municipality
2. State existing use and occupancy of pr,em~ses and intended use and occupancy of proposed construction:
a. Existing use a~d occupancy ....................................................... k. ...................................
b. Intended use and occuponcy ............................ x ............ ~'.;.....; ...........................................................................
3. Nature of work (check which applicable): New Building .................... Addition .......... ~"...Alteration ....../':':t~-... ...........
Repair ............... ~,~,.Removal .................... 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 ............................
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 ............ .q~.. ............ Rear ............................ Depth ............................
Height ............................ Number of Stories
9. Size of lot: Front ...~..~:~..f...C.(..: ........ Rear ............................ Depth
10. Date of Purchase ........................................................ Name of Former 9wner ........................................................
11. Zone or use district in which premises are situated ............ './~'. ....... ¢~:.~:.7¢:.....
12. Does proposed construction violate anYrZOning law, ordinance or regulation? ......... ~..- ..................................
13. Name of Owner of premises..t...:.~.~...~..~..~..'7....~ .......... Address ............................................ Phone NO .....................
Name of Architect ........................................................ Address ............................................ Phone NO .....................
Name of Contractor/..:......L~-. :v'~..:,-..~..vlk....',.~ ............. 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 NE"~ ~P~l(,ffy ) S S
COUNTY OF ...~...',.,,/r:.2J;..'~.,..~..'' ....... ) '
................................. 7...:.-...:.;:..'.~.:~. ....................................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing appl~atlon)
above named. He~'s the ............................... ~~,~ .............................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or hove 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 m.ann~t~h in the application, filed ther~itb.
Sworn~bef~emethb .-.,, I /;' ~L~,~t~ ~ ~/~ .~1 ~1~,~
........................ day at ....................................... ~-r~f~.~e.o~6z8 ~}~ ~ tb~gnature or appu~n~