HomeMy WebLinkAbout509-zFOI~I~I NO. 4
TOWN OFSOUTHOLD
BUILDING DEPARTMENT
TOV~N CLERK'S OFFICE
SOUTHOLD, H.Y.
CERTIFICATE OF OCCUPANCY
No ..........~....~..9..G..... Date ................................ .J..u.,~.~?....7. .......... , 19....6..0..
THIS CERTIFIES that the, building located at ..!~./...s...,B.a.~.~...'.A..v...e..n..~.~.'....?.,r.~ .e..n...t..'.....N...'...Y.'Street
Mop No ......................... Block No ......................... Lot No ...................................................................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
November6 19....5..~., pursu,a'nt to which Building Permit No. Z 509
dated 5Tovembe r 6 58 .
...................................................... ] 0 ........ , wa.s issued, and conforms to all of the requirements
of the applicable provisions of the Jaw. The occupa,ncy for which this certificate is issued is ................
PRIVATe: O~E ~ A~4ILY DT;~LLIST(.~
_ Eleanor ~to~fel, owner
This certificate is issued To .....................................................................................................................
(owne. r, lessee or tenant)
of the aforesaid, building.
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? 509' Z
Date ............ No.v.e~her......6 ................... 1~.~ ....
Permission is hereby granted to:
Ele~r..B.tof. f~l ....................................................
.... :~:.....~.e.. ...........................................................
.............. ~:tent e.....~,.~., ....................................
to ~tlct an addi.tton on an .eXi~;~Dg .d~..1..].,/~g .......................
at premises located at ......W~J.....~.I~lr...~Y.9. ..........................................................................................
Orten~
pursuant to application dated .................. NO.'F.~J~.~F....~..,.......1.9~..~......19 ........ , and approved by the
Building Inspector
Fee $ ~. ~,.0.,.0. ..............
Building Inspector
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Exominea ............. v ..................................
Approved ........................................ ]9 ........ Permit No ...............................
Disapproved a/c ........i ........ j;z:~:~ .......................................................................
Application No ..... ~..~. .............
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
/Var
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 o 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 ~S HEREBY MADE to the Building Department far 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.
...............
......
......... ?.. ;.. ..... ..~, .......
.... (Address of applicafit)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
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 .....~./"~........~....~....~. ....... ~ ........... 7..~ ......... ]~"/":"'~'" ........................
~, 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 applicable): New Building .................... Addition ...... ~....Alteration ....................
Repair .............. ~v...Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost..G/..~....~....~.. ............................................ Fee .....................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling umts ................................ Number of dwelling units on each floor ............................
If garage, number of cars ............................................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent f ea. sh type of use ..............
.............
7. Dimensions of existing structures, if any: Front ............. .~....?.. ..... Rear ................. Depth .....~....~. ..............
Height ............................ Number of Stories
Dimensions of some 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 .... /...].~....~. ............ Rear .....~....'Z....~7 ............ Depth c~"O ~
10. Date of Purchase ........................................................ Name of .F, or~er Owner ........................................................
11. Zone or use district in which premises are situated ................. ./.~
12. Does proposed construction violate any_zo~n.g law, ordinance or regulation? .............. /.~.?. .............................
13. Name of Owner of premises..~.~..~.~..Address ............................................ Phone NO
Name of Architect ...................................... ~ ................. Address ............................................ Phone NO .....................
Nome of Contractor .................................... Address ............................................ Phone NO .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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'~¢( Y~P~K¢, ~)/ ) S S
............................... L.~'~*~...,..-~.....~..,,~.~.~.~...ir.,.~x....,..,~. .......... being duly sworn~ deposes .and soys that he is the applicant
above homed He Is the ~....~.,., .......
(Contractor, agent, corporate officer, etc.)
of said owner Or owners, and is duly authorized to perform or hove performed the sold work and to make and file
this application; that all statements contained in th~ application are true to the best of his knowledge and belief;
and that the work will be performed in the manner ~,'~,,~.J~.c4n the application filed therewith. ~ ~, , ~
Sworn to before me this ,, II~/~li~, ~ ~O~,n~. ~ d .Z~ ///. ~7
.............. ~ ...... day of ....... ~K..~TT...~: ..... 19.~.?.(~/~.?'007r o~? ?o*~ (Signature of applicant~ / /)
--~_~=,.,zQ~.~t~-'~ ~:,tl)l).e ~?aO0 ~oty '" '
FORM NO. 1
TOWN OP SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLDr, N. Y.
E×am ned .............
Approved ......................... ~..] ........... 19...~!...Permit No...~...~...?.....~ ........
Disapproved o/c .....
............ ...............................
(Building Inspector)
Application No.......~...c.?....~I ............
APPLICATION FOR BUILDING PERMIT
Date ............ L .V'~...C.?...~<. ...... ..~.~ ................... 19.~..~ ....
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 cov, ered 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 krept on the premises available for inspection throughout the progress of the work.
e. No building shall be occupied or used in whole or in pert 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 issuanc,e 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 alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applioable laws, ordinances and regulations.
.... ~ ............................................. .: -.~,.-..-.. .................. : ..............
(Signature of apphcant, or ndme, ~f a corporot on)
......... 7' .................. '(~l"~J;~ ' ~:( '~;'i;~ht:")" ......... ;:) ................
State wheth~er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nome of owner or prem~ses.....~ .......... ' ................................ ~.* .......'~?p' '-' ........... "~ ...................................................
If epplicant is a corporate, signature of duly authorized officer. / ~
.............. '('l:,l'a'me and title ~'
1. Location of land on which proposed work will be done. Map No: ...:: ....................................... Lo No: ....................
Street and Number .....~./~.......~.i~..c'J~ ...... ..~-~...~ .............. "~"~"%~:~ .......... "~" '/":'~"/": ........................
Municipality
2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ............... t~ .................................... .'~ ..............................................................................
b. Intended use and occupancy ................................................................................................................................
3. Nature of work (check which applicable): New Building .................... Addition ...... ~....AlteratJon ....................
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 natur.e, and extent,of eafh 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
9. Size of lot: Front ..... ./..~..~ ........... Rear ...... /...Z...../. ........... Depth ~yO f
10. Date of Purchase ........................................................ Nome of Foxn~er Owner ........................................................
11. Zone or use district in which premises are situated .................................................................................................
fv
12. Does proposed construction viola,~e any ,.~o~n,g law, ordinance or regulation? ....................................................
13. Name of Owner of premises...~..,~....'.Sz.. :.~-...Address ............................................ Phone NO .....................
Name of Architect .............................. ; ......................... Address ............................................ Phone NO .....................
Name of Contractor......:.-...i..;~, ............ ;...'..'~ ................ 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 NEW YORK, , ) S S
COUNTY OF .~....~.~._..0_~ ........ ) '
.............................. ~~.~....~~..: ........... being duly sworn, deposes and says that he is the applicant
(Name o fc~i~u-a !
obove 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 ore true to the best of his knowledge and belief;
and that the work will. be performTd ,i~ the mann~ set~ .D ,jr~h,,,.i,n the application, fil,ed,.tl,erewith.'