HomeMy WebLinkAbout510-zFOI~M NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No ........ ~..278 ....... Date .................... At~J,~,....~/~ ................... , 19.~.9....
THIS CERTIFIES that the building located at..~e..~,k~e.~,..&.~,:~,t,t,e~..~4~, ......................... Stree~t
Map No.~.°..~.}..~..w.9..O,.a. ...... Block No ......................... Lot No, ..,32.~ .......... ~O.g,t,~,¢l.~....~,.[~ ...................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.......................... i.~o~e~e.~.....6....., 19~J~....., pursuant to which Building Permit No..~...~.~..0. .................
dated ........................ ~Jil~'a~l~l~e..~,. ......... , 19..5.~..., 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 ..............
...................... ~l'~tA ~L~..g~ .~A~L~.. D.~i~hI~ ...................................................................................
This certificate is issued to ..l~d~k~...~,~.~;~J,l!J.',~;c~l' ......... (..~'~'~.e~..). ...................................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
The O, H, MacGillivrays
42-20 Kissei]a Boulevard
Flushing 55, New York
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town c,=.K's OF,CE
SOUT,OLD, N. ¥.
Examined .......... ~ ....~.~. ......... 19....~...~
Approved ........................................ 19 ........ ~erm t No ...............................
o~s o pp roved a ~ c ......................... /.Z~C.~ :;'~'"'__ '~ZZ'_ .____ ~
........ ............................
(Building Inspector)
Application No. ~¢- ~ 0
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This opplicotion must be completely filled in by typewriter or in ink ond su~ornitted in duplicate to the Building
Inspector.
b. Plot plon showing location of lot ond of buildings on premises, relationship to adjoining premises or public streets
or areos, ond giving a detoiled description of layout of property must be drawn on the diogrom which is port of this locotion.
c. The work coYered by this oppllcation moy not be commenced before issuance of Building Permit.
d. Upon opprovol of this opplication, the Building Inspector will issue a Building Permit to the applicant. Such
permit shall be kept on the premises avoilable for inspection throughout the progress of the work.
e. No building shall be occupied or used in whole or in part for ony purpose whotever until a Certificote of Occuponcy
shall hove been gronted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Deportment for the issuanoe of a Building Permit pursuont to the
Building Zone Ordinonce of the Town of Southold, Suffolk County, New York, ond other opplicoble lows, Ordinances or
Regulotions, for the construction of buildings, odditions or alterations, or for removal or demolition, as herein described.
The opplicont ogrees to comply with oil applicoble laws, ordinances ond regulations.
.... ...... ..................................
(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.
................................. .~...o..~/.~'.z.~.z...%C?' ~.. ,"~--~ . .............
Name of owner of prem,ses ....... ~..~..~.../~....,,...,..v ..................... ,.....*~...~.....,~...~...-~...~....J*....~..(:C.,~.-r ..................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Location of land on which proposed work will be don~e. Map No: ..~..~.~~.:~.¥?...~..J~... ...... Lot No: ~..~ .......
1. Street ond Number .~~.~.. ....... .r~;.,.....~...~'~':;"c¢':C'.'~¢ ............ ~Z~-~.~..¢L .......................
Municipality /
2. State existing use and occupancy of p~emises~nd intended use and occupancy of proposed construction:
. . //(~/-~ o.~./--- ..
o. existing use and occupancy .................... r .......... y~: ...............................................................................................
b. Intended use and occupancy~ ........................ ~~~..~.[. ...................................................................
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....................
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 ........ '.Z.~ ........ Rear ........ ~.. ................. Depth
Height ............................ Number of Stories ...... ~...
9. Size of lot: Front ../.~...~.....?..f~q..~.. Rear .../..~./.~[ ............. Depth
10. Date of Purchase ............ ~.....~.....~'.....~... ........................ Nome af Former Owner ..............................
]]. Zone or use district in which premises ore s~tuated ................................................................................
12. Does proposed construction_ ~f/Avi°~te ~y zoning law, ordinance or regulation? .........
13. Name of Owner of prem~ses..~..~.l.f..~'i .......... Address ............................................ Phone NO .....................
Name of Architect ........................................................ Address ............................................ Phone NO .....................
Name of Contractor...~.:...~.~...~ ............ Address ............................................ Phone NO .....................
PLOT DIAGRAM
I,ocate 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.
/~7 '
STATE OF NEV',Z, YD~,If~,/), ) S S
............................... I:L.?....~::.........'~.......~ ..................... being duly sworn, deposes and says that he is the applicant
(Nome of individual signing appl~otion)
above named. He is 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~ set~rth in the appli~tion filed th~ith.
Sworn to before me tMs - ~ ~,~li? ~e~o~ '~ / J ' /* ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFfiCE
SOUTHOLD, N. ¥.
~pproved ........................................ ]9 ........ Perrmt ~o ...............................
Application No ...... ..%~...z.'...O.. ...........
APPLICATION FOR BUILDING PERMIT
Date .................. /.'*'.t~..'.~.. :'~:. ...... ~ ............ 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 o 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 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 Socrthold, 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.
...... ./: ...... ....................................
(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.
t.~ . ~ 7' , '" ..........................................................
Name of owner of ,rem,se, ...... .Q.~:.~.../~....T~.....~.. .................... L.r..L.....~....t,,~. ............................ ¢ .................................
If applicant is a corporate, signature of duly authorized officer·
(Name and title of corporate officer)
Location of [and on which proposed w.o~k will, be done,. Map No: ..~f...c.~..~r..::.z'?...~..5.~:?.r.:L.:.: ....... Lot No: ....................
1.
Street and Number ....~,~.....%r5,,¢...*~...'.*~, ........ ' ......................... '.:.::;1.,;.,.1,....7/. ............. :.~,~¢;..~.%,-,'.~-:°~.;¢;:\:;,r .........................
Municipality
State existing use and occupancy of premises.,¢nd intended use and occupancy of proposed construction:
2.
a. rxisting use aha occupancy ............................... .o....... X~. ................................................................................................
b. Intended use and occupancy .........................t*~...k.~:~..~..:>~:';¢~:~'¢4..~.:'....¢ ...................................................................
3. Nature of work (check which applicable): New Building ....... ~/../~.........'.Addition .................... Alteration ....................
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 ............................
cars .............. .~ ............................................................................................................................
If garage, number of
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 ......... ~.:..~¢..z. ....... Rear ........ :;,v...~.. ........... Depth ....~....~/.. ...............
Height ............................ Number of Stories ....... ~..~..
9. Size of lot: Front /o "? ~r ~., ~ Rear ..../...f:/...c.( ............ Depth ~-' ~ ?///~-~'/'~' '~.
10. Date of Purchase ............../....F...~..:.~... ....................... Name of Former Owner ......
11. Zone or use district in which premises are snuated ................. ~- ........ ~.~:¢'. ................................
12. Does proposed construction violate ar~y zoning Iow, ordinance or regulation? .......... ,/~..~. ................................
13. Name of Owner of premises....£4;..;~..~..,~. ........~ .......... Address ............................................ Phone NO .....................
Name of Architect ........................................................ Address ............................................ Phone NO .....................
Name of Contractor ............... )..l.t ........ - ............. 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'~ Y~fD~RI~ ) S S
COUNTY OF .~c~.. .~.~::~.:~.~.. ........ ) '
................................... ]~ ....... ~ ...... .~ ..................................... being duly sworn, deposes and says that he ~s the~phcant
(Name of individual signing app~ation) ~.
above named. He is the .............................. .~:~.~.~:~.~:...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 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.an~ s~tb in the a~plic~ion filed the~ith.