HomeMy WebLinkAbout512-zFOP~M NO. 4
TOWN OF $OUTHOLD
B'U ilLDIHG DEPARTMEHT
TOWH ClLERK'S OFFICE
SOUTHOLD~ H. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at .~e~,~,[e~i...1)~.,.~.,;~.~.~..~,,~.t~t~ ........... Street
Map No .......~w~ ......... Block No: ....... Wa'W ....... Lot No ................... ~:~...,~ ........................................
conforms substantially to the Application for Building Permit heretofor, e filed in this office dated
512
.............. ~-~t~e~"~. ........................... , ]c)..~[. pursuant to which Building Permit Ho. ~"~1~'
doted ...~r~.~l~ll....lB ......................... , lC)....~lB was issued, and confot;ms t~,oll of the requirements
of the applicable provisions of the I,ow. The occupancy for which this C(~rtificote is issued is ..........
This certificate is issued to .................................. ~.~.f~,~,~l:l..~e[~I/',~...O(~'l~ ........... r ........................
(owner, lessee or tena~nt)
of the o,foresaid building. ~,
c' /~ ~'~- '
.......................... ................ i ........
FORM NO. ~
TOWN OF SOUTHOLD
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? 512, z
Date ................. .~.~..O..~...e..~..~...e..Z'. ........ .~. ............ 19~...~ ....
Permission is hereby granted to:
~.~..a...~..~..~...~.:!~.z. ~. ......................................
........ ~i~.~,.a.g..~,~r....-....~.~..~ ................
................ ~.~..~.,......~.~ ...................
to ........ ~.~...~.~...~.~ ~.~g ........................................................................................................
at premises [~ated at ..... ~.~.~...~.~...~.~ ....................................................................................
............................................ t'.'!~.~...Y~t~.....~.~.~.~.,......~,.z,. ...............................................
pursuant to application dated ................. ~Y.~.~.....~. .................... 19~...., and approved by the
Building Inspector
FOE~ NO. I
TOWN OF SOUTHOLD
SOUT,O,O., ,. ¥.
, ~ '~. ~22. ~,~ ~
Approved ........................................ ]9 ........ Permff No ...............................
Application No......~..../..2Z~: ..........
APPLICATION FOR BUILDING PERMIT
Date ........... ........................ ,gL.Y.......
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 p art for any puFpose whatever until a Certificat. e 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 alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances an~,~%gul~tion,~,
...............
(Sign,g,~re of applicant,'~r ~f <~'~ation) '"
(Address of applicant) "
State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, elect'rician, plumber or builder.
Name of owner of ............................. ~Y ...............................................................................................
If applicant is a corporate, signature of duly authorized officen
(Name and title of corporate officer) ~._.1
1. Location of land on which proposed work will be done. Map No: ............................................Lot No: ....................
Street and N ...... r ............................................................ .~ ............................................................
Municipality
2. State existing use and occupancy of p,emises and intended use and occupancy of proposed construction:
a. Existinguseandoccuponcy...~..~..~.~...g~../,: ...... .~...~...~.../~... .........................................................................................
b. Intended use and occupancy ....... ~./~.~.,......~.~...,?g../..~.../y.......~..~.~.K...L..,.~..~..~. .........................................................
3. Nature of work (check which applicable): New Building ....... .~...........Addition .................... Alteration ....................
Repair ................. ..~,emoval .................... Demolition ................ ....z~Other Work (Describe) ....................
4. Estimated Cost......~....,('.~.;~..~..~...~.. ............................... Fee ......... .?'../..?..:....~?.. ...............................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ........~.~(.~r ............... Number of dwelling units on each floor ............................
If garage, number of cars ..........~.'~ .~.....~..o.~....~. .............. ~.~..~...~...~..~.. ...........................................................................
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 ........ .~.,.~.. ............. Rear ......... ~....~..../. ......... Depth ............................
Height ..... ~...~..../. .............. Number of Stories .'~.'.~L.7~.....~...~...~...~,..~' 3 J~'u~ £ $'
9, Size of lot: Front ....... .?.~...~.~.~ ........ Rear ...... .~.i?...'..~..~ ...... Depth ........ (.~....~.. ..........
10. Date of Purchase .................. ,.~12J-~. ..~..~,,,/ ../. ,~'~'...~. ............ Name of Former Owner ..~.L~..Z./.t?..~....~.....~....~..'?.~..~..,~.~.../~./~.~.f~,~r
11. Zone or use district in which premises are situated....~.........~.~...~'./'.~..~...~.~/..~...z......~..`~.~.`~.E.'~..~.~....~.~.~.....~. ..........
12. Does proposed construction violate any zoning law, ordinance or reg,~,~ation? ......... ,~....~.. .................................
13. Name of Owner of premises.~.~.fL~TZi(~C~..Z..Z...~.....Address .~'..~-~...~.4~...~ ........ Phone NO. ,~f,.~...~.~-~ ......
Name of Arch.tect.~.g~.~ ~.~....~.r,.~..~/,~..~...~.. ......... Address ~ .......~.._.._.._.....-~.~.. hone NO..........,...'--'-~.~ .....
...... ,~,~Wp~
Name of Contractor......:.~..~. ......... ~ ....... ~ ............... Address ....../~../F.~>~./.?.~:~/..¢.~, .......... 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.
/.o7'-
STATE OF NEW YORK ) S S
COUNTY ~.~ '
................ i ............... b, ng duly sworn, deposes and soys that he is the applicant
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 applicat on; that al statements contained in this application are true to the best of his knowledge and belief;
and that the work will be--~e~/)r~ned in the ~anner set forth in the application~led~he~.
Sworn ~ b~f~_re me ~ ~ ~ "A..Y.~, "OCli, ~~
~.~;~.:~~~~~oy ...... ~.... C~t~::, :k~~~(S,gnotur~' of ap~cant)
TOWN OF $OUTHOLD
, U,LDI.G D P^.m. NT
Town CL RK'S OmC
SOUT.OLD, N. 'r.
.................
Approved ........................................ 19 ........ Permit ~o ...............................
Disopproved o/c ..............................................................................................
(BuHdf~ {Inspector)
Application No.....?./.L.~ .............
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 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 cowered 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 k, 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 Certiflcafe 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 alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and
(Signat~e of apphcant, or name,t,'~'~ corporation)
....... ~.. ......... ~',~dd ~ ~ · ~ ~' '~'pp i'[~ ~ t)',v ............. :<~ ..........
State whether appJicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................. .O...~.~. ..........................................................................................................................................................
Name of owner of premises ............. ,~.~.. .~ ....................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
I. Location of land on which proposed work will be done. Map No: ............................................Lot No: .....~....~.~.~.. .....
Street and Number ....................... /~..~.~.'./~...~../.~.......~...~.~ ............ ~...2~.~.~..~..~.:,4~Z' ...................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ................ /'f.~-..c:'~..~..~.i..~......~.'..~..,~..i'..~.. ..........................................................................
occupancy .............................. ~...,,~...~.. . .~. _Z~...x7,,,2.4,. ~-
b. Intended .se and .,,... '..~
/
3. Nature of work (check which applicable): New Building....J~...... ........ Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition ............... ,:,..Other Work (Describe) ....................
4. Estimated Cost...~'.../~,~.~..~i..~...~.. ................................... Fee ......... .................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelJMg units......~.~.~'. ................ Number of dwelling units on each floor ............................
If garage, number of cars . ..~..d~...~.../~.~.~..'..~.....~...~.~.....(~,~/~, .......................................................
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 ........ ?Z') ................. , / ri
! ........ ~O ................ Depth ....~...'~ '~
8. Dimensions of entire new construction: Front .......... ~..~.. ........... Rear ....................
Height ........ ~..~...~. .......... Number of Storie~..~'..~.(.~......~'T....~.]./~...~.j-
9. Size of lot: Front ..... .~..~.1..~.(~. ......... Rear ..... ~..ZT,.,...~'..~.-- ......... Depth /.d)~/~
10. Date of Purchase .~.,.~..q.~.y .¢~.~.,,~ /ff.,$.~.. of Former Owner J4Jl. J'~L/~....~J~W"'~..ff'.ff. ff..fz..~/,~/I
............ Name' "~' .......................................
..........."" ftc.s' '
11. Zone or use district in which premises are situated,.~. ........ J~-~'.':l~..~/../~.~.....?... /~R~..~.'/d.,~/~J~ ..........
12. Does proposed construction violate any zoning law, ordinance or re.~ulation? ...../J~.~... ........................................
13. Name of Owner ofz2 / ~/ ,'~ %~,~ ---~z~,/premise '~'~'~'/~'"~'Y'~""~'/"~'"2'~'/~'"'Address .,~..f.?..~..~:t~./~.,..~.,t.~.~.~F~,~/~,P~h~n:d~;~ ~/ ~/'~_ Og NO. ~.~.. ....
Name of ......... ....... Phone NO .....................
Name of Contractor F.~.~.~.. J..~.~..~...b.~.. .......... AddressT~....~..~'..~_~..~.ff:..~'.)~/~d~ Phone NO ../~.....c?...~.?~.. ....
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.
.............. '
.............. · ,~dZ~._~......~ .................... .. ................ being duly sworn, deposes and says that he is the applicant
(Name of individual sig~Tfng application)
above named. He is the ............................................... z~m,4,,~,,,~. .......................................................................................
(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 b,c-'l~formed in the manner set forth in the application fj~d thcf~wj~. ,,
Sworn~to before me thj~'_~-~¢9~ , ~ HARRY G, NOCKi:ij ~/~
.....................~. ~ d~~'"c-"~,, ! ........ 19.~....~..?"~'~ s6;~t~3;'o ~'w ¥o* (Signature of appl~/n,)
/ / ,;,'