HomeMy WebLinkAbout726-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at..0~.,~l~04~t~...l~L~'.~.~,.~.U,~...~.,.~.~ .... Stree~t
Map No ..... ~.~..~. ............ Block No ........ ~..~. .......... Lot No ....... ~ ......................................................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
........................ ~T~l~e...,~ ................ 19.~.~..., pursuant to which Building Permit No.....~....?.~..,6. .............
dated ....................... ~..t~.e.....~...~. .............. , 1 9..,~.~., 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 ..............
PRIVATE 01~ FAM~L]f
This certificate is issued to ....J~..~.._~.~..~.:.O..~..~...~..~..L..O....~...e..?. ................................................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
~0~ARD M, TERRY
FOI~M NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS ~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 726, Z
Date ....... J~e 22 ........ 1~..9.. ....
Permission is hereby granted to:
S..t~niey. ~. Suffoi~ Developments Inc.
'~7~"'~'~"~t'~'~,.' ...................................
.~..~2 ..............................................................
at premises located a~
Building inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
Approved ......... No ........
Disapproved a/c .................................... ... ..........................................
Application No ..... ..~...~ .........
.......... (Building"Jnspe~~ ....
APPLICATION FOR BUILDING PERMIT
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 part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building inspector.
APPLICATION 1S 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 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.
Buil~ e~ x ,
Name of owner of premises.....~'.~.~,L'lk....~!.~10W.$.~f.~L ...........................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map No:Ma.$~i~O~ ....................... Lot No: ....................
Street and Number Ol~$~l~e.....N~.~$~u~k...~ow~...~...$o~ol~ .............................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ........... ~$~d~&...~.a .........................................................................................
b. Intended use and occupancy ........ B~ild~$..ho~Ee...&...dw.elli~...~e.E~ ...........................................
3. Nature of work (check which applicable): New Building ...... ,,X ........... Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost ........ ~1.2,,~.00. o. 0~1 ............................. Fee ,/f~..~.o. ............................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ......... Qll.~ ................. Number of dwelling units on each floor ............................
If garage, number of cars ..........0~1~ ...........................................................................................................................
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......3~.! ................ Rear ...~.(~.! ................... Depth ..~,.~. ...................
Height ...-]...5.! .................. Number of Stories ......Qtl.~, ...............
9. Size of lot: Front ...10O. .................. Reef ..... ],0.0.t .............. Depth .....1,~.~ ...............
10. Date of Purchase ........ ]c):sJ~ ...................................... Name of Former Owner ........................................................
11. Zone or use district in which premises are situated ................................................................................................
12. Does proposed construchon violate any zoning law, ordinance or regulation? ......... Z~o ......................................
13. Name of Owner of premise~'.r..~tzlk..~-t].o~cl~k.:l. .......Addressp..!.~O....~;.,...I~I.a~.~.t.t,~t~k..Phone N(~A.c).?.~.(}0~ ....
Name of Architect...r..a~.e~'...C.elrz~". ........................ Address .I-[~.{~.k.~l~k...l~.~,J:..~ ....... Phone NO .....................
Name of C~ntract~.~.~ek~:..k~f.~.~1.k:..D~..°...AddressB~;...~.~...2~.~e~ ......... Phone NO.A~ll]..-..~.80.O..
PLOT DIAGRAM
Locate clearly and distinctly oH 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.
STA'TE OF NEWe-yO,~K~,. ~, )
Is ~
COUNTY OF ... ,~'A~Jc4~ ) '
............................,~/~ )~ ........ ~ "~ ~;/t~),Z{ ~r t h
....... '...'t~...:...~...~ ........... ..~....: ........ .M....z.....k::...belng duly sworn, deposes and says hat e is the applicant
(Name of indiv~ual signing application)
above named. He is the ................................................... ~'~;~."~: ......................................................................
(Contractor, agent, coqborate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file
th s appl cat on; 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 manner set forth in the appllcation f~iJe~J,t,~ith/
Sworn to befo,~re me this /~ ~-~
.................... ~-.. da~ of .................. ~......~ 19 ....... ~"t' ",t~-, ~ubt~c, state o~'"~'[~iggt~~~ t}pp '
// ~'~ ' ~ ~ C~//
Notary Public, ..~~...~;..¢;~T..County c~,~ ~-~i~s I~ ~ ~ /
FOR1Y[ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined .~ 19
Approved ............... ~..~ 9.~.~.... Permit No ........ ~...,~..,~..
Application No ........... . ..~..~...~.. ......
APPLICATION FOR BUILDING PERMIT
Dote ....... T.,4n~..1.~,.,,]. 9.~.~ ........................ 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 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 tb 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 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 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.
........................................ ~k~,.4.~.~. .........................................................................................................................................
Name of owner of premises......~T'~l~.....t~.:l,]LO~ltk/ ...........................................................................................................
If applicant is a corporate, signature of duly authorized officer.
.................... ~'~;' bnd' 'fiji ;'~?' '~'~ 'o;~;' '~)'i~;~) ........
1. Location of land on which proposed work will be done. Map No:~.~¢.~¢~. ...................... Lot No: ....................
Street and Number .~e.J.u~e~e....t~.~¢.~o~..~.~:..~;:.~-~ ............................................................
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 ........ ;B~.~].~..~.~..~..~.~..~e~ ................................ ~ .........
3. Nature of work (check which applicable): New Building ....... X ........... Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost ............. ~.2~/00'~} ............................. Fee ( .~.. ..................................................................................... ~ (to be paid on filing this application)
5. If dwelling, number of dwelling units ......... o~ ................ 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 ...... ~6.~...~ ........... Rear ...~.6~t .................. Depth ...£/j,.t. ..................
Height ...."l'~.t ................. Number of Stories ...... ~ ...............
9. Size of lot: Front ...],~0.~ ................ Rear ....."1'~(~. ............. Depth ......];,~.~ ..............
10. Date of Purchase ......... ~. ..................................... Name of Former Owner ........................................................
11. Zone or use district in which premises are situated ................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ~t~} .....................................
13. Name of Owner of premisesf,,~R~A..~..~OWli~~ ...... Address~p~:.~...~t.;...[~t~.~,.~l~.~.Phone NO~0.~...
Name of Architect....]~eB~.e~...~3.OA~' ....................... Address ..}~.e~e~a~i~.F)l.;~T.; ...... Phone NO
Name of Contractors¢.~.]:e~...~f~.~O.}.~....;~.....Address "~o:~'"~(J?"~'~e~r ........ Phone NO. ~.~.~.800.
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.
,( tt
(Name of individual si~'~ing application) ,~
above named. He is the ............................................ ~.~.~i..~.~.'..-.~- ..............................................................................
(Contractor, agent, coriSorate officer, etc.)
of soid 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 conta ned in this application ore true to the best of his know~edge ~nd~,b, ciief;
and that the work will be performed in the manner set forth ~n the opphcat~on
Sworn to before me this /~,~ .~,~.? .~,~-~'~/~ ·
................ ,.'~....0, doyle_ .~.~...~...~~. ~. dl,~..?...Z. (Signature"of applicant)