HomeMy WebLinkAbout759-zFOI~M NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD:, N. Y.
CERTIFICATE OF OCCUPANCY
No. ~ 't299 . Date ~T~.ttg;~. 24 19.,...~...~
THIS CERTIFIES that the building located at
Map No.~'.~.~. ................ Block No .......~:~.. ............ Lot No .... ¢~.~'.~. ....................................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.............. .~...~..]-.~....?. ..................................... , 19..~.,~.. pursuant to which Building Permit No. ~...~5.~ ....
dated -..1J~'..~1~1.,11,.]/'...? ........................... , 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 ..........
............. ~R~-~t&~l~..01~:. ~/~Zt-~.. ,OJ~'ltO .................................................................................
This certificate is issued to ................ .~.'.~..~...~.....~.t.....~.?..~..~.,?.~....9..~...~.?,,~. ............................
(owner, lessee or tenant)
o[ the ,oforesaid building.
Building Inspector J
FORM NO. 2
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. ¥.
BUILDING PERMIT
(THIS DERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 759 Z
Date . ..
Permission is hereby granted to:
Ivan T. Ho~mett
..Thiz'd ~ O.~.chaztd..~ee.~ .........................
New ~uffglk~ Ne~
pursuunt ~o upplicufion doted ............... Jul~ '~ ............ ~9.~..., ond upp~oved by the
Buildin; Inspector
FOEM NO. 1
TOWN OF SOUTNOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
19,...~..,~rmit ~;~ ..?..."~....,
Approved ............. .....~. ~ ...~., No ...............................
Disapproved a/c .............~ ................... ~.:;~ ............~ ........... ~,-
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 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, }he Building Inspector will issue a Building Permit to the applicant. Such
permit shall be kept on the premises ova.liable for inspection throughout the progress of the work.
e. No building shall be occupied or used in whole, or in port for any purpose whatever until o Certificate of Occupancy
shall hove been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Buil~ling Deportment for the issuance of o 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, os herein described.
The applicant agrees to comply with oil applicable tows, ordinances and regulations.
....... ....................
(Signature of applicant, or name, if a corporation)
.... .............
~/~;:,,/_~ / (Address of agplicant),_
;il
State whether applicant is owner, lessee, ~agent, archite¢, engineer, general cdn'tr~fctor, ele'~fRci6n, p'lurn~r or ouilder.
· ,, :/....: :?
Name of owner of prem,ses ...... ~.:,..~. .......... ~....~.¢.?:c.,./.¢~.. ........................................................................
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 done· Mop No: ................................. ~[. ........Lot No:_,,.....c~-Z ..........
Street and Number ....................................................................
Municipality
State existing use and occupancy of premises and integded use and occupancy of proposed construction:
use and occupancy ........../¢'~'.':~:~.....Z~.~.~(;:~'d'~;~--/ ............................
b.
Intended
3. Nature of work (check which applicable): New Building .................... Addition ......... ~..Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (DesCribe) ....................
4. Estimated Cost .............. ~r~..J,..,. ......................... 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, ,f any: Front ........... c~...~. ...... Rear ....... c~...-~ ......... Depth ...o,~./.....,~.. ..........
Height ................... .'7.:~ ..... Number of Stories ........ /.~ ....................................................................................
Dimensions of same/structure with alterations or additions: Front ........ .~'. ........... Rear ........... ..~..~.;. .........
8. Dimensions of entire new construction: Front ....... ..~.... ............ Rear ........... ~ .......... Dept~..
Height "' Number of Stories ......./ .....................
9. Size of lot: Front ............ /~...~... ...... Rear ............. ..~....~.,,.*'~... Depth .../~. ............
]0. Date of Purchase ........................................................ Name of Former Owner ........................................................
] ]. Zone or use district in which premises are situated .............. /~. ........... /~-~.~,--~C~..~..~.~.,.~ ................................
12. Does proposed construction violate any zoning law, ord_irlance or regulgtion? ~~ ..............................
Name of Owner of premis ress
Name of Architect .................................................... Address .......................................... Phone NO .....................
Name of Contractor .................................................... 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 indk ate
whether ~terior or corner lot.
STAT'E OF NEW ~)P~./Z!. S S '
COUNTY OF
....................... ~~~,~/,....~.being''" duly sworn, deposes and says that he is the applicant
above aaName°f ndvidua s~n ng ~ (rr ed_Heisithie._._._.l....i..._.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 ail statements contained in this application are true to the best of his know[edge and belief;
and that the work will be performed in the manner set forth in the application filed therewith.
Sworn to before.me this ,q ·
.......... .~.,,.~, day. of ,;, . ........... ) ,~Y~(~19..,~...~.'. JUDITH T. BOKEN
-- ~"'"'-~. ~ No ary Public State o! New York
No 52-0344963, Suffolk unt
Notary Public ~.~..,.~.. Ce~,~t~ - . ....... .~,.~l~rre of applicant)
l~Ol~ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
~is~pproved ~/c .......................... ....~v~ ...... ~=:.~.=~.~ ...................................
Application No ........... ,,~.~ .........
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 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 regulations.
....... ....................
(Signature of applicant, or name, if a corporation)
...... .............. ............
.............................................................. .......................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Location of land on ........
which propos~ed work w~ll be done. Map No: ............................ ~ ............... Lot No:..~ ........... .~. ....
Street and Number '"~ '~'"'~f'"~'~/~'"' :~~~'~Municipality ............................... ~('"'/'~"'~"~ ~"~'"~'
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. IntendedEXisting use andand occupancy ............ ~"r/~k~'~..~.~./~..--~~/~,~. ~ ............ ~~"" '""'"'" "'"'""~--'".'"'""'"'"'"'"'""
3. Nature of work (check which applicable): New Building .................... Addition ........ ~.Alteration ....................
Repair .................... Remov~ .................... Demolition .................... Other Work (Describe) ....................
4~ l~stlmoted Cost ............. ~ ................. Fee ....... .~C~.......: ........................................................................
~f~_~?.,2c ~ (to be paid on filing this application)
5. If dwelling, number of dwelling units ............Z{ .......... 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 ...o~../...J/..d: ..; ..... Height ............................... Number of Stories ................................
Height ~- Number of Stories ........ .~.. .................... /~.~/ Z
9. Size of lot: Front ............ ~.'.~.~.... ..... Z-J
Rear .............. .~..dB ....... 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,~_o~iz, law, ordir~once or r~gulg,t, lon? ...,~ ..............................
13. Name of Owner of premis .~~ress ........... O .....................
Name of Architect .................................................... Address .......................................... Phone NO .....................
Name of Contractor .................................................... Address .......................................... Phone NO .....................
P.LOT 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 indica, te
whether ~terior or corner lot.
....................... ~ .... bein0 duly sworn, deposes ond says thor he is the *pplic~nt
(Name of individual signing ~Hc~)
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 application; that all statements contained in this application are true ~o the best of his knowledge and belief;
and that the work will be performed in the manner set forth in the a~i~ion filed therewith.
Sworn to before, me th~s ~'~ ~" ' ~
............. ~ ............... ~ ~ ~~-- ~ ~~ ................ ' ...... x~ ~ '~ ~
~otar- Public ~-.~~~~v~"'~'q~ ,(Signature of app cant)