HomeMy WebLinkAbout775-zFO~ ~O. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at J~/J~.J'~J~l.~l.l'~..?,z~..~ll..8/.S..l~es:~l'il~ ..... Street
Map No. I/e,l~on Block No.
.......................... ..; ................... lot No..~ ...........................................................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
....................... ~.g,l~......~. ................. , 19~...., pursua'nt to which Building Permit No....~,.....'~..~ .............
dated ......................... .3'.9~1,~.....~.~. ............ 19.~.c~..., was issued, and conforms to oil of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ................
............. ]~'£~t~. ~. f~ fLy...d~elliug ..............................................................................................
This certificate is issued to .....~.,..g.,..~.J,l~.~fl~l~.~gtJ. ............ [Q.~I,e.T.) ......................................................
(owner, lessee or tenant)
of the aforesaid building.
FOI~M NO. 2
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,° 775, z
Date. ~ ~ 19~'~
Permission is hereby granted to:
to.. ~ .~....~.. ~..-.~..~..]:?.....~....~?...3...~..~....!~...: ..................................................................................
at premises located at ...~../...~...~.~....e~..?.~.~....~.......~....~"..~..~...~....?../..~....¥..?.?.~-~...?...~.~.~ ..........................
...................................... ~ .t,.t..~ ~ L~.?...! .q.z'~ .............................................................................
pursuant to application dated ................................. ~.11~1..~. .............. 19.~.~.., and approved by the
Building Inspector
Building Inspector
FORI~I NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved .............. No .........
Disapproved a/c ..............................................................................................
......................... ....i
(Building Inspector)
Application No ......... .~...,~...~....
APPLICATION FOR BUILDING PERMIT
Date ....................... ~ ~ 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 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 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 oll applicable laws, ordinances and regulations.
.......... ...........
(Signature ~7applicont, or name, ~ corporation)
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Location of land on which proposed.,~~' "~ ,./-/~ ~ ~ ~,, . '~'-- '/-)w°rk will ~be_~df~ne.,. Map· . ,-Ne: ............... .'~""'1· -. ..................... . _..Let' No: .................... .
Street and Nurnb~r .~...~..~.~.......~.~~7~,...~,,~....~...~....~.~..~...~.~ ........
/ ~~Mumc~pality / ~~~ ~,_ ~
State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: ~
o. Existing use and occuponcy.....:~~~~ ~ ........................................................................
......., -
3. Niatu~e of work (check which applicable): New Building ...... f...~... ....... Addition .................... Alteration ....................
Repair .................... -,;~/~..~--~ ~/'R'~em~val .................... .Demolition ............. ~.....O_th~er Work (Describe) ....................
4. Estimated Cost ...... ..~'..~.~...,..~'.....~ ................. Fee ....~.~..~.~...~ ....................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ............... ~ ............... Numl~er of,~dwelling units on each floor ...........~. .............
If garage, number of cars ........... .~. 7~..~.....~?..~ ..........................................................................
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 .............................. .~.'f~..Number of Stories ................................ ....~...t ~...Y.~.......
8. Dimensions of entire new construction: Front ....... h ................ Rear ~ ............. Depth ............
Height ............................ Number of Stories ...... ...~.. .................
9. Size of lot: Front ........... ~,~:~.. Rear ......... I'..~....~....~. ..... Depth ..............
10. Dote of Purchase ........... ..~..~... ................... Nome of Former Owner 2. ....... ~.~.. ·
· .......... z ,,,/_/.
11.
Zone or use district in which premises are situated ............. .¢../... ....... ~...,~...'~: ............... :..i.f~ ........... .7~/.._. ......... .....
Does proposed construction..~.~.~,~,.4. ~ ~., ~ ~.~___ ~/violate any zoning law, ordinance or regul,~ionrj..<.,..,~../---,~ ..................................
13. Name of Owner of premises~,.~.~...~-.~z-'-~~....~;~ne NO .....................
Name of Architect...~~.~Z.~;~ress .......... .¢,....,~ ....................... P~hone NO .....................
Name of Contractor--S.' .~ress ~,~-2/~...~ ..~one~--~- ~--z,~-- 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, end show street names and indicate
whether interior or corner lot.
STATE OF NEW Y.~DR.I~,., ~/'/) S S
COUNTY OF ~~ ' ,
........................ ~,Z'~_..,.~~ .......... being duly sworn, deposes and says that he is the applicant
'(Nome of indi~'~-~l sig~¢zt~i~. ~,
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 are true to the best of his knowledge and belief;
and that the work will be performed in the manner set forth in the app[icati~ filed the(¢with.
NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUT.OLD, N. ¥.
Examined .......... ~..~.../~19..~.7~
............ ~...~.....~..19 ........ Permit No ........~'~"~'~"~7~,.~....~.~.
Approved
Disapproved a/c ..... .~. :......~]....-'--~..-.~ ..~...~, ..................
.....
Application No. ,. ,,~,, ,~.~,,.,~,,... .........
APPLICATION FOR BUILDING PERMIT
Dote .............................. ; ) ..... 19..¢j ....
~,~ 1~' /
INSTRUCTrONS
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 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 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 a Iterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
.......... ............
(Signoture~-~pplica~t, ~r name,~ corporation)
~; "~" '"~Z" ~ ........
~ , ~oress o~ a~ncant~ ~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~ .~'~/~:.~.'~ ~ .............................
Name
of
owner of premises......,;~.:.~ .,7~. ....~,~:~5:.~.~?;j.~~_,~,~,,) ...................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and tit~e of corporate officer)
Location of land on which proposed work will be done. Map No: ............................................ Lot No: ....................
Street and Number ...~..~..~x..~....~~..,'~'~..;~..~.~-~ .c.~p'/~/~ .~:,--~ .~..~.
State ex~st.ng use and occupancy of p~em.ses and .ntended use and occ~p~,~f~f0~ose~
................................................
Intended use and occupancy ~ >C~.~ ~,~:~ ~~: ~:'b 7~
..... ............... : ....................
property lines. Give street and block numbers or description according to deed,
whether interior or corner lot.
3. Nature of work (check which applicable): New Building ...... L~..... ....... Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost ...... ...~¢./.~..,..,..~.~-~6'~,....~.. ................ 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 ........... /6L? .¢~,~.....~'..~..~.~,¢_~,~,~..:.. .........................................................................
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
9. Size of lot: Front ........... ~...~...f..~... Rear ........ ...~.'....~,...C~.'. ..... Dept'h .../~ .~....'. .......
10. Dote of Purchase /Z-,~,~_ Name of Fo, rmer OwJ~er
11. Zone or use district in which premises are situated ............. ¢'%Z... ....... .~.¢:.~?~;¢r.:(.$ff'::.L.'Z..~L.;~........7~:..~......: .....
Does ro osed construct on v o ate o,B oning law dinan or regu~tion~ ..~:"~.'.~/~.~ ..................................
13. Name of uwner or prem~se~:!%.~ .......... .~......b%~f~'M....,~ad, l'~ss~..r.%'r ............ ;';:...:. ............... ;.'m~one r~u .....................
Name of Architect ..........~..~..~.~:;:¢..':~.~!;f~ress ........ ¢¢7,,':;T~.. ............. ,~...,.__,,~J~ne NO .....................
Name of Contracto~~ ...................... ~: .... :...~dress ...7.,.~ ...... ~. .........Phone NO .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
and show street names and indicate
(Contractor, agent, corborate 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 Jn the manner set forth in the application ~d therewith.
)
// ~ ~~ /, ~otary PuN;c, State of New York
NotcI~ Public,~...~.,. · ~ .......... ounty Uo 52-0344963. SuffoLk County //
~ , , ~om n ss on Exp~[es ~ar~ 30, ~ ~