HomeMy WebLinkAbout784-zFOI~M NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTNtENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
De¢ mbe
Map ~No ......................... Block No ......................... Lot No .....................................................................
conforms substantially to the Application for Building Permit heretofore filed in this office doted
dated ........................... .~.~..~, ........., 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 ..............
(owner~ lesseo or tonont)
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? 78 , Z
Date ................................. J~/l~t ...... .~. ...... 19~9 ....
Permission is hereby granted to:
· ~d gl e ~. J~. ~.i;cn... A/C.. ~h~.~. ~L~b~an~ ....................
..... ..~.~.~..,~.~ ........................................................
........ ~ .%.,. k*.~.'~.~.,.....~:~ :. ........................................
to. ~.~ ~.1~..~U..~¢~i'.~,~ ..~..~..~i~ .~i~g..~Y~.~i~g ........................................................................
at premises located at ~/~;..~ide..~.J~ .........................................................................................
........................................ F~st..C~.~4~g~....~.~r. ..............................................................................
pursuant to application dated .................................. J~....,..~. ........... 19.~.~..., and approved by the
Building Inspector
Building Inspector
FORH NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ........ .., .~.~/_/d...~...... ~../. ...... 19....~'....~
Approved ........................................ ]E ........ Permit No ...............................
Application No....~.?..~..~.. .............
(Building Ir/specter)
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 6pplicant. 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 puFpose 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 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.
'~~"~i i[~'i~'~: '~'~' ~ ~ ~ [. i~'~'[[~[~[~ti[[i .........
// (Address of ~pp~ant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nome of owner of premises...~...-6~..~ ........................................................................
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: ............................................Lot No: ....................
/ ' ' Mumc~pa~ty ~'
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing useandoccupancy.....;~~.,~....~......~~~ ................................................... ·
b. intended use and occupancy ................................................................................................................................
3. Nature of work (check which applicable): New Building .................... Addition .......~... .......... Alteration ....................
Repair .................... Removal .................... Demolition ......... .,~ ........ g~ther 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 ....... .~:....2~..../. ......... Rear....~.....~;...' ............. Depth ,..,~....~..~ ...............
Height ....... .~....?,.~ ........... Number of Stories ..i..2::T... .....................................................................................................
Dimensions of same structure with alterations or additions: Front ...~.~....('V..~. .................. Rear ..... ~...~'..i ...................
Depth ......~..~.:. ................ Height ....~..~.(. .................. Number of Stories ...... ~,~./. ....................
8. Dimensions of entire new construction: Front .......... Z../. ............ Rear ........... ~..f. ........... Depth ....../. .. .2,. . f. ..............
Height ....... ./...~..../.. .......... Number of Stories .......... ./. ................
9. Size of lot: Front ....././...~..'..'. ............. Rear .......... ..O. ............... Depth ..~...~...~...i.E...~.../..~'
10. Date of Purchase .../~'.../..2....~.../..~...)~..../'. ............................ Name of Former Owner ..~.~~" ~v ~-~ ..........
]1. Zone or use district in which premises are situated....~'~." ~ ...........................................................
12. Does proposed construction violate any zoning-law, ordinance or regulation? .....~.~.~. .......................................
13. Name of Owner of premises.~~~Address ...~~ ............ Phone NO./~.~.~.'.~7...~.i?...~?-'
Name of Architect .......... -,~'~-// . ~',--,~~~'~'~Z'~'; ............................ Address ............................................ Phone NO. ~.,~)Z~_.~..~;.~..;y~
Name of Contractor~/..(4~:..?~.~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, end show street names and indicate
whether interior or corner Tot.
STATE OF NEW YORK, ) S S.
COU IxJTY OF ............................ )
~..~/~/.~~?~.'""L ................ being duty sworn, deposes and says that he is the applicant
(Nome of individual s~/gn_jir~_a/4~Dplication)
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 oil statements contained in this application are true to the best of his knowledge and belief;
and that the work will be performed in the nm3nner set forth in t,h~ appbc)3~i~? filed therewith//7
Sworn to before me this --.- /~/'.///~.~/ ~./~ ~ ~ ~
~ - ~b~e~e i n t r a Ii nt
........ ~.~ .... day of ~ ............................ ~~ (S g a ure ora~plica )
Notary Pub ~,~~,~.~ r
C ~ommls~iO~tes M~ ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ........................................
Disapproved a/c .......~ ....... ~,~ ............. ~-~. .............................................
(Buildin~ Inspector)
Application No ...... ?... ,~.... ~. ..........
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 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 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 pui'pose 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 alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
.... ~~namre or opl~~~'c~'c~i'c~'r~i .........
.... ................
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nome of owner of premises. · ....................................................................
If applicant is o 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: ............................................ Lot No: ....................
Street and Number ...:~.(~...~....~...r...).~~ ......... ..~.~'.~..;.......~.....~ .......................
. Municip~ality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing useandoccupancy ........ -- '/~~..~.~ ...............................................
b. Intended use and occupancy ................................................................................................................................
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition ....... ~, ....... ~n.Other Work (Describe) ....................
(to be paid on filing this application)
,5. If dwelling, number of dwelling units ......... ! ...................... Number of dwelling units on each floor ........ ~. .................
If garage, number al~ 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....,,~...L'.. ................. Rear ..........................
Height ........?:...~...~ ........... Number of Stories ..... ~ .....................................................................................................
Dimensions of same structure with alterations or additions: Front ...... ,X.,~.. .................. Rear ..,~...4~....~. ...................
Depth .......~Z~...¥..../. ........... Height ....~....~. .................. Number of Stories ....... ..g:n. .....................
8. Dimensions of entire new construction: Front ......... ~...'. ............. Rear ....... .~....i ............. Depth ..../.....~.,...~ ............
Height ......... ../...Z(...../. ......... Number of Stories ....... ./. ..................
1 I. Zone or
12. Does proposed construction violate any zoning law, ordinance or regulation? ...~.....~.. ......................................
13. Name of Owner of premises~dress .~ ......... Phone NO..~...~?...fi.~..~.~.~...~?~
Name of Architect ........................................................ Address ...~ ......................... Pphh~ 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 NEW Y_~RJ~ ,~,~) S S
COUNTY~a~.~/~/~ / ~. ,~ 0 F~. ,~,¢ l-,.,.,~(..~¢~r-,~;~' '
(Name of individual si~ 6~lic~ .
~bove n~med. He is the....~ ......... '.' ............................................................................................................
~ (Contractor, agent, corporate officer, etc.)
of ~aid 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 t~ ,~pplicat¥~fi[ed t~rew]th.~ ~
Sworn to, before me this ~A~--- ~~ ~ ~' ~
Nota~ Public~,~,~? ...... : ......