HomeMy WebLinkAbout825-zFOR~ NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPAt, ICY
No ...... ~.. ~,,~, ........ Date . ~'eBr~?.~... 23 1 ~).....~...
at ~S E. B~noh of De~ ~ole Drive
THIS CERTIFIES that the. building lacated ..~i~j_~,~..~.6~ ............... : ...... ~.... Street
"/wap No ............... ~ ......... Block No ......................... Lot No ...................................................................
substa/tially to the A~lication for Building Permit heretofore filed in this office dated
conforms
~U~S ~I 19....~, pursu.ont to which Building Permit No.' ...........................
dated ........... ~ ................ ~..~. ...... 19...~.~., wos issuod, ond conforms to oll of the ~equirements
of the applicable provisions of the law, The occupancy for which this certificate is issued is ................
........................................................ ~.:[:?/k~(~...9;~... ~..~. ~..~..~...~. ~. ...................................................
This certificate is issued to Haro:].d
(owne. r, lessee or tenant)
af the aforesaid, building.
FOI~M NO. 2
TOW~q OE $OUTHOLD
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? 825 Z
Date ........................ .&~g~l f~,...~; ............. 19~.~. ....
Permission is hereby granted to:
Fred L. ~o~re · .. ~t/~.....H~r. cl~. ~r~ell ................................
........ ~.%t~-tuok~.-...N,Y- .........................................
to. ~u~..ne~..one..famil~...d~el~i~g. ...............................................................................................
at premises located at ..E/5....~ee?.}~<~.le..~.~.i.ve ..................................................................................
............................................ ~att~uck,.... ~[ .~., ....................................................................................
pursuant to opplicotJon dated ............................ .~,d~T~,~.....~.~. ............... 19.~..., and approved by the
Building Inspector
Fee $~O~OO-.pa~d..-cheek
FORi~I NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ............................. ~,,~, ........ 19....~....Permit No. ~Z~,~ %
DisapproYed a/c ........... .~.....~.,,,,,.,~......~_.. ...........
..................... ...................................
(Building Inspecto~
Application No. ~k] 9~ z~
APPLICATION FOR BUILDING PERMIT
Dote \,
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and sut>mitted 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 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 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.
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: ~
Street and Number ...~ ................................................ ~.~.. .............. ~ ....... ~ ......................... ..~...~..~-.~;~..
M6~nicipality
2. State existing use and occupancy of pr. emises and intended use and occupancy of proposed construction:
a. Existing useandoccupancy .............. ..~....C.~.~.~.¥.(.:.q.~...~.......~.~.~. ........................................................................
b. Intended use ond occupancy .......................................................................................................................
3. Nature of work (check which applicable): New Building......~ ........ Addition .................... Alteration ....................
Repair .................... Remova~ .................... Demolition .................... Other Work (Describe) ....................
...... : .........................................................................
4. Estimated Cost....~...~..j.....°~.r...:. ....................................... 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 ............................ 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 ..../'...~ ........... Rear ....... ./...~ .......... Depth ..~...~.3...~ .........
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
11, Zone or use district in which premises ore situated .............. ~.i ...........................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ............ ./..~../....~-'~ .............................
13. Name of Owner of premises.,./..V.:...~ .......... Address ....... ..~.~?...~:.':..~ ..................... Phone NO .....................
Name of Architect ..........:.. ............................................ Address ......................................... Phone NO .....................
Name of Controctor...~.~..':..)~'-Z~g3..'~..'?~ .................. Address .................. .~: ........................ Phone NO .....................
PLOT DIAGRAM
L.ocote deafly and distinctly oil 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..~YOI}I~, ~,,~ ) $ S
COUNTY OF .,,_,~...~?.F:...~.;:.) '
7~'']~c~ ~ ~~- be ng duly sworn, deposes and says that he is the ~pplic~nt
(Name of individual signing application)
above named. He is the ............................................. ~~ ............................................................................
(Contractor, agent, corfforate 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 m.~nner set forth in t~D~p~c~ filed therewith.
Sworn to be~ me this ~ NOta~ Public, State of New ~e~
........ ~.~.. day of ................... ~. 19.~Z~... ~m,s~i,,~,~~ ~ PP
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N, Y.
Examined ........... 4 ....... ~. ....... ¢.~ ........ ]9..!.....
Approved ........................................ 19; ...... Permit No. ~ ¢~ " '
Disapproved a/c ......................... : ................ <.-: ............... ;~ .......................
.................... L.~ ......... l,..: ....... ::~:..:¥ ...................................
(Building InspectS()
Application No. ~:'~ ~ ~
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink ond submitted in duplicote to the Building
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to edjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drown on the diagrom which is part of this location.
c. The work coYered by this application moy not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Buildin~ Inspector will issue ~ Building Permi~ ¢o ~he ~pplic~nL Such
permi~ sh~ll be kep~ on ~he premises ~v~i1~bie for inspection ~hroughou~ ~he progress of ~He work.
e. No buildin~ sh~ll be occupied or used M whole or in p~r~ for ~ny purpose wh~ever un,ii ~ Certificate of Occupancy
shall have been granted by the Buildin~ Inspector·
APPLICATION IS HEREBY MADE to the Buildln~ Department for the issuanc.e of a Bullding Permit pursuant'f6 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·
............................................... .L~-:.~X.:K;~:.~¢. ....... :.,~::.~.:::~.~ .......................................................................................................
Nome of owner of premises....lz. ................................ : .............................................................................................................
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. Map Nok. ............... · .................... ~,,. ..... Lot Np: ......... ~...~ ......
' .......
Street
and
Number
...................................................... ~'~nicipality
State existing use and occupancy of premises and intende~d~se and occupancy of proposed construction:
a. Existing use and occupancy .....................................................................................................................................
b. Intended use and occupancy .................................... 12~ .............................................................................
3. Nature of work (check which applicable): New Building.....72%~ ....... Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
........................................................................
4. Estimated Cost....../.].)....,~.~:O. ...................................... 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. Jf 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 ..../.~. ........... Rear ....... /..4,:cO .......... Depth ...~.¢¢.~.Z.~..J~ .........
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 o~(~,,r~egul~'o?? ............. ~'.~/~....~ ............................
13. Name of Owner of premlses.../(,,-/.....~,~",.~,~ .......... Address ............................................ h e NO .....................
Name of Architect ........................................................ Address .... ................. ~, .................. Phone NO .....................
/
Name of Contractor......~:.'~...,~.._4,~-~',,~' .................. Address
............................................ Phone NO .....................
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 shaw street names and indicate
whether interior or corner lot.
STATE OF NEW YOR, K, ~,. )
............................... !~....i ......... f.~r::.~..,.l........°~.~..~.~,-m ....... being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is the ............................................... ~~:.: .................... . .......................................................
(Contractor, agent, corlborote 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 a 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 ~j~/l~,rl~l~.li~J~n filed therewith.
Sworn to before m.e this Notary Public, State of