HomeMy WebLinkAbout830-zFOI~ NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No ......... ~..~.'~1~. Date J~e 15 19 60
THIS CERTIFIES that the, building located at ..~.~.~....D.~."..~.....~..~.~....~...~..e.~.`~....~..~.~..~...~..~reet
No ......................... Block No.
Map *** ........,...............~** _u~/^- No ...................................................................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
........................... .~.~.~.~.~,~..,~,,,~,,., 19~',?...., pursu~'nt to which Building Permit No ...... .,~...~..0. ........
dated ...................... ~.~,~,.~?,,.,~...?...~,...~ ..... 19..~.~., was issued, and conforms to all of the requirements
of the applicable provisions of the Jaw. The occupa,ncy for which this certificate is issued is ................
......... .........................
This certificate is issued to ................... .~.?,.?.?...~..~,....~,.?..,..~..~..~...~..?,,~.,,....O.~.~.,.~. ..........................................
(owne, r, lessee or tenant)
of the aforesaid building,
Building Inspector
FOI~M NO. :~
TOWN OF SOU?HOLD
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? 830, Z
Dote ..................... ~e~c~e~.....~ ............ 19.~9 ....
Permission is hereby granted to:
L~ker...~..~i~kei,~en...A/~..Ro~erl..~b~ae. ...........
.............. Soulho3.d,...~..~: ........................................
to ........ ~i~d.. an....afl~!~:ton., on.. a~.. ~xLaid~.g. dwell.%~g ................................................................
at premises located at ~/JB......~eR~l..e.'a.~ ........................................................................................
pursuant to application dated ............................ ~p~,~e~....~ ............ ]9~..., and approved by the
t3uilding Inspector
Fee $..5~(~ ..............
FOR1YI NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMEHT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined .......... ~.. Z.... 19.....~..,~'
Approved ...................... ~..~. ............... 19 ........ Permit No....'~...~.. ~...C? .........
(Building lnsJ~ector)
Application No........(~....~...C.). .........
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completeiy 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. Up, on 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 o Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuence 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 oil applicable laws, ordinances and regulations.
...... ...............
(Signature of applicant, or name, if a corporation)
................ .)y... .................
(Address df applicant) ~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder.
Name of owner of premises ........ : ..................................................................
If applicant is a corporate, signature of duly authorized officer.
..... )
(Name and title of corporate officer)
1. Location of land on which p.roposed work will be done. Map No. "i ............................... ~ ,,,/Black ..................................
Street and Number~,~-_~c~.~....~..f~.z...~<...)...~..~'.,,~...~...,~:Z~',~'...~...~m...~.-~~ ........................
2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction:
o. Existing use and occupancy...../......'.~'..~'~*~,.~.~..'?..'~'(_,/
b. Intended use and occupancy ..........................................................................................................................
Nature of work (check which applicable): New Building .................... Addition ..... ~ ......... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
0*5
4. Estimated Cost ............................................................ tee ..........................................................................................
(to be paid on filing this application)
FEES:
· / u
5. If dwelling, number of dwelling units ............................ N tuber of dwelling units on each floor.....~. ....................
If garage, number of cars ........................................................................................................................................
If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................
Dimensions of existing structures, if any: Front ....... ~......~.. ........... Rear ....... ..~......~.. ........... Depth .....-~...~. .................
Height ....... ./.....~.. ............ Number of Stories ............/.. ...............................................................................................
Dimensions of same structure with alterations or additions: Front ........... .~..41~.. ........... 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 .......~.....~]-~o.. .........
]0. Zone or use district in which premises are situated ......................................................
11. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~.; ....................................
12. Name of Owner of premises~L]:¢~.~.~Address ...... ~.~.~......~...:~L:.Phone NO...~ ...........
Name of Architect .................................................... Address ........... ~ .......... Phone NO .........; ...........
Name of Confroctor~.~]..l'...~~..Address ..~ ..................... ~/..~...Phone NO.~?.7...~...%~..~..~.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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'T'E OF NEW YORK, -- )
............ ~~.'-,~. .............. be lng
(Name of individual signing opplicption)
duly sworn, deposes and says that he is the applicant
above named. He is the ..........................................................................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or hove 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 application filed therewith.
Sworn to before me this
................... .~%"'"day of .............. ..%.)...~ ..~....~ 1 9..
~. 52:LI3449~3, Sulfa (, .
(Singature of applicant)
FORM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUT,OLD, N. 'r.
Examined ............ ~......~?.... 19..5.~
o
Approved .................................... k..19 ........ Permit .........................
Disapproved a/c .... ~~.._.._~... ~... ..................
(Buildino Inspector)
Application No ~ C~
APPLICATION FOR BUILDING PERMIT
Date ............... . .~...~Z..~.,~.. ~.~-..:....~.? ........................ 19. ~.~ ..~. ....
INSTRUCTIONS
o. 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. Ul~on approval of this application, th~ I~uilding Inspector will issue a E~uilding 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 p.urpose 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 P~rmit 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 a~plicont, or name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder.
Nome of owner of prom ses .............. .............................................................................................
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. Mop No ............ B ack .................
Street and Number ...~. ~....~..~7.~.~....T ........
2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction:
a. Existing use and occupancy ............ .~.~. . . ..............................................
b. Intended use and occupancy ......................................
3. Nature of work (check which applicable): New Building .................... Addition ..... .~ .......Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost *~'3~ o ~ F~,=
(to be paid on filing this application)
FEES:
If dwelling, number of dwelling units .......... ./.. .............. Number of dwelling units on each floor......(] ....................
If garage, number of cars ........................................................................................................................................
If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................
Dimensions of existing structures, if any: Front......~...~...~. .......... Rear .....~....,.~......r. .......... Depth ..~..~../. ...............
Height ..... ./...~......f .......... Number of Stories ............/. ................................................................................................
Dimensions of same structure with alterations or additions: Front ...... ~ ............... Rear ....~. ..................
Depth ..... ..,~...,~...r. ........... Height ........ ../...~....~ ........... Number of Stories ........ ./.. .....................
8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................
Height ............................ Number of Stories ............................
9. Size of lot: Front ...... .,~...~ .......... Rear ........................... Depth ............................
]0. Zone or use district in which premises ore situated ................................................
I l. Does proposed construction violate any zoning law, ordinance or regulationP
Name of Owner of premises.~..7~.~.,.~',~Address.~...~.~.~....~../..~...../i~....Phone NO .....................
~2.
Name of Architect ..................................................... Address .......................................... Phone NO .....................
Name of Contractor.'.~.'~...~......~~??.1~ddress ~~...~...~:.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 indicate
whether interior or corner lot.
S*ATE OF NEWc O J< S S'
....... ~.~~ ............................. belng duly sworn, deposes and soys that he is the oppllcant
(Name of individual signing application)
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 Jn 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 application filed therewith.
Sworn to before me ,this
.................. ..~'.. day of ...... ~ ................. 19.,~..~.
Notary .~ ...
Cunm,ss~on .kx~olr~s ~.a~clJ 30~ ~,~ f'/
(Singature of applicant)