HomeMy WebLinkAbout851-zFOYer ~0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.
CEBTIFICATE OF OCCUPANCY
No. Z903 Date ~ovember 21.0 ~'~, 40
· - N/~ ~in Road ~ treet
THIS CERTIFIES that the building located al .................................................................
~vlap INO ....................... ~ uc ~u ........................................................................ ~ .... , ..........
conforms substantially to the Application for Buildin~ Permit heretofore filed in this' ~ffiee
dated Septeraber 19 19.~.. pursuant to which Building Permit No. ~ 851
September 1~9 ~9
~ated ................................................. · ........ was issued, and conforms to all of the requirements
a~cah~evv_ ~ provisions of the law. The occupancy for which this certificate is i~sued~ is
of
the
Business building ~era ................... J ...........
This certificate is issued to De~ies~ ~neral Homes Ino 0~e~
(owner, lessee or ~enant)
of the aforesaid building.
Building Inspector \
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.° 851' Z
Permission is hereby granted to:
l~.~t .~;~J. oaL ~.~.....~...~ ~..~..~...z...~. ho
.......... ~,.t~..~,.. ~.,. ~... ..........................................
at premises located at ..~/,$...]la~,i~.]ll~i~, ............................................................................................ I
....................................................... iia~-~t~..... ~o:~.~ ................................................
pursuant to application dated ..................... ~ ...... ~ .............. 19.~)..., and approved by'the
Building Inspector
Fee $'~i~ ...............
FORI~ NO. 1
TOWN oF SOU~,O,D
BUILDING DEPARTMENT
·OWN C'E,,'S omc£
sou~.OLD, N. ~.
Examined ......... ~..%..~.....r.Z ........ ~..~.
Approved ........................................ 19 ........ Pe m No ...............................
.................
............. ..................................................
(Buildin~ Inspoctor)
APPLICATION FOR BUILDING PERMIT
Date ............... ............
INSTRUCTIONS
a. This application must be campier, ely 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 odioining 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 pukpose 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 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 oil applicable lows, ordinances and regulations.
.... .......
(Signature of applicant, or name, if o corporation)
(Address of oDplicont)
State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
of owner of
Name premises ........ ~.....~:.~. .................. · .~.?. ........... : ......................................... ' ................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work wiJl be done. Mgp No: ................ : ........................... Lot No: ....................
/6 ltd 0 ~ ~
Street and Number ......................................................................................................................................................
Municipality
2. State existing use and occupancy of ~pr,emises and igtended use and occupancy of proposed construction:
o. Existing use and occupancy ....... .F'.u'....~...~.. ~.?...~........I/~.~.. .~'. . , .~. ........ ~..: .~....~.....~..~...~... !...~...~...: ........................................
/..~-- ~.~.- /i~.~.~
b. Intended use and occupancy .......... '.~.....~.. ...................................................................................
3. Nature of work (check which applicable): New Building .................... Addition .....~....... ....... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
(to be paid on filing this application)
5. if dwelling, number of dwelling units ................................ Number of dwelling units on each floor ....... J. ...................
If garage, number of cars ............................................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of ea. ch type of
7. D~mensrons of ex~stmg structures, if any: Front ...... .~ .................... Rear ............................ Depth ............................
Dimensions of same structure with alterations or additions: Front ........... .~..0, .............. :. Rear ....... .~.1~.. ..............
Depth .............................. Height .............................. Number of Stories ................................
8. Dimensions of entire new construction: Front......~..'~J~. ...... Rear ........ l..~ .............. Depth ....~....~. .................
Height ............................ Number of Stories ..... ~. .....................
9. Size of lot: Front ............................ Rear ............................ Depth ............................ /~
10. Date of Purchase ........ ~.?....U. ........ J..~..~..~. ................. Name of Former Owner ............... 7.~ .....................
11. Zone or use district in which premises are situated ........ J.~ .............. ~;~.~ .......................................
12. Does proposed construction violate any zoning law, ordinance or regulation? .:~Z...~.....: ....................................
Name of Architect ........................................................ Address ............................................ Phone NO .....................
Name of Contractor .................................................... Address ............................................ Phone NO .....................
PLOT DIAGRAM
buildings, whether existing or proposed, and indicate all set-back dimensions from
numbers or description according to deed, and show street names and indicate
Locate clearly and distil
property lines. Give ~street ~n~.~lo~:k
whether interior or Iorner ~.~.~
STATE OF NE~YO~/~4,#//.. ) S S
.............................. ~.~1~....~....~-m~..~....%...~..~.....being duly sworn, deposes and says that he is the applicant
(Name of individual signing appli~tion) . .
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 to the best of his kno~ledae and belief;
and that the work will be performed in the manner set forth i~app~p~here~
Sworn to before me this
~ dav~ .. .............. 19 ...... ~... lUBJT, T. B0~ignature of applicant)
NotaW Pubhc, ....... ~, .ty[oJlJl~JiSlOlli'I° 52-0344963,[x¢lresSUffolkMafgjl Cu""i~ ~/30.
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD~ N. Y.
Examined.....~:... ~..~.:.. ..................... 19 ........
Approved ........................................ 19 ........ Permit No.
........................ '('J~'~l'i'J'~l i~; ;i .................................
FOR BU,mNG PERM,T
Date .......... ........................
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 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 sha~l 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 issuanoe of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffotk 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)
.... .......... ...........
(Address of applicant)
State wheth,er applicant is owner, lessee, agent, architect/engineer, general contractor, electrician, plumber or builder.
Name of owner of prem~ses.....~..~.-..x ........................ 4 .............................................. t ...........................................................
If app'licant 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. Mai) No: ........... ~ ....................... Lot No: .~ ...........
Street and Number ../..~./. ..................................................................... . ............................................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
o. Existing use and occupancy ....................................................................................................................................
b. Intended use and occapancy ................................................................................................................................
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost ........ I....~ ........................................ 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 ............. ..~.....o. ....... Depth .....~...?..i.~. .............
Height ............................ Number of Stories .............................................................................................................
Dimensions of same structure with alterations or additions: Front ................................ Rear ................................
Depth .............................. Height .............................. Number of Stories ................................
B, Dimensions of entire new construction: Front......~,/.....~,-- .............. Rear ....... .~.....~. ............ Depth .... ..~......~. ...............
!
Height ............................ Number of Stories ............................
9. Size of lot: Front ........................... Rear ............................ Depth ..........................
10. Date of Purchase ...... /.~.../-.~..~...(... ........................ Name of Former Owner ....~ ...............................
!1. Zone or use al'strict in which premises are s'tuated .............. ./.~ ...........................................................
12. Does proposed construction/, ,-.--,-~ ,,/, ,-,vi°late any zoning law, ordinance or.~..__~, ,~.____regulati°n? ........... ~ ..................................
13. Name of Owner of premises~..~..~T...'z~...~((.~...~.A'ddress ....... ...'~....~..[~.~[.....~...~....~..J:~hone NO .....................
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 sh~w street names and indicate
whether interior tr corner lot.
STAT[! OF NE~,¢ ¥9~,K~,//' ) S S
COUNTY OF .....c~.~,PF~...~..) '
................................ ~ .................................. . ......................
(Name of in,ividu~J signing~,-~--
abow named. He's ~he ......................... ~.~ ................... ~ ....................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or hgve performed the said work and to make and fife
this application; ~hat all statements contained in this application are true ~o the best of his ~no~ledge a~d bel]ef;
and that the work will be performed in the manner set forth in the ~ion filed ~ith.
Sworn to before me this ~ k · ~1/
T ~ BOK
, Z / day_of .......... ~L~...~... 19 ...... Z.... Jura · ,~Jgogture of app icant)