HomeMy WebLinkAbout594-zFOiEiVJ~ NfO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF' OCCUPANCY
No. Z 782 Date ~Uly ~. 19 60
THIS CERTIFIES that the building located al .~./~.._N...~..~f_o..~!~..~.?..~....C...~...~.~.hq~t
Map No..~. ............. Block No .......... ~...Lot N'~ ...........................................................................
conforms s~bstantially to the Application for Building Permit heretofore filed in this office
~ch 5 59 ~ 594
dated ......... ~ ..................................... 19 ........ pursuant to which Building Permit No .........................
~rch 5 59
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
.. ~ ~ _ .0~...F~7~.. D~L~ .........................................
~ee Dean,
This certihcate is issued to ..........................................................................................................................
(owner, lessee or tenant)
of the aforesaid building,
.... ~uildink..insiSe~et~F
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.° 594 Z
Date ................... ]//11,~]~., ,. ~ ....................... 19~ ....
Permission is hereby granted to:
J~e~ Dea~ ........................................................................
....... ¢-utohe~me ,....I{,¥. ........................................
to ... Iq~b~l.. all..duel,,l:tn£ ............ ....
at premises located at ..S/S....New..,S~£o;Lk..A~e~ ..................................................................................
............................................ C ,,,z.t chr.,~z.~.r... ~..~ ......................................................................................
pursuant to application dated .......................... I~a~..oh. ........................ 1~(~....., and approved by the
Building Inspector
Fee ~.0~, DD ...............
TOWN O.F SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OF~:ICE
SOUTHOLD, N. Y.
Examined ....... i.~..~.c.:..~..~..... ~.... 19~..~..
Approved ........................................ 19 ........ Permit No. -
Application No....:..~i..:( .......
APPLICATION FOR BUILDING PERMIT
D~te ............................................................ 19 ............
INSTRUCTIONS
a. This Qpplication 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 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 I~uilding Inspector will issue a Building Permit to the applicant. Such
permit shall be l~ept on the premises available for inspection throughout the progress of the work.
e. No building shall be occupied or used in whole or in p art 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 alteratlons, or for removal or demolffion, as herein described.
The applicant agrees to comply with all applic.able laws, ordinances and regulations.
(Signature of applicant, or name, if a corporation)
(Address of applicant)
State whether a~licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
......................... ~,~rT:~'~r~: .~: . . '.
Name af owner of
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: ....................
Street and Number ............../..¥-'.' ........... ~'~. ...................~ ................................... ~ ............................
,~1 Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a, Existing use and occupancy ....................... !..<."~..~.,~'....:."?.f:~.:.~.:...'.~.:.."~.. ...................................................................
b. Intended use and occupancy ............... ~/ '.~.~.~.:~'..:~...; .................................. ~ ........................................
3. Nature of work (check which applicable): New Building ....... ~, .......... Addition .................... Alteration ....................
Repair ......... ........~.Removal .................... Demolition .................... Other Work (Describe) ....................
4. Eshmated 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 ............................ Rear ............................ Depth ............................
Height ............................ Number of Stories .............................................................................................................
Dimensions of same structure with alterations or additions: Front ................................ Rear ................................
Depth .............................. Height .............................. F ' L~Number~ of Stories ....~...~:
8. Dimensions of entire new construction: ronr ............................ Rear ............................ Depth ............................
Height ............................ Number of Stories
9. Size of lot: Front , ~ G. ? ~ Rear ............................ Depth ..................
10. Date of Purchase ........................................................ Nome of For~er Owner ........................................................
/~-
11. Zone or use district in which premises ore situated ................................................................................................
12. Does proposed construction vi~late any zoning law, ordinance or re, gulo.tifgn? ....................................................
13. Name of Owner of premises .................................... Address ........................... ' ................. Phone NO .....................
V
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, end show street names and indicate
whether interior or corner lot.
/
STATE OF NEV~L.)FJ~K~O./~ ) S S
COUNTY OF '""~':"r' '/~"'*'""~':/~i ....... ) ~' ~
.............................. .,....~ ........................................................... g duly sworn, deposes ~nd seys that he is the epplicont
(N~me ~dividuol signing opplicotion)
obove n~med. He is the .............................................................................................................................................................
(Controctor, ogent, corporate officer, etc.)
of s~icl owner or owners, ~nd is duly ~uthorized to perform or hQve performed the seid work ~nd to moke end file
this epplicotion; that ell statements conteined in this epplic~tion ~re true to the best of his knowledge ~nd belief;
end that the work will be performed in the m. Qnner set forth in the ~pplic~tio~ filed therewith. ,. ~
Sworn fo before~ me this~ .,. ELOr~ - ~ , ~ t~ ,, /(.,~
:. '-. ,
................ .....,.:.: ............................ ., :,,.,?
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Extra,ned ............ ~ 9 ....
^pproved ........................
Disapproved o/c
.........
APPLICATIO. FOR BUILDING .ERM~T
Date ........... . ,~..~....~...':.......~.. .................... 19..~,.~ ......
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and suOmitted 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 hove 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)
.................. ~..~...T....q....6..0...~..~..~.-......~ ...............................
(Address of applicant)
State wheth,er a~2,.p,,licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
;a am~, :¢fa::~: raOfco~ r;crm: st: s..~.~¢..-~...~n atu re ofd :; ';":'~' 'e'~;: .........................................................................................
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Mai) No: ............................................Lot No: ........... "~.-. .......
Street and Number .%~..~..~.~........~.....~...~....~,~....~ .............. 2~.~.~...~~.......~.....~'..~ ............
j/// Municipality
2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction:
e. Existing use and occupancy ................................................... ;:;..z ............................................................................
use and occupancy ................ ~.~...r. ..........................................................................
b.
Intended
3. Nature of work (check which applicable): New Building ...... ~ .......... Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
/,~'
4. Estimated Cost....t..~.;~..~ ......................................... 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 ~
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 ...~.~...0..~..¥. ..............
Height ............................ Number of Stories ..... ~ .........
9. Size of lot: Front ..... ?.....~...~...:..~.?'... Rear ....... ..~....~.:..~...~..~'Depth ...... ..~.'...~....~...,q.....
10. Date of Purchase ........................................................ Name of Former Owner .~....~'. ...................
1 I. Zone or use district in which premises are s~tuated ............................................................................................
12. Does proposed construction vi,¢late any zoning law, ordinance or regulation? ...... ~ ......................................
13. Name of Owner of premises~....~.~ ....... Address ........... ~..¢-c~... ............Phone NO .....................
Name of Arch tect ........................................................ Address .............. ~ ............................. Phone NO .....................
Name of Contractor ................... k..k ............................ 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 show street names and indicate
whether interior or corner lot.
STATE OF NEV'~YO~.J,(, ~ ~,. ) S S
COUNTY OF .~..~%....) '
................................ ~......~.% .................... being duly sworn, deposes .and says that he is the applicant
(Name ~¢in~ividual signing applicotion)
obove homed He ~s 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 applicatio~ filed therewith.
ELOI~E
Sworn to before me this - _ ~ ,~,,, .,,?w~, ~ ~. ~
~av of . ~.~ , 19 .~.~'~;~,~c~v°~/Si~nature of app cant)
.................. . ~'. , ' ..... '~ .............. W ;~_- r~o. 52.~%78r:h-~n,~ ~
.............. Cou .o. ,.