HomeMy WebLinkAbout583-zFORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SGUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No...Z..3.~i~ ............ Date ............................. /~,t~.~....~. ......... 1959 .....
THIS CER'I-IFIES that the building located at.....S/S..~o~.~weed..~ ............................... Streert
Map No:lC~. ................... Block No.~.~:~ ................... Lot No...~......~,~.%~,.~ltCk~....~,]., .......................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
......................... ~el~/-.-.D,4, ........ ~ 19.~...., pursuant to which Building Permit No..~.....~ .................
dated .............................. ~.el~a~ ......~/, 19.~9...., 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 ..............
..................... P. rJ,~ t,e ..on~ ..£~1¥..d~e~.;~L'~g .....................................................................................
This certificate is issued to ...Cl'I~t~Lo~..]KI~.Ox*. ........... ~(~a~'). .........................................................
(owner, lessee or tenant)
of the aforesaid building.
................. r · .,i. ~,,~.,,..; ........................................... ¥.
Building Inspector
FORM 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.° 583 z
Dote ............... ~.el:l'~l~.....;~,1~ .................... 19.~....
Permission is hereby granted to:
Cha~t~..geelO.~r ........................................................
...... _a_~__. &~2... ]att ltuek~....Il,!, .......................
to ...... J~a~t. ~... ~welli~ ...............................................................................................................
at premises Io~ated ot .5/.~....[nellweod,.;Lal~. .....................................................................................
................................................. I~tt~t~uek~.... l,~., .... . ..............
pursuont to opplicotion doted ......... J'~....~,~ ................................ 19~...., ond opproved by the
Building Inspector
Fee $ .~.,.0~. .............
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, b~. Y.
Exammed' ...... ~'~ .I~~'~ ............................ '~ ( 19 ...... ~ ~
Approved ........................................ 19 ........ Permit ..............................
Disapproved a/c ..............................................................................................
....................... .................................
APPLICATION FOR BUILDING PERMIT
Dote ......... ...........................
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 port of this location.
c. The work covered by this application may not be commenced before issu.ance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the appticant. 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 p art for any purpose whatever until a Certificafe 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 Sou'thold, 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, ordlnances and regulations.
........ .........
(Address of applic.ant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of ~ ~=D~ ~'~b~/~ ~'~"~
premise ........................................ ....... ......................................................................................................
If applicant is a corporafe, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land an which proposed work will be done. Map No: ........... Lot No: ....................
Street and Number .~.. ...............................................................................................................................................
Municipality
2. State existing use and occupancy of p~emJses and intended use and occupancy of proposed construction:
o. 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) ....................
~'J/-/. 00, ~ Fee J 0 ~
4. Estimated Cost...~...~.~/..~. .......................................................................................................................................
(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 ......... ..~,..¢3. ........... Rear ....... .~....~.. .............. Depth ......~.....~... ............
Height ............................ Number of Stories ...~ .........
9. Size of lot: Front ../..7....O.. .............. Rear ...... ./...'..7....O. ........... Depth
10. Date of Purchase ...........................................Name of Former Owner . .r. ...........................
] 1. Zone or use district in which premises are situated .................... r.... .! ............................................
12. Does proposed construction violat~l/,/ any zoning law, ordinance or ,regul~tion?,r~,/j~. ....................................................
e o ner of remises ~ ~..~ A ~ress ~~ Phon
13. Nam f Ow p ........................ d ......................................... e NO .....................
Name of Architect...,~.~..~........~....Addressk-h _ ~ ,~.. ~, I ~ ~ '"~"r'"'"~~'~'"Ph°ne,'h _ -,~-/) ~ NO .....................
1.1~,
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
properly lines. Give street and block numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
L
STATE OF NE~YC~I.(, ~)J~.. )
COUNTY OF ..~...~....) S S.
................................................................................................. being duly sworn, deposes .and says that he is the appllcont
(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 in this application are true to the best of his knowledge and belief;
and that the work will be performed in the manner seLforth in the application filed therewith.
Sworn to before me th s ~. · ,
~ H~,, of ~~ l~,~'~.5'u~r~,~u c0un~ (S nature of a cant)
............ ~ ....... ~ '"'~'""~'"""" ........v'";;]. ';'~'r,~.T'~2-~8~r~. .,,,~,,~ ~ g ~ PP ~ ~
..................................
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ........................................ 19 ........ Permit No ...............................
Application No....~....~.. ...........
Disapproved a/c ..............................................................................................
.............. .............................................
(Building I~spector)
APPLICATION FOR BUILDING PERMIT
Date ......... ~..7~.....~. ........................... ! 9..~....~....
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 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 issuonoe of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Sou'thold, 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.
......................................... ...........................................................................................................................
Name of owner of premises .........................................................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
l. Loc~tion of l~nd on which proposed work will be done. M~p No: ... :~;k....~.;t~: ............ Lot No: ....................
Street ond N ....... ; ............................ ~ ....... ' .......................................................................................................
Municipality
2. Store exisfin~ use ~nd occupancy o~ premises ~nd in~ended use ~nd occupancy of proposed construction:
o. · ............... ...........................................
b. n~endea' use ona' occuponcy ............ ~,e..:'.~' ~k' ~ ~ ~ ~'~';~..~-...;~.~ .................. ~' ....... :...~ ...............................................
3. Nature of work (check which applicable): New Building .................... Addi ion .................... Alteration
Repair ............ ~.....Removal ..... ~ ........... Demolition ..................... (~er Work (Describe) ....................
4. Estimated Cost.....~....f.2....~..¥. .......................................... Fee .....L ....................................................................................
(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 ~ c~ Depth ~ ~
Height .................... .~..~.,~Number of Stories ............................
Size of lot: Front ............. . ...... .~ ...... Rear ............................ Depth ......................... e- ,
10. Date of t'urcnase ........................................................ Name. o~f,.Form~ uwner ,~,......~. ...............................................
1 ]. Zone or use district in which premises are situated ................................................................................................
12. Does proposed construction violat,~ any zoning~ law, ordinance or reg~tion? ....................................................
13. Name of Owner of prem,ses.....~..~.-'r~...~..e.^~¢~.....Address ....,~... ............. [' .................... Phone NO .....................
Name of Architect...~.?.~...~..~.:..!.~...~.....l~..~--"''~~. ..~~.~..~.~X.....Address ...~.;......~.q.%.4.;..~.~.~:..~.....Phone,.~_-- ~ ~-~-. 6 ~ NO .....................
Name of Contractor~ ............ ..~..~r.c...~..*..~.%..~.. ......... Address .......r...~..~,~.Z?&,':,.~.~n.~.~. ........ Phone NO .....................
PLOT DIAGRAM
Lacate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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
COUNTY OF ....¥_...f.~-.: ..........) S S.
................................................................................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing?,g~plicat, io_n)~
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
th s application; that all statements contained in this _ap_p[ication are true to the best of his knowledge and belief;
and that the work will be performed in the m.ann~thae~tJle application filed therewith.
Sworn to before me this
,?.....~..~ .<. ..~ ~.~?,! ~;,~3!;~"~ ~ (Signature of applicant)
....
:....: ....... : .........
~om yubhc~ & y '