HomeMy WebLinkAbout629-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the. building located atD...e..e.~....~.~.~..~...e.....D.~.~..~....M..~...t~..t..~..t..u....~..~.~¢~.~*.~§treet
Map No. **** Block klo *w~ Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office doted
..................... ..A~..~.~.~...~ .................. , 19..~.~.., pursu.ant to which Building Permit No ........ ~...6.~). ......
doted ....................... ..A..~.~$..3:....~ ............. 19..5..?..., 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 ................
.............................................. ~.~.~...9.~ .. ~,m~_ ,z. ~...~:~ .u,.~ ..................................................
This certificate is issued to ...~.~.~..~..~.~.~...~..*~.~...q~.~c..~....?..a..~...~..~...~..k.y..~....~ ...............................
(owne, r, lessee or tenent)
of the aforesaid, building.
~uilaing 6spector
HOWARD M, TERRY
FOR~ ~0~ ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS P~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
629 Z
Permission is hereby granted to:
Edward Tabor ~ky
Deep Hole Drive
,..~...t..t...i..t.~.~.k..L~.e.'.:~....Z..o..~ ................................
build a private one-family dwelling
pursuant to application dated ................................ .A..?.?..~?:.....? ............... 19..~.?..., and approved by the
Building Inspector
.............. ....
_ . .B. uild_ing Inspector~ '
~owarc ~], ~'erry
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
Examined ............... ~.~....r~.... 19..?./~.~
Approved ................. ~..~..... 19.~9.~.(. 'lbe r mlt
Application No ...... ..~..'....~....~.. ........
APPLICATION FOR BUILDING PERMIT
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 issuanae 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 all applicable laws, ordinances and regulations.
............
(Signature of applicant, or name, if a corporation) l
...................... · /-. ...............
State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nome of owner of premises ..............................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
which proposed work will be done. Map No: .............. .'..~;..~ ......................... Lot No: ....... ~ .....
1. Location of land on ~~~
Street and Number ....~..t~..c...~.~..~:....z:~..,>, ..........................................................
/ Municipality
b' Intended use and occupancy .~..~.~ -
~A
3. Nature of work (check which applicable): New Building....: .............. ddition .................... Alteration ....................
Repair .................... Removal .................... Demolition ......... ~ ......Other Work (Describe) ....................
4. Estimated Cost ..~./.~./ ~./ / Fee T/~.?~
(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 ....... --/..~.; .~p~.//~ .......... Rear ......... '/--..~...~.... ......... Depth ./..~....,~ ...............
Height ............................ Number of Stories ............ ~ .....
9. Size of lot: Front .............. ..~....~....... Rear ....... ./......~., ........... Depth .....~..~... ........... -' --
10. Date of Purchase ..~...~-~......//...,Z'..~....~....~.~... ........ Name of F~ormer O,,~ner
11. Zone or use district in which premises are situated ............ xK.'TZ. ...... ~.~d: ........ .G,~..~ ..............................
12. Does proposed construction violate any zon~g lav~, ordingnce or regulation? ..... :~..~.,~t .............................
13. Name of Owner of premises...,.~'~~..~..~....~.~..~..~..?,.~h~o~ NO.~... .................
Name of Architect ...........~~__,r~'.~....Address .................. '"'v','", ............ wPhone NO .....................
Name of Controcto~..~.....Address ..... ;....~....~hone NO .....................
PLOT DIAGRAM '
Lacate 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 show street names and indicate
whether interior or corner lot.
/0
STATE OF NEW Y~. K,~J.,,/;'~/'~__S S
(Nome of individual signal ~a~pl, ica~t~n,)ff , , ' '
above named. He is the ................. ~~ ........................................................................................................
(Contractor, agent, corporate officer, etc.)
of said o~ner or bwners,, and is du, ly a~t~orized to perfocm, or'have ,performed the said work and to make and file
thi~ app cation; that ail statements cohtained in this applisation are true to the best of his knowledge and belief;
and that the work will be performed i~the ~p~er set forth in the application filed therewith.
Sworn to ~gfqr~me this '~Z,~St~
.... .~ ...... day of ~~~r~ . ~(Signature of applicant} 1
....... . , , t__
Noto~ Public, ::::~../~..'~l~&/ ~~C / ~ ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ................. ]9..~rmit No .....................
(Building Insp~ ,
Application No ...... ..~...%~...~... .......... ~
APPLICATION FOR BUILDING PERMIT
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 buitding shall be occupied or used in whole or in part for any puFpose 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 o 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 a Iterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applic.able laws, ordlnances and regulations.
............
(Signature of applicant, or name, if a corporation) ~
..................... .............................
State wheth,er 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)
1. Location of land on which proposed work will be done. Map No: .............. : ............................. Lot No: ....................
Street and Number ...... " . ....... :, ...................................................
/ - Municipality
2. State existing use and occupancy of premises and intended use aQd occup.ancy of proposed construction:
a. Existing use and occupancy.:.'.....~:£~~../...~~¢~<'~"~.~../-~.~.~~~'"~'
3. N6ture of work (check which applicable): New Building .................... Addi ion .................... Alteration
Repair .................... Removal .................... Demolition ........ .~'_.~ ...... Other Work (Describe) ....................
" ~ Fee'~"-/~
Est ma ted Cost .....-~.. ~-,~..¥..~--:.-,. J~"~ "/- ~:~' ~;'¢ '~)_ .............................. ..........................................................................................
4.
(to be paid on filing this application)
5. If dwelling, number of dwelling units ........~.t~ ........ Number of dwelling units on each floor ............................
If garage, number of cars ..........~.. ~ ........................................................................................................
business, commercial or mixed o~cupancy, specify nature and extent of each type of use ..............................
6.
If
7. Dimensions of existing structures, ~f ~ny: 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 .....~ ............ Dept~ ""7~ ............
10. Date of Purchase ~/~Z'""/'"'7'~""~ .......... Name of Former Owner ~.:..:..~.....~.....~.......~..;.
11. Zone or use district in ~hich premises are situated ........... 4Z~./x....~;:.....:~ ......... ~ ............ ~..ff....Z.2: .................
12. Does proposed construction violate any zoning law, ordinance or regulation? ..... ~ ..........................................
13. Name of Owner of premises....~ ......... ,~..~s, ........ ,, ............ z.~....~..~, NO .....................
...... ................................ .....................
PkOT DIAGRAM
kocato cleorly ond distinctly oll buildings, whether existin~ or proposed, ond indicote o1~ set-b~ck dimensions from
property lines. Give streot and block numbers or description occordin0 to deed, ~nd show streot homes ond indicoto
whether intorior or comer lot.
F r/r'/L,._I
STATE OF NE'v~.,~/..4~
COUNTY (~F~.T~.~_~- -'
(Name of individual sign~g applicationF '
above named 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 ~ann~ f~rth in the application filed therewith.
' ~ ~b ~" ~o~
Sworn t~e~ me th~s
........... z ........... of .................
Noto; PuN,c, ...~.,..~ .........