HomeMy WebLinkAbout1290-zFOI~I NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at ....... ~.J~.....~e..~a,l:~e ............................ Street
Map No. a~...Ti;.~;... Block No....~::~J~ ........... Lot No. ~ ......... .g..~..t.-~..h...?.~.?:.~..L.....N..'...~,~ .............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
................................ D~G~J::~.....28 ...... 19~0.. pursuant to which Building Permit No.
dated .................... .])~:~d~z~......2~.., 19(~0..., 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.~lv.~te...one.. f. amll~.., dw~lli~ ..........................................................................................
This certificate is issued to ....~.~t~Z~...~a~,e~ ........ i;~,'r~;r? e~sse~"~';'T;~;;~i' ...............................
of the a,foresaid building.
FORF[ 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? 1290 Z
Permission is hereby granted to:
~ tanle~,"-' ~g, Tt;~'/¢ ...........................................................
...... Cutehog~.e'~'""'N;'Y~ ...................................
to '"'~'~'~'~'"~"~'~'"~;~i~Xf' a;,~i'~'~ ...................................................................
ot premises [ocoted ot ......W/S.....C.~......T~.~ ...................................................................................
........................................................ ~ii'~t¢,.'~ L4~'; '""t~':'cZ': ..................................................................
pursuont to application dated ...................... 'l)~'Ef~i~t~'""~' ............19...~.0, and approved by the
Building Inspector
Fee $""]L'O';'O0 .......
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
×om ned ..........
Approved ........................................ ]9 ........ Permit No ...............................
Application No. / ~ ~ O
APPLICATION FOR BUILDING PERMIT
Date ........... ....~...~.....~ ......... lC~.[~. ....
INSTRUCTIONS
a. This application must be completely ill[ed in by typewriter er in ink and submitted in duplicate to the Building
Inspector.
b. Plot plan showlng 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 cowered 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 o 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 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 a[[ applicable laws, ordinances and regulations.
..... ...... .....
(Address of applicant)
qtate wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ...... ..~.~' .................. i . ...............................................................
If applicant is a corporate, signature of dulylauthorized 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 ...~./,~'......~. ,¢D-~..~~ ............ ~.~.~ ..............................
Municipality
2. State existing use and occupancy of p~mises and intended use and occupancy of proposed construction:
a. Existing use ond occuponcy ....................................................................................................................................
b. Intended use and occupancy ............... .~..~.'~.....~...:...~..[c.~.....~..~..~..~..~..~I ......................................
~ t
3. Nature of work (check which applicable): New Building .................... Addi ion .................... Alteration ....................
Repair .................... Removal .................... Demolition ............ ,~.....Other Work (Describe) ....................
4. Estimated Cost J~ ~ ~ ~ , 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 existinfl structures, if any: Front ............................ Rear ............................ Depth ............................
Height ............................ Number of Stories ...................................... ~ .....................................................
Dimensions o e with alt ns or additions: Front .....~..'~.:...~ Roar
Fa
Depth ........... .':'~g~..2...~. .... Height .............................. Number of Stories .~ ....................
............................
Height ............................ Number of Stories ..... /.....~. ...............
· 9. Size of lot: Front .... ~.'...~....O. ............. Rear ...... .~....z~..O....J~.. ....... Depth ./..~..~./....../~...~.../.. .... ~ j
10. Date of Purchase .............. /...?...~.....~.. .......................... Name of Former Owner ..... ..~...~...~....~..~ .......
11. Zone or use district in which premises are situated ........ ~.~. ................................................................................
12. Does proposed construction vioJ,ate any zoning /aw, ordinance or r,,eguJa ' n .....................................................
13. Name of Owner of premises.~'~..~''''~'~'.'...Address''~ ,~ ,~---~n ~ ... ~..~...~ Phone NO
Name of Architect ...... ~__...~.....~m...~:...~.' .........Address ...il..~iiiiii!~ii'.iiiiiiiii'~iPhone~" ">' NO'.
Nome of Contractor ...... ..~-.~: ......................... Address ....... ..~....~-.'~...~..~..~.: .............. Phone NO .....................
PLOT DIAGRAM
Locate 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 acc'ord~n~g to deed, and show street names and indicate
whether interior or corner lot. ~
STATE OF NEW ~OR, K~. /;~ ) S S
COUNTY OF .;~~..) '
~~,F ..~~ ....................................... being duly sworn, deposes and says that he is the applicant
(Name of(v/qdividual,/~..~ing application)
obove named. He is the ........... (.~_~....6.~ .............................................................................................................................
(Contractor, agent, corlborate officer, etc.)
of seid owner or owners, and is duly authorized to perform or have performed the said work and to make and file
this application that a 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,,i,q~l~h~. ~jcation filed therewith.
Sworn to be re me th s /'1 q'otarv f~l~i',c, Sta'tesu~iotkof ~le~ Y~o~vk
~,~? ' · ,~,
..... ~.~. ............ day of ......... ~~.~./. 19.c/~.~,~i°o~ ~×~s ~cl~'°u"' ~ I~, ~gnature of applicant)