HomeMy WebLinkAbout972-zFO~R~ ~0. 4
TOWN OF SOUTI{OLD
BU~LDIN~ DEPARTN~V-NT
TOWN CLERK'S OFFICE
SOUTHOLD, N.
CERTIFICATE OF' OCCUPANCY
No .......g.., 9.4...0. ...... Date ..................... .N...O..V..e. rLb...e. ~..~.5. ........... 1~...0... -
THIS CERTIFIES that the building located ai .lq,Zs...~l,~Jshtr..lt~d~.,...~a.t~.~.... Street
Ma~t. ~ark Pro~.
_Map No ....................... 'Block No.....~..*..*. ........Lot No~8,...49. ..................................................................
/' conforms substantially to the Application for Building Permit heretofore filed in this office
dated ......... .....?..eb.{.u..~{~....!.7....., 19.6..9... pursuant to which Building Permit No ..... M......9.7..~ .......
4ated ......... ~'~]o~g.~;~ 1~ ..., 1~.0 ..... was issued, and conforms to all of the requirements
of the appXicable provisions of the law. The occupancy for which this certificate is issued is
I~RXVAT~ 0~.. ?..~ .~.L...Y..P .W~L;[~.~ .................................................
This certifma~e is issued to .....
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector[
FOEi~I ~0. ~
TOWN OF $OUTHOLD
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? §7~ Z
Building Inspector
Fee ........................
FOEM NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTJVJENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved l C.per t No ...... ....
Disapproved o/c ......... ]]..:~~~~ ...... ~-~
.............. ....
(Building Inspector) ~ ~
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 approvo of this application the Building Inspector will issue a Building Permit to the applicant. Such
permit shall be kept on the premises ava.liable for inspection throughout the progress of the wor¢.
e. No building shall be occupied or used in whole, or in part for any purpose whatever until o 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 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 whether applicant is owner, lessee,%gent, architect/engineer, general contractor, electrician, plumber or builder.
Name ~/~ /~/ ~ '
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate, officer)
1. Lecation of land on which proposed work will be done. Map No: ..... ~./~..~..~?.(~...J.J...~. Lot No: ...~...~, .~.i../.~..~...
Street and Number ....... ....... : ........ .~ .........................................................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..... ~ .....-- ~';":4'---: .................................................................
b. Intended use and occupancy ..................................................................................... ............................................
3. Nature of work (check which applicable): New Building .................... Addition ...... X ........... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost ....... .~....0...0.....~ .................................. 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 ..~..~...._r. ....................
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 ............................ Depth ............................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
11. Zone or use district in which premises are situated .......... ~*~ ~
12. Does proposed construction violate any zoning law, ordinance or regulation? .............. ~ ..................................
13. Name of Owner of premises ........................................ Address .......................................... Phone NO .....................
Name of Architect .................................................... Address .......................................... Phone NO .....................
Name of Contractor .................................................... Address .......................................... Phone NO .....................
PLOT DIAGRAM
Lacate 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 NEW~,YC~R,~,/~ ) S S
COUN'I'Y OF ..~..~r~....) ' ' '
....................... ~~~....~~ .............. being duly sworn, deposes and says that he is the applicant
(Name of individual sign~g a~~
above named. He is the ........................ ~.z;-zm::z.z.~..z ....................................................................................................
(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 application filed therewith.
IUDIT~ T. BOKEN
~o a ~ P~?c~ S~a~e of New Yor~
Sworn to before me this N0. 52-0044983, Suffo]k Cour~ty
............... ......... ........... ....
Notary Public,~f~,,...~~ ........ y (Signatur~of applicant)
FOI~I~ NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
Approved ~:C~.~...l~..., 19~...Permit No.
.... ~%~...~..~,.~,~,: .....
Disapproved a/c
.................. ~,,~:~7~ .........................................................................................
(Buildin~ Inspector)
APPLICATION FOR BUILDING PERMIT
Application No .......,~,.16,~...d~z...:~ ........
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 I~uilding 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 issuance of a Buildin9 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 taws, ordinances and regulations.
(Signature of applicant, or name, if o corporation)
...... .......... ...............
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.h,
Name of of .... ........................................
If applicant is a corporate, signature of duty authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map No: ...... /.,¥........: ...... ;....:.: ......... ~i Lot' No:. .
~'i Il,. , q ,,,, 4/ ~,,[
Street and Number ..... f~j:,....,,~,~.~f.n,..,~.,.I .................................. ,~ .............................................................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy , ""' ~ :,. .... ' .... ,.' , ~ '
.... t. ......... ~ ................. ~..~,..,>, .............. [ .......................................................................
( ~ I~ ~ ' ~j' r/C~,, f/,.[/~'~
b. Intended use and occupancy ......................................................... : .............. ~...:~.,..,~ ..............................................
3. Nature of wark (check which applicable): New Buildin~ .................... Addition .......
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
700 3
4. Estimated 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 ........ ~.....'f:.::...i ...... 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 ........... .c~. .............. Rear ..... ?. .................... Depth ....~ ..................
Height. ........................... Number of Storms ................................
9. Size of lot: Front ............................ Rear ............................ Depth ............................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
11. Zone or use district in which premises are situated ................ ': .~ ...................................................................
12. Does proposed construction violgte any zoning law, ordinance or regulation? ........................................................
13. Name of Owner of premis~(.--~ ..j/....~....r~(.. Address .. ~r,x~.j~.~.. ....... Phone 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 show street names and indicate
whether interior or corner lot.
STATE OF NEW~. YORK · ) S S
COUNTY OF ..~...~./...~./(. ....... ) ' '
.................. !J..L..~,....Y.z.,....,~ ........ ¢;[~.....A ~ .............. be ng deposes that he is the applicant
........... (Name ~f i~l~id"'bb" s ~ng~i%~qi6h~ duly sworn, and says
above named. He is the ...................... -- k~u,, ,~ , e ,~~~'~'~"~Z~'~'~"~f~'~'c~"~'~'.~ .......................................
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 application filed therewith.
Sworn to before me this ~o.
~otarg public, State o~ Flew
.............. o, .........
Notary Public,~o~,~.~......~~.. ~- (Signatur4of applicant)