HomeMy WebLinkAbout1085-zFO,R~ ~0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located al ]~r.~,.-.l~,., ...~./S..~y~'~..R(~... Street
3/lap No ........ .~. ......Block No ..... ~$ ....... Lot 1¥o ................................. ~ ......................................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ..................... .~...~--~....~..0. ......... , 19...6..0., pursuant to which Building Permit No ...... ..Z.....~..0..8..5.....
~lated ....................... ..~...~.~..~,0. ........ , 19...1~, was issued, and conforms to ail of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is
1~:[ .V~&l'll..01~IL FI~t,~.. ll~ ................................... i ....
This certificate is issued to ................. ,~ohn...l~,i~.,...otell~a~' ............................................................
(owner, lessee or tenant)
of the aforesaid building.
/ Building Inspector
FOI~M NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. ¥.
BUILDING PERMIT
(THIS I~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 1085' Z
Permission is hereby granted 1'o:
Douglas
Date ....................... t~r ""~;O ................. 19'1~0"
Beebe.' '&" ~om'"' Ai/~'''' -~To~t"," '~'lee ......................
"~:tt't:~P/ti~i~ ........................................................
.................... ~ff~..~. ...................................................
to .-...~tt~.2~., s~u..~d~ton..on.. ~z~..e~J:~ng..d~et~..-.; ................................................
at premises located at "~"~O~'~""'~/~'""~;'"~t~f'~'~'"~O~l~ .................. ; .............................
............................................. ~o~t~hotd.~. ....... ~.'~ .................................................. : ..........................
pursuant to application dated ............................... ~r .......~ .............. 19.60,., and approved by the
Building Inspector
Fee $'"%~"""?~eek
FOI~M ~0. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ......... ~ ..e..'T..~...'~...O...., 19...~...°..
Approved ...................................., 19 ........Permit No .................................
Disapproved
a/c
............................. ............................
Application No ..... {....0.....~...~ .............
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink end 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 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.
.................... ..'{..,......: ............... .:..~. ........ .~ ............................
(SignetS're of applicant, or heine, if a corporation)
(A/ddress of applicant)
State whether appli,cfant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
/
remises ........... ~ ~';. · .~.... ~ ~:?.:.~.: ......................................................................................................
Name of owner of p ..~..
If applicant is a corporate, signature oF duly authorized officer.
(Name and title of corporate officer)
I. Location of land on which proposed work will be done. Map No: ...................... '~-.: .................... Lot No:..T...~..- ...........
Street and Number ~.~..~..~f~.A...~.:..~./.~..2..?..~..~.~.~..~z(..~.~:.~..:~...~...~:~¢..~...Q.~...~`~...~.~....~..~.f.:~~ ......
/ Municipality cz
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
' 1'-eduseandoccu anc " ~/ ~c')/~-d~z~'Zc"~-~d~:~
o. mend p y .......................................... ~/ ..................................................................................
3. Nature of work (check which applicable): New Building .................... Addition ....... ~......Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe)
(to be paid on filing this application)
5. I~: dwelling, number of dwelling units ..................... ./...Number of dweIling 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 ............'T~.......~. ........ Rear ............... ..~.....~...... Depth .......... ~..~'....f .........
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 ....... ../...t~ .......Depth ..........'~......~... .......
....... ...~.....~.. .......... i,~JT,~rnber of Stories .......... ?""7~""";;'"
Height
9. Size of lot: Front ....~'...~...~.. ............ Rear .............. ,.~./...~....~. Depth ................. ...~..\,~? /
]0, Date of Purchase ........................................................ Name of Former Owner ..... .~ .......... ; ......................................
1 1 Zone or use district in which premises are s~tuated ~.. :.; :~...~...
12. Does proposed construction violate any zoni~n~ Iow, ordinance or regu,!~tion? ...... ~'/"~'~ .......
13. Name of Owner of premlses......~.~':.'m..¢.../../.-~..~?.,f...,Address ....~,f.:(..~.~..~.T~'.~.. Phone N~i..~...~..~..."~-
Name of Architect ,m~ ................. '~' ~.~..'~,~;..~..~.....Address ..f ........... ~ ......................... Phone NO .....................
Name of Contractor~.~.¢t.~/~)-~Z/,cZ,~..~.?.~...~'.../...~'..~'.Z,~..~Address .......... .~..~.~.~,~£.~.?. Phone NO...~..~..~...'~'...~./.~..,~,'~
PLOT DIAGRAM
Locate dearly end 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 corne, r lot. ~'/z/' / ~' t/
STATE OF NEW Y(~K/,/ ///,~ S S
.......................~//~x~ ,~¥////~...~...~..??..~.~,~..~. . . (~e . ,-,~..~.~...~// ......... being duly sworn deposes and says that he is the applicant
(Name of m~,fidual s,i~mng apphcotlon)
above named. He is the ...,~.C~'.¢.~...(~'....C~.~.f~.~.~.~-..~.~ .......................................................................................
(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 opplication; 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 bef~ me this
...... day of ...............
(Sig~/~ture of applicant)
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLDI, N. Y.
Examined ........... .>..~4~4~.. cc.,zi.~;.... 19...~. ~
Approved ...................... 'r~ ............... 19....~..Permit No...~.~./,.~..~,.~)...'~. ....
Disapproved a/c ..............................................................................................
.............................................................. . .~., .~.7.~ .~ ........ ~-~.~ ~:
....... ..... -7: ........................................
Application No.
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS~
a. This application must be complefely filled in by typewriter or in ink and submitted in duplicate to the Buildinfl
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to adioining 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 pr~ogress 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 issu~noe 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 a Iterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
....... · ............. ...................
l,~dress of applicant)
(~.State~wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................................................................................................................................................
Name of owner of premises....~.~..~.~.i ............ /....~Z.~...~:..:~~. ............................................................................................
(/
If applicant is a corporate, si~ature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map No: ............. w ............................ Lot No: ........ ~ .....
Street and Number .~...~.,,~.,....z~..~..:.....~'~.~ .~..~;.~,~....~.?..~J.....,~..~...~.,~.~:~.~.~.. ..........................................
/ ~' Municipality
2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction:
b. Intended use and occupancy .............................. ~z ......... ~.: ...................................................................................
3. Nature of work (check which applicable): New Building .................... Addition / Alteration
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost ...... .~..~.~.'.'.-..~.....~ ............................... Fee ..~..~..~ ......................................................................
(to be paid on filing this application)
5. if dwelling, number of dwelling units .......... ,J.' .................... 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 ..... .~....O....f ................
Depth ........ .~. ................... Height ...../.R~.. ................... Number of Stories ................................
8. Dimensions of entire new construction: Front ........ .(..~.. .............. Rear ...... ../.~ ................ Depth ..~...~.. ....................
Height .....[.~.. ................ Number of Stories ..... /.. ....................
9. Size of lot: Front ........ ..~'..,~Z...~..:..'L ..... Rear ...~.(~.~'.:..~ ........... Depth ...~..~. ....................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
11. Zone or use district in which premises are situated ............ '..'i~...i'.......~..~.'~'.:...~.C.~.~....:f; ..............................................
12. Does proposed construction vig]ot'~' an~,'~ging~,~/,/~/~/ ~-'Z~J~ taw, ordinance ,qrr~o~?~}.....,J("~ '~-~-~'~7, ,,~9'' .t: ..~.....~.') ..................
13. Name of Owner of premises;r;:~.~..~.....Z..F~... ............... Address ....~...~-~':....¥ .............. Phone NO.~ ....................
Name of Architect....~ ....... ./...~.~ ...... ..:..; .......... ~......Address ................ ,..-~ ..................... Phone NO .....................
Name of Contractor...~...:.?,....~.¢...~;(..~...~).?Address, ...~-~:f-~....~.~.~..-=......Phone NO,/,~...~..?..~...~../..~..
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate al/ 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. -jI~Z_'~.~~/
STATE OF NEW~*O,,~/I,~,
SS
COUNTY OF .~..~~ ) ~ '
~,d ~/ ~ ~ ' sorn d
..................... ..~..~...~ ...... ~ ...................................... being du y w , eposes and says that he is the applicant
(Name of~ndividual 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 float the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
,~ ~z/~. f ~/~'~c~, 19 ~ o (Signatgre of '
.......... '.~ T.. aay o ....... .............. .¢.~ r. ~..'~. ~.~ .,/ ...... ............ //'~, -~'~, "~,~' '" /7
Notary Public, ..Z~'.~m.Z.~.:..~.C../'"'~..~,~.C-~mtY