HomeMy WebLinkAbout1374-zFOI~i~I NO. 4
TOWN OF SOUTHOLD
BUiLDiNG DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLO, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at ~.~..~....~..~.~...e..~.~.~..~..~..~.~.~..~..~..~L~.~..~...q.~.~:~et
Map No.ce~'~a¢~Jlock No....~.~. ............ Lot No ................... ~..~..~Z~..~..D~,...~ ....
/ conforms substantially to the Application for Building Permit heretofore filed in this office dated
.............. ~...~5 .................................. , 19..~. pursuant to which Building Permit Na. ~..~.~4..
dated ...~D~&.~...~ .............................. , 19....G~ was issued, and conforms to all of the requirements
of the applicable pravisions of the law. The occupancy for which this certificate is issued is ..........
This certificate is issued to ............................. ,C,~.~l,..C~}.~,,~,l$~.t,~sl3~.r~,-¢~v~G~ .......... , .....................
(owner, lessee or tenant)
of the ~:foresaid building.
FOI~M ~0. ~
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.° 1374 Z
Dote ...................... .A~.]~ ....... ~..~ ........... 19...6~.
Permission is hereby granted to:
. ~.l..~l~.~t~u~ .....................................
........... So,~thot~ ~..... !t~.~, .................................
to ......... ]~t~l- - aw.. one..£~i, ty...dwet, t ~ ..............................................................................
at premises located at ..~O{..j~..'~.~.~tt....,(~.C]~l~...]~,&~l,~..~.~g .....................................................
.............................. Gea~a~,..beaeh...~,o~d...wc~ .............................................................................
................... : ....................................... ~thetd.r...t~.~ ..................................................................
pursuont to opplicotion doted .............................. &l~l...~.....~..~ ............ ~9.~.1..., ond opproved by the
Building Inspector
FORM NO. !
Approved ........................................ 19 ........ Permit No ..........................
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Application No..../..?.....~....f~.. .......
Disapproved a/c ......
......................... .................................
APPLICATION FOR BUILDING PERMIT
Date
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 drown 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 Occul~dncy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE tO the Building Department for the issuanoe of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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, ordina~pc,es and regulations.
¢ ........... ~ ....... i.,,~...::..~[~.' ..........................................................
(Signature of applicant, or name, if a corporation)
......... .....................................................
(Address of applicant)
¢tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
............. ~...~.~.~.~.~.~.~.~.~..... ~..~. T ............. ~.. ...............................................................................................................................
owner of ~..~,,., .......... ..%,~..~..=d..~...x .......................... :'. ................................................................................................
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: ..k,~,..c,.(.~T.r~ ..... ¢~¢:....~..I....~... Lot
Street and Number ...8.~.~..~.~..~....~. ,~:..~, ~z ........... ~.~t'~' ~ . Z<.,~ ..........
Municipality
2. State existing use and occupancy of p~emises 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) ....................
4. /:st mated Cost..~....~.....~,,j,.,~.~....C~.....~.. ..................... Fee .,~,,,,~, ................................................................................
(to be paid on filing this application)
unit
5. If dwelling, number of dwelling s ................................ 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 ................................
f ....~'...~.'..,~..... Depth ..~...~.~..'i/..~...°.;.,~..~
8. Dimensions of entire new construction: Front ....... ~.~.......O. ...... Rear ..............
Height ............................ Number of Stories ...~ ..................
9, Size of lot: Front .......d'....~.....~ ........... Rear ......... ./.....~z.? .......... Depth ...~:.,.~..'?.~.~......~....~...~-
............ ...Z 9' (~o
10, Date of Purchase ....................................... Name of Former Owner ...... ,...~ ...............................
11, Zone or use district in which premises are situated ...............................................................................................
12, Does proposed construction vi,o, late an, y,fonlng law, ordinance or regulation? ..... ...ff.....O. .....................................
13, Name of Owner of premises..(.~..~....Address ..... ~..~ ............... Phone NO .....................
Name of Architect ........................................................ 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 descrip~qn according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NE'~.ZC~,,~..- ) S S
COUNTY OF .,.~(..~...,.,) ~ '
(Name of individual signing application)
above na~. H~ is the ...............~....~~.: ............................................................................................
(Cantractor, agent, cat,orate officer, etc.) -'
of sa d owner or owners, and is duly authorized to perform or have performed the said work and to make and file
this app cat on; that all statements contained in this application are true to th~ best of bis knowledge and belief;
and that the work w be performed'm the manner set forth~u0min the~ ~o~applicati°n filed therewith.
Sworn to before me this ~ , ~ ~/ary Pulhe
FORM NO. I
T~OWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ........................................ ]9 ........ Pem t No ...............................
Disapproved a/c ......~~
.................. ..................................
(Building Inspe/~or)
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 coYered 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 Certificafe of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuanc.e 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, ord,~s 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)
/of,
Location of land which proposed work will be done. Map No: ..,,-~,~. . . ' ..................... Lot
Street and Number ..~.~....~....~...~ ....... ~~....Z~ ................
Municipality
State existing use and occupancy of p~emises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....... ~..~. f~ ....... ~.: .......................................................................... ].---'-
'
b. I~te~d~d ~se ~nd ~c~p~y
3, Nature of work (check which applicable): New Building.....~.~....~....~..,..Addition .................... Alteration ....................
Repair .............. ~?...Removal ......;~..;, ....... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost.....r'~.~....~...P...O.?........~..~.../~.. ..................... Fee J....~. ..................................................................................
(to be paid on filfng 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 occupanc,y, 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 ...... ...~..'~.~..O ....... Rear ...... ~s~:...~.:..O ........ Depth.~.'.~:./;~.O:.~.:;
Height ............................ Number of Stories ..~-~.. ...................
9. Size of lot: Front .......~..~...~ .......... Rear ......... Z...cL'~. ......... Depth ,.,~..~/.,.'!~../...~./.'..~./.:~'-'~
10. Date of Purchase ............... ...................... Name of Former Owner ...... ./.-,~.~.:(mz':.~:T.,3. ..............................
1]. Zone or use district in which premises ore situated ........... '.i.~..(.[i ............................................................................
12. Does proposed construchon vi~late~.~;.~/i__~.an~ z. onmg law, ordinance__ .v-~ . ,')ar regulahon ....... ..~.....' ......................................
Name of Architect ......................................................../3 ^ ,~ /) .., Address ............................ ..~ ~,) ............. Phone NO .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property fines, Give street and block numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW./.,YO~,~, ,~.~ ) S S
COUNTY OF .,,,~.~:.¥;~.~.~.....) ,~'
................. ~ ~.~ ...... ~t~:,~ ~ - ~;~ be ng duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is me ............... s~,=,~,,z;,,~.,,~,.~...,. ..................................................................................
(Contractor, agent corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the sa d work and to make and file
th~s' app ication,' that all statements contained' 'm thru' app'h cohort' are true to the best of his. knowledge and behef' '
and that the work will ~e performed m' the manner set forth_inzumT~theT ~0~applJcatJ~n filed therewith,
Sworn to before me this ~ ~ ~ota~y Public Sta~ .
_., .............. o, . ........ . , ,. .. o: >,,, :r, , , - - -
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