HomeMy WebLinkAbout1378-zF~OI~V~ MO. 4
?OWI~ OF SOUTHOLD
BUILDING DEPARTMENT
'I'OWI~ CLERI:'S OFFICE
$OUTHOLDu ~. Y.
CERTIFICATE OF OCCUPANCY
No.Z. 1~.~ ............ Date ...................................... ~.~.~......(. .... 19...~.~
THIS CERTIFIES that the building located at ~[~.....Y~i~...R0g~ ........................ Street
Map No. ~ ................ Block No .......~ .......... Lot No. ~ ........ ~~ .............................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .................. APr. i~.....~. ......... 19~.. pursuant to which Building Permit No..~8. .....
dated .................. ~l~.....~.~ ........ 19.~.~.., was issued, and eonfoms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is ..... .~,i~.. ~l~f~ ....................................................................................................
This certificate is issued to ..... ~ose.phine...Rutko~ski ...............O~ne~ ............................
(owner, lessee or tenant)
of the aforesaid building.
FORM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 1378 Z
Permission is hereby granted to:
~teht ~ ~?e..~.z..~.r..9.y..?~.~...t.~..c..9~....~..c.~.~..~..~.t.~.e.~..~t~t
(~eenport,
t Build an addition on an existin~
pursuant to application dated ......................... ~,]~,~.....],~ ................. 1~]......, and approved by the
Building Inspector
Building Inspector\
~_?_~_~,~_~ TOW_~: O[$OUTHOLD PROP~:RTY
RECORD C~RD ~'
i DtST.i SUB. LOT
I V',/(~ ~ ~~-
,
~ND ': IMP. TOTAL DATE
AGE
NEW NORMAL
:ARM Acre
illable
loodland
~eadowland
louse Plot
oral
BUILDING CONDITION '
BELOW ABOVE
Value Per V~lue
Acre
FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
BULKHEAD
DOCK
¢tension .... .,.¢ > ..:~ ".
Foundotion
Basement
iBoth / , Dinette
'eezewoy
=r~ge
Ext. Wails
Fire Piace
Type Roof
i Jntenor Fmish
,Heat
iRcoms !st Floor
:LR.
DR.
,BR.
Recrection Room :Rcoms 2nd Floor FIN.
Dormer Drivewmy
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Exam,ned .........
Approved .......... No. .......
Disapproved a/c ....... ~~~.
...... ...................
(Building In p c
APPLICATION FOR BUILDING PERMIT
Date ............. ......... t...? .......... .....
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 issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appllcable 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 ali applicable laws, ordinances and regulations.
(Signature of applicant, or name, if a corporation)
(Address of applicant)
State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises.....?...r%.~..~ ........ '..~..~...~..~ ......... ~:~ ........................... r"wa'~' ...................................................................
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: ......~.~i.i~'.~.'~ .......................... Lot No:~...f.~ ..............
Street and Number ....... ~...: .......................................... ~:.. ........................................... · .................................................
Municipality
State existing use and occupancy 9f premises and intended use and occupancy of proposed construction:
2. 'x.st.n use andoccu one ~i~..~.~'~'~ t}6 ~,,
a. ~ ' ' g P Y ......................... "'~ ........................................................... '7~ ................... ',;~"~;t ............
..... ,, '~ W~C~ ~- ~
o. nrenaea use aha occupancy .............................................................................................................................
3. Nature of work (check which applicable): New Building .................... Addition ....~... ......... Alteration ....................
Repair .................... Removal .................... Demolition ......... ~, ........ Other Work (Describe) ....................
4. Est mated 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 ............................ Depth ............................
Height ............................ Number of Stories .............................................................................................................
Dimensions of same structure with alterations or additions: Front ................................ Rear ................................
Depth .............................. Height .............................. Number of Stories ................................
new Front ............ '-~..~....~...~ ................... ..~...~.,~..../~'--.. Depth .... 2...~.~..~.... .....
8. Dimensions of entire construction'. ~ Rear
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.i./.~.."..../.~..: ..........................................................
12. Does proposed construction y~olate any zonina law, ordinance or regulation? ..... ~ ......................................
13. Name of Owner of premlses~ ~' ~-
· .~.. ~.~ ress ............................................ Phone NO .....................
Nome 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 NE~-~r'O~J~, 0Jr ) S S
COUNTY OF ....~.~: ....... ) '
................................. ~' ............................................................... being duly sworn, deposes and says that he is the applicant
o o. .............................................................................................
(Contractor, agent, corlborate officer, etc.}
of said owner or owners, and is 8uly 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 Jn the application fi,~ed therew~tl3.-~. /
Sworn to before me this /~ '"-"-// ~'~ / / /
................ "1"1 day of .;......~~.,~. 19..~..! .... (S~gnature of applicant)
Notary
FOEi~I NO. 1
TOWN O,F SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD~ N. Y.
Approved ......... ~<~.~.....*¢..~]~.....J...~...19(.~.L...Permit No....~...~"¢]../..f4 ..........
Disapproved a/c .............................. k ~..~7.<:7. .............................. ~ ~.
APPLICATION FOR BUILDING PERMIT
Date .................... V. ...................................... 19 ............
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
shah 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 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.
(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 prem.ses.....~;,',~.~,
If applicant is a corporat.e, signature of duly authorized officer.
1. Location of land on which proposed work will be done. Map No: ............ ~v. ..... Lot No~,~,',.,.a ..............
Street and Number r~, ~ ~ ~ ~, f~ ..... ~ ..~.. ~ ~d~ ~.~...~,..~.z. ....................................
,, .~.v ................... Mu~icipo ity-- ~
2. State existing use and occupancy of pFemises and intended use and occupancy of proposed construction:
a. Ex~st~ng use and occupancy,...~.:' ....... ~..~.~ ......... '...~ ...................................... .~..~ ......................................
....... ..........
b. Intended use and occupancy ........................................................... ~.
3. Nature of work (check which applicable): New Building .................... Addition ..... ~k.~ ......... 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 .......... ;;,~3'~.~ ........ Number of dwelling units on each floor ............................
If garage, number of cars . .
6. If business, commercial or mixed occupancy, specify nature and extent each type o use....~...k ........
7. Dimensions of existing structures, Jf 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 ........ ~..~ ....... Rear ............ ~..~. Depth .....~..f ~ . ....
Height ............................ Number of Stories ............................
9, Size of lot: Front ............................ Rear ............................ Depth ............................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
12. Does proposed construction y~olate any zoninfl law, ordinance or regulation? ...... ~.'.a .....................................
13. Name of Owner of premises ~.~....~; ... ~,~.._..
.: ~ s ............................................ e NO .....................
Name of Architect ........................................................ ~ Address ............................................ Phone NO .....................
Name of Contractor .... ~.:~.' ':=.. a~.~ .... ~.....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 NEVt/~YOgJ~, O~ ) S S
COUNTY OF ....%~..-.~.~.'.~..'. ....... ) '
................................. I/ ............................................................... being duly sworn, deposes ond soys that he is the ~pplicont
(N~me o~ individuol sig~ opp[i~ ,
above, named. He ,s the ................. ~;.~ ..................................................................................................................
(Contractor, agent, corhorate 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 ail 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 / .
...... / ........... /. ....... ..... "