HomeMy WebLinkAbout1579-zTOWN OF $OUTHOLD
BUILDING DEPAP~T/vlENT
TOW~I CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at ...~J.~'~Jill~,..~..~,....~...~J~.~..~...~..~..~, ........... Street
Mapq~.~...t...,K..&.,~..~....~...~l~j'ock No ...... ~*..~. .......... Lot No..Ti ..............................................................
conforms substantially to the Application for Building Permit heretofore filed in this office doted
.................................... O..,~..~...~..~..?..~....?. ......... 196j... ..... pursuant to which Building Permit No, . ....... Z. ....... ]L579
dated ............................ ..Q.~...~.?.~...~..~....,~.,.~., 19...~...~.., 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 ..........
................................... ~;~.~,'~.. A.~....~...~.....~...~..~., .~...~:...~...e. ................. i .........................
This certificate is issued to ]~.~.~.~. ~O~lZ'IIBO~ ~.~..~...~.
- (owner, lessee or tenant)
of the ~,foresaid building.
Building Inspector
TOWN OF sOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS P'ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 1579 Z
Permission is hereby granted to:
St a.n.l~¥.....S.c~ ~,~o..,, .A]C...~e.~g~t .. ~:oh.n s~n ......
.... ~a '~?o ~4:.tte]~,c.f...~[.~ .~£-~ ........................................
to..B~t~:i~-. ~zn...adc~i.t.~ cmo'.'on'-R:n" exi.s~.i~g-' ~4~'ii~n~ .....................................................
at premises located at "~0¢'"~'¥'""~}0~k'"~ ....... ea~2'"l~J[~d'"~'2aqt'e~- ....................................
......................................................... Im~. e.¢,..&..~,~-~F.J:am. *R. oad ..........................................................
................................................................ Y~ ~*t.~.~. ~c*~z ...........................................................................
pursuant to applica~iot~ dated ............................ 0¢.$o~e:r.-....9 ............ 19.6.~..., and approved by the
Building Inspector
Fee $...~.O0...pd...cash
Building Inspector
FORI~ NO. 1 '~t /~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
E×om ned ...... ........ ,
Approved .......................... ~ ........... , 19 ........ Permit No .................................
Disapproved a/c ............................................................................................
(Building I nsp'~tor)
APPLICATION FOR BUILDING PERMIT
.......... .......................... ,19..C..! .......
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 application.
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 pa rt 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 o 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, ordinanc~and~ regulation~//~
(Signature of/~pplicantj/or name, if a corporation)
......... '~'~"'"'"'"'"'"'"'?"'"';.l(Address of applicon[~/' .....................................
State w¥~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ..~~A'x/ ............ ~ In....~.~..~ .................................................................
/ /
if applicant is a corporate, signature of ~uly authoriz~Yofficer.
(Name and title of corporate officer)
1. Location of land on which~a~opos.ed w,ork will be do~n~. Map No: t N~ ..........
Street and um er
~ ~ /~ 0 O Municipality ~"/~ '~,~L, ~t-
2. State existing use and occupancy of Dr/emises and intended use and occupancy oF proposed construction:
a. Existing use and occupa cy ...~.~ .,~....~L. ....... ~~ ......................................................
b. Intended use and occupancy~__L~,:... ........... ~ ............................................. '1'~"
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 .......................... q..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 ........................................
! /
8. Dimensions of entire new construction: Front.......-~....:..~. ................ Rear .....~....,~..../. ......... Depth ......~....~.. ...............
Height ............................ Number of, Stories....../...~ .... / ~ ~
i F ant /~.. /f /;/~6'/~P'~ Rear /r th //TZ]'~' ~7//~//'/~,/~// '~ r~
S ze of lot: r ......... ...,¢.~,...~./... ............................. Dep ...........~.:....:.../~,.7.~......./.... '
9. Date of Purchase ...~..~ ....... /....~.. ..................... Na~-~of Former Ow, her .~,~....~..~.~ ......
10. // ,~"~ ~
11. Zone or use district in which premises are situated.....J~-~...~......~ ........................................
12, Does proposed construction vio~te any/~on]ng law, ordinance or regulation? ....... ~..~... ..................................
13. Name of Owner of premises ~Address ....... ...'~...:....,~'...: ................... Phone No .....................
Name of Architect .~ .................... ..;..~.__..v.__...Address .......................... ., ................. Phone No .....................
Name of Contracto~~..~..',,ec~./z~c.,r~.~--~/,~ ,~, ,~--- ...... 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 lat.
/cz
STATE OF
' OF S.S.
being duly sworn, deposes and says that he is the applicant
(Name ~zTj~.~__z~_,,~application)
above named. He is the ........... .~-.~,~...~-~.~-.;.. .............................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duty 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
.............. .2..: ...... ...........
Notary Pubhc,~4,,.....E~..:~...'TX'...~u~'t'~-- /(Signatu¢ of applicant)
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN ¢.':R,,'S O.,CE
Examined .............
Approved ........................................ , ]t ........ Permit Na .................................
DisappraYed ale ............................................................................................
(B6'ilding 'i nsp;~c~r) ............ T ......
Application No .............................
APPLICATION FOR BUILDING PERMIT
Date ........................................................ · 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 application.
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
perrnit 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 pa rt 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 lows, ordinanqes and regulations. //
h'
................ ,
(Signature of/applicant/or name, if a corporation)
.....-.. ...........................
(Address o~. appl'ican~
State whe/t~er ~,pp/liC~nt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
........ ..................... .............................. ........ .........................................................................................
Nome of owner of premises ....~'..:..~<r.'/,~.:.~ .................. ~):..., .................. : ...........................................................................
If applicant is a corporate, signature of duly authorize~//oofficer.
(Name and title of corporate officer)
1.
Location of land on which p,~/c)posed wa k w'l be dar),t ap No: ..~..:. ......... ~..:r/....: Eot Nob'......, .............
Street and Number .....
State existing uSeandand occupancy....~.s~.,.~x,?Z~4?Zf~nf~.of ~pmises and intended use,, '//~<, ,* ~~Pd occupancy of proposea construction:
a. Existing use occupancy ...... :~'f.?~:'J~Zi~...~ .....................................................
b. Intended use and occupancy .~~'~.~ ........... .~{. ~C 7.~ ................................
3. Not~re of wdrk (check which applicable): New Building .................. Addition ..~ ..... Alteration ..................
Repair .................... Removal ;..~ ................ Demolition ......... .~,2~.~,J~Dther Work (Describe) ........................
4. Estimated CostJ~.~.~.....~....~.. ................................. 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, 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...~...~....~....].Z.~...,~. Rear ...~...~....] ...........Depth ...~.....~.....X ............
Height .................... ~ ....... Number c~: Stories.... / ~
10. Date of Purchase ..~.~' ]..~.. ,Narr~of Former Ow'ner^......'-tm.,..?.,~
11 Zone or use district in which premises~are .../~.~ .....
· s tuated .............. ~ ....
12. Does proposed construct on volute any /z~)ni~a aw, ordnance or~a~ ~t~on? ...........................
13. Ixlame or uwner of premises ........... 4,;....(.~'. ................... 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 ~how street names and indicate
whether interior or corner lot.
J
STATE OF ) S S
,,~~~~ .......................................... being duly sworn, aeposes and says that he is the applicant
(N~of i~Wdual ~[~ning _a~ati~n)
,. ......... ...........................................................................................................
(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·
Sworn to ~f~ me this
.............................