HomeMy WebLinkAbout1723-zFOEM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCC:UPANCY
No. ,~],~J ............... Date ............................... JJl:~l~t.....~..., 19..~,.
THIS CERTIFIES that the building located at ..... ~.~.~.~.:J;~..~J~a~...(.+u~..~.~:~k,) .......... Street
Map No. ~.~.~.~.~8~.e..~jock No ....................... Lot No ...................... ~,sl~?~..~[.s~Cl, ...............
conforms substantially to the Applicahon for Building Permit heretofore filed in this office dated
..................................... J~p~'-~,i..-...~O ....... , 19.6~.. pursuant to which Building Permit No. ~.t.~.2.~...
dated ........................... ~.~ ....... ~L. ......... , 19. ~., was msued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ........
............ ~ ~ at e...or~e...1'.am~ i.,~ .. ~,~;..3.~.ng ..................................................................................
The certificate is issued to ....... ~.[.[~a...~...,q~.r~.~ ............ (A~e.~ ..........................................
(owner, lessee or tenant)
of the aforesaid building.
FOF,~ 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.° 1723 Z
Date ....................... ~ ..... .~ ... 1 9...6~
Permissbn b hereby granted to'
A.~.~ada. A/~ .~I1~. ~.. S~d~ .........
............. ~$~s- ts~ ......................
to .~ ~.. ~..~t ~..On.. ~.. eXiS ~- ~IZ-[~ ...........................................
at premises located at ...~..~.,.~..~.~a~ .~~ ..............................
pursuant to application dated ............................... ~ .-.~O ...... 19.6~ , and approved by the
Bu~ding Inspector
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Exam,ned ....... .........
Approved ........................................ 19 ........ Permit No ...............................
.............. .................................
Application No. / ~ ~' '~
APPLICATION FOR BUILDING PERMIT
D Apr i I 30 62
ate ............................................................ ]9 ............
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 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~,an,~J regulations.
...................
(Signature of applicant, or name, if o corporation)
])rawer B~ Fiehers Island~ New York (Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................ ~.e..n..er..e.1...~..~ .t..r.~ .c..t~r. .............................................................................................................................
Name of owner of premises ............ ?..!.!.!.!.a..~..C........S.?..h..m..J..d.~ ....................................................................................................
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. Mop No: ..................... .?.?..r..k,,..A,.r...~..,... Lot No: ....................
Street and Number .......................................................................................................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
o. Existing use and occupancy ............. .....................................................................................................
rea i dance
b. Intended use and occupancy ................................................................................................................................
3. Nature of work (check which applicable): New Build g .................... Add't'on ................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost ...... .4..,.0..0..0..:..0..0. ....................................... Fee.....5.....0..0. ..............................................................................
(to be paid on filing this ~pplication)
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 ..............................
§0' Rear ........ ~.0.~ ............... Depth 100'
7. Dimensions of existing structures, if any: Front ........................................................
Height ....... ].~ ................. Number of Stories ....... ~. ..............................................................................................
Dimensions of same structure with alterations or additions: Front ....... .5..0. ..................... Rear 60
Depth .....]:.0..0. ................... Height .............................. Number of Stories ................................
8. Dimensions of entire new construction: Front.~.0..'....x....1.?.! .......... Rear ]'?' Depth 10'
Height 1.5' Number of Stories 1
9. Size of lot: Front a..+-..~..a.c..h..e...d....~..k..e..+-.9.hRear ............................ Depth ............................
10. Date of Purchase ............... .1.?...5~.. ................................. Name of Former Owner Ret[ina]'d Auchincioss
!1. Zone or use district in which premises are situated ......... .r.e.f.j..d.~.n.~jA~. .................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ......... .n..o. .......................................
13. Name of Owner of premises...~..J.J..].J..a..m...O..:....S..c..h.m..i..cl.~.Address .F.J.e..h..e..r..e....!.s..:...N..e..w..Y.°..r..k...Phone NO .......... 2.3.),. .....
Name of Architect .........n..o...n..e. ....................................... Address ............................................ Phone NO .....................
Name of Contractor...A..t...d..°..h..n...~..a...~.. ......................... Address Drawer Bs Fishess ISPhone NO. 231
........................ N';Y'; ...............................
PLOT DIAGRAM
Locate clearly 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 corner lot.
STATE OF NEV~ YOP~K~ ) S S
COUNTY OF 4/'~ ........ ) '
......... ~ ..................................... being duly sworn, deposes and says that he is the applicont
(l~~ sig niD~g~opplicat ion )
above named. He is the ........~~.:i~.i ................................................................................................................
(Contractor, agent, coriborate 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 appl~the, rewith.
Sworn to before me this ,~
..~....'. .............. d~' of,...~...::~ ............ ,. 19 ............ '- ~n~a'tur~°f ~PPlicant)