HomeMy WebLinkAbout1910-zTOWN OF SOUTHOLD
BUILDING 17EPART/viENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. :~ '15~? Date ~l'utte '1"/ 19.?.?
................................ ,~,,: ...... a5 eet
THIS CERTIFIES that the building located at ~1.1~ ~.~..O.~ ~..O. aCl~. East; ,~'$.o tr
Map No. ~:.le~[~.... Block No ....................... Lot No .......................................................................
Po:~nt
conforms substantially to the Application for Building Permit heretofore filed in this office dated
Oc~,obe~' ].0 19.....6...~ pursuant to which Building Permit No. Z 3.9:L0
dated ~IOct:obez' 26 62
...................................................... , 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 ........
....................... ~t 'r.V~'~.. ~1~,..F~:I,Y..D~,~.~. .............................
The certificate is ssued to ~.~.~.~ ~.~.~.t;..O..~.,....O~...t!.e..~. .......................................................
(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°. 1910' Z Date ................... O*.~o~.....~e ............ ~eZ...
Permission is hereby granted to:
John.....Bauer..... i~O.....,Tol~ ~. No.l.i tm, ..............
........ 6reenpo~'t, ..................................................
to .IPat.l.d...he-,l-one..l'eml. l.y...d~ia.l.:L..~: .....................................................................................
at premises located at ...tot...3~i......see~on..~.i..fl.l~a~e~..Poittt...sttb~ ..............................
.................................. ~//~e..... Snag" '}Ial'bo~" ftoad' i'"" .O~reenpm- t ...............................................
pursuant to application dated ........................... Oe~,Ob~.l~--...."lO .......... 196~_..., and approved by the
Building Inspector
Fee $"tOi.'OO ..........
Buildin9 InspectorI
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N, Y.
Examined ........................................ , 19 ........
Approved ........................................ , 19 ........ Permit No ............................
Disapproved a/c ............................................................................................
Application No../..~..!..0. .................
(Building Inspector)
APPLICATION FOR I~,UILDING 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 punic streets or
areas, and giving a detailed description of 1ayout of property must be drawn on the diagram which is part of this applica-
tion.
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 opplica:nt. Such
permit shall be kept on the premises available for inspection throughout the progress of the work.
e. No bui]lding 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 1S 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, alterations, or for removal or demolition, as herein described,
The applicant agrees to comply with all applicable laws, ordinances and regulations.
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~ ,x,3
Name of owner of premises ...~..~...~..~c:~..:....~~... .................................................................
I /
if applicant is o corporate, si~n'ature of duly authorized officer.
(Name and title of corporate officer)
I. Location of land on which proposed work will be done. Map No.: . Gk..'~.... ~ . Lot No.: ....'~.....~ .....
Street and Number ~a~a-,,~ L.~..~ · .~.....~, ~.
Municipality
2. State exisling use and occupancy of premises and intended use and occupancy of proposed construction.
a. Existing use and occupancy
b. intended use and occupancy ........ ~~ ..................................................................
3. Nature of work (check which applicable): New Building ..... ~ Addition .................. Alteration ..................
Repair .................. Remora! .................. Demolition .................. Other Work (Describe) ..................
4. Estimated Cost ........ .~m..~=........O.....o...O. ............................ Fee ...~..O ...............................................................................
(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 occupo'ncy/~specify nature ~ond extent of each type of use ....................................
7. Dimensions of existing structures, if any: Fronl~ ............................ 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 .~..'.,~......'~...,o~.!.~i...
Height .............................. Number of Stories ..............................
9. Size of lot: Front ........... /...~? ......... Rear ........... f...~ ............ Depth ._./ 7 ~
10. Date of Purchase ............... .~...~..~...~ .................... Name of Former (~'~i"iiiii~~.~ ...............
11. .Zone or use district in which premises are situated ........ ~ ...... ~( .~..... .....................................................................
12. Does proposed construct on v qrk~te gny zen ng la~v ordnance or renu at on~ ~ .~...~....~
13. Name of Owner of premi~e,~ ..~"'~"'~ddress ............ ..~....'~,..~ ...~...,.':L ......... Phone Ixl~,. ..................
Name
of
Architect
..... ~~~.~..~.." Add ress ........ ............. Phone N° ...................
Name of Contractor .'~..q'-~ ~ ,r~..~...~ Address . ..~., phnnm
PLOT DIAGRAM
Locate clearly and distinctly ali 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 NEW Y~RI~,/. ,~ ~ ) o,
COUNTY OF ~.,~ .~'~'
.............. ~'~~(Nome of indi¥iduol signing ............................................ application) be,rig' duly sworn, deposes and soys that he is the applicant
o.bove 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 know[edge and belief; and
that the work will be performed in the manner set forth in the application filed therewith.
Sworn to befor~ ~e this --,~
............. of ......... ,2.., ,_,,
, ( / ,,. ) ........ .......................................
Notary Public .:';~~..,.~.4r~'.. C,~ou, n~ ~/,/' J (Signature of apphca,nt)
NO~ pul~kc, Sta~e c~! New Yor~ ~ / ' "
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