HomeMy WebLinkAbout2086-zFO~M NO. 4
TOWN OF SOUTHOLD
BUILDING DEPART/V~ENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No..~1:7.34- .............. Date .................... J~c)Vembe~. .......~,. ...... , 19...15~.
THIS CERTIFIES that the building located at3~.&.a..~e~C,..~.,.r...~e~O~j4:i .............. Street
Map No ...... ~t.~ ............ Block No .....~.~. ............. Lot No .........~.~ ........................................................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
............................ ~.~.~...~ ..................... , 19.....~..~. pursuant to which Bui'Jding Permit No..~..~OJ~6
dated .................. ~'1;1~1e...1.0. .................... , t 9.....~,,~lwas 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...Obl~.. ~.Rlvl:r ~.. la~Ta;Z~;l~G .................. : ................ : ................................
The certificate is issued to ...lt,~L4~Jt,~t~J..C~Ll~i~.~-.~91ala~. .................................................................
(owner, lessee or tenarit)'
of the aforesaid building.
FOI~i~ 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? 2086' Z
Date ......................... ~TI,~3.~ ....... ~g ........... 1963....
Permission is hereby granted to:
........... ~oseve.tt .-.l~etct. ................................
...................... G~r.d.~n¢t.~ ...................................
to ..B~...t~...a~&l~.~.o~a..smd...r~.. al.~'a.t~o~s...on...a~..~l.st~g...6~m~g~ ..........
at premises located at ....];Iltli~tl...~e~l~..La,llo ...................................................................................
................................................. .P.e~oz~ie. .............................................................................................
pursuant to application dated ............................... ~'Ur~'..-.~'O .............. 19.6.~..., and approved by the
Building Inspector
Fee $...~e.,O0 ............
~ '" Building Inspector ~'~ '
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ....................... '..: .............. , 19...t..'...Permit No...~..¥...?..~?..~? .......
Disapproved o/c ..... ::t'7 ..........:;;%'z:'~-' ........
............ ................ ;.'..: :: ~".-;'::'L :: ...............................................
(Building ~spector)
APPLICATION FOR BUILDING PERMIT
Date z, dC: -/¢~ 19..
INSTRUCTIONS
o. 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 o 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 P~rmit to the applicant. Such
permit shall be kept on the premises available for inspection throughout the progress of the work.
e. No building shaft be occupied or used in whole or in pa rt for any purpose whatever until o Certificate of Occupancy
shall hove 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 Southdd, 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, ordinances and regulations.
(S~noture of opphc~X or nom~.i~/o co[¢~otion)
~ 0,:,,~:.~ ~ ,~ ,,~
'...a. :>. :.",..,~':,,.,.: ...... ~.'.....: ..... ...... :... :.z,.:,-.:: .... ~ ::.. ?..'
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~"'c ,,'~ ,', / (c,,, ,4,,,..,,
,I /:.,: /
Nome of owner of premises ................................................................................................. ~ ............................ y ......................
If a~/!~lican, t is a corporate, signature of duly authorized officer.
ll v' , ,; ",,;~ '/~ ~ ~:~ , , ~
, , . .>. ., ,,.,.,: (..
,w" ........... >;X..l;: : .................... ; ...... .,' ..................... : ...... r' ................
· / /~r, lame and htle of corporate officer)
/
1. Location of land on which proposed work will be done. Mop No: ............................................ Lot No: ....................
Street and Number .......................................................................................................................................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
/,-,..,,,/.,/... ,.,,,
o. Existing use and occupancy ............................................ ~ ........................................
b. Intended use and occupancy ....?..r:..:.'.Cfr..... ..........................................................................................................
3. Na~jure of work (check which applicable): New Building .................. Addition .................. Alteration ....
Repair .................... Removal ................... Demolition .................... Other Work (Describe) ........................
Eshmated Cost ............... ,, ............ ~.. ........................... Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units ......... t~ .................. Number of dwelling units on each floor
If garage, number of cars ........... ~..£.g4'...~ ...................
6. If business, commercial or mixed otcupancy, specify nature.and extent of each type of use
7. Dimensions of existing structures, if any: Fron ......................... Rear Depth
x3 '
Height ....... ..~ .................. Number of Stories /
Dimensions of same structure with alterations or additions: Front ...'-~...2t ....................... Rear ........ .~..~..'.
8.Dimensions of entire new construction: Front..~..¢Z.~.:.....a'..:/.'L..~...*:.... Rear ............................ Depth
Height ....../..~.~..~.£.y ........ Number of Stories ..................................
10. Dat,e of Purchase ........................................................ Name of Former Owner
11. Zone or use district in which premises are situated..
12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ~...~
PLOT DIAGRAM
I.ocote clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-bock dimensions fr
property lines. Give street and block numbers or description according to deed, and show street names and indk
whether interior or corner lot.
STAT'E OF NEW/Yg[~K~,/ , )
COUNTY .OF .%~-¢,~-... ...... ) S,S.
.... i ......... .~....z~....~..L...i.). ........... .~..: .......... be ng duly sworn, deposes and says that he is the applicc
(Name of individual signing application)
above na~ed. He is the ...... ~..~..'M.I./~,.~.~....c..T:.e.I.~. ..............
. (Contractor, agent, corporate officer, etc.)
of said owper or owners, and is duly authorized to perform or have performed the said work and to make and ~
this a.pplicbtion; that all statement~Uo~tc~in~E~ this application are true to the best of his knowledge and bell
and that the work will be perf82~,~,gt~u~oC~oe~,Ptr~et forth n the app cation f ed therew th
Sworn to before me this CJ~,~i~ Expires March SO, ~-9/~'~' /'~,' ,q j'
.............. ,...... /.-/ .] :~../ ~ ......... .' . ................ .~(.,...; ,.:~..~...~.,.<.,.: ......................... !..,j,...
Notary Pul~lic,~:f/-,-4?r~. .~..:.~.~....~ ~r...~ (~e~-.g?applicon,)
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. ~
19..~....~.
Approved ...................... ~/ ./..k. .............. ,19...!:...Permit No.....~......~.....O,..~..-:..,~. .......
APPLICATION FOR BUILDING PERMIT
Date .............. (./..~...~'; ................................ , 19 ................
INSTRUCTIONS
o. This application must be completely filled in by typewriter or in ink and submitted in dup~ic~ote ,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 o detailed description of layout of property must be drown on the diagram which is port of this application.
c. The work covered by this application may not be commenced before issuance of BuiJding Permit.
d. Upon approval of this application, the Building inspector will issue o 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 hove 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, es herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
.......... (":~:ft~)'; .......... of pp';~'~/;;' ~ ~?~' cor~k~)~ti~ni .........
(Addres~ ~f ap~cant) ~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pJumber or builder.
of of ....... ........ ........... ................. ................ ...... ................ ......... .....................
If applicant is a corporate signature of duly authorized officer.
,~¢"- /~Nome ond htle ~ corporote officer)
]. Location of lend on which proposed work will be done, ~ep No: ............................................Lot No: ....................
Street and Number .............................................................................................................
Munidipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction: .
a. Existing use and oqcupancy ...... ../(. ~./~.( ......... <..':?/.~.~..Z'7. ...... ,.e.. . : ......................................
b. ntended use and occupancy ~...~?,, ~ ............. , ......... '..,
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ....
Repaii .................... Removal ........~..~ ......... Demolition .................... Other Work (Describe) ........................
4. Estimated Cost ............ ,~..~...~..~' ........................... Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units ......... L .................. 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 d ~ Rear
Depth ......... ~.~...~ ....... Hmght ................................ Number of,Sro .~es ....................... ~..d..~.,.~"~
8. Dimensions of entire new ¢onstructJon~ ~ron} ................................ ~ear ............................
/ ,
He,gift . .~.~.~.c.y. ........ Number of Stories ..................................
9. Size 6~ lot: Front ...].~.~. .................... Rear ...J.~..g ................ Depth ~ ~
10. Date~of Purchase ........................................................ Name of Former Owner
~. Zone or use district in which premises are situated
~2. Does proposed construction violate any zoning bw, ordinance or regulation?
~Y~.~..~.<,.r...4
of Owner of .......
~? ~f A~hite~t .~.CV.¢~Cf.....JG~.~.~.:~ ................ Add~ ...... ~. .................... ~. ............ ~ho~e ~o.
' )~M~'J...~',: - , ~ ',{' ~/~ ~ Phone No.~
......... ..................................... ........
PLOZ DIAGRAM
Locate dearly and distinctly all buiJdings, whether existing or proposed, and indicate aH set-back dimensions
property lines. Give street and block numbers or description according to deed, and show street names and
whether Jn~erior or come~ ~o~.
STATE OF NEW/Y~)~K, t . )
COUNTY' O F t~...~. ~:~:[ .~, · ....... )
............ .~.~..<~.f...l). .......... ~..: .......... ~<~].~.~ .............. being duly sworn, deposes and says that he is the
~(Name of individual signing application)
above no~ed. He is the .......
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have per~ormed the said work and to make and
this application; that all stateme~T~o~t~ in this application are true to the best of his knowledge and b~
a~ that the work will be n~P~,i~ ~r set forti~ in the applicat[on filed therewith.
Sworn ...... to 'before me this' '- Nb-SZ,G~4963, SUrloJk bOUil[y / /
~/ g ~J/ ~2 J~ , , J~t~g~-...=..q~~....,' ....... ~j-~...~-~ ..... ~ ..............................
Notary P~bJic,~(~:~..~,~.'.~g~.....~{~ou'fY / (S~u~ of apphcant)