HomeMy WebLinkAbout2222-zFOP~i~I NO. 4
TOWN Oi: SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, iq. Y.
CERTIFICATE OF OCCUPANCY
No ...... Z...227. Q ........ Date ................ iCic.t:.ob,er...1,1,. ............... , 19..(~5..
THIS CERTIFIES that the building located at ...... .~r~.~/'.~.e~-.~&~..~: .............................. Street
No..~[ ............. Block No....X~C~ ............ Lot No ....
Map
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.................................. O~ti:~ja~..'l.4 ........ , 19..~:~. pursuant to which Building Permit No. ~..~,~.
dated ........................ CI~2~;:~7~t~...~LI~ ....... , 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 ........
.................................. .~..c!. ~.~.o. ~... ~..o....~...~.~L ;~.~ ...............................................................................
The certificate is issued to ....,,Ttg]J~..~a;~,...~.C~.~/~l~ ..........................................................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN (~L~:RK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
2222' Z
Permission is hereby granted to:
...~.¢~bm.. ~. ¢~t~zo~l~ ..............................................
.......... ~.~ .r...Y. ;ke.w...~t ~.~ .......................................
............. ~,t,.b,o. lfl ................................................
to ..~..t..Z..a....~.....~.a...4.%~.o.~...~ rLmz...e~%~J~,r~..~t~,~J,~,~,,-~g .....................................................
at premises located at ....~'.~........~.-~k.~.....~l'J,~l~/..~O.~ ............... ; .................................................
............................................. ~.c~t,k~A~.....t~.y, ................................................................................
pursuant to application dated ............................... ~)~.t,o~t~.....]~ ....... 19.~.., ~nd approved by the
13uilding Inspector
Fee $...~. ,. ,0..0... ..........
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved .............. No
19 ........ Permit ....... : .........................
Disapproved
O/c
(Building Inspector)
Application No......~....~.....~.....~
APPLICATION FOR BUILDING PERMIT
Date.. ~-.c'.~..~'.., ....... .J..,~....? ............................ 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 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 part for any purpose whatever until o 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, os herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
//(Signature of opplican~T~br name, if o corporation)
.......
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder.
.................... ..................................................................................................................................................
Name of owner of premises d~ 0
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 ................................... Block ..................................
Street and Number~.~l?l,~..~/..;.~,l~; ....... .~..'.~..J'-~.~J~. ............................. : .................................................................
2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction:
a. Existing use and occupancy...,~J~.),U,,l~,,.~.,,~.4.,,.~ ~.~..~.~..i ~ ~ ~..~.'.~. .............................
b. Intended use and p ~ ................................................................ ~ ...........................................
3. Nature of work (check which applicable): New Building .................... Addit on~ .................. Alteration ...............
Repair .................... Removal .................... Demolition . ................... Other Work (Describe) ....................
4. Estimated Cost ...],.~...O....Q....~ .............................. Fee .................
(to be paid on filing this application)
FEES:
5, If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............
If garage, number of cars ..............
6. If business, commerical or mixed occupancy, specify nature and extent of each type of use .........
7. Dir~ensions of existing structures, if any: Front ..........~......~. .......... Rear ........ .~....?. ............ Depth .....
He?ght ............................ Number of Stories ....~ ....................... .~ ............................................................
Dimensions of same structure with alterations or additions: Front ...~..~ ................... Rear ..,.~,...~..
Depth ....~.....~n. ................ Height .............................. Number of Stories ...~ ..............
8, Dimensions of entire new construction: Front ........... L~......~.. ...... Rear ............ /~-"~................ Depth .../....~..:.-..~.. .....
Helght ............................ Number of Stories ..... ~..,/..?..~...
9. Siz,~ of lot: Front ......./..,/..~.. ............ Rear ....././...~..:...~..~,... Depth ....... ..~..,.O. .............
10. Zone or use district in which premises are situated
1 1. Does proposed construction violate any zoning law, ordinance or reg,
12, Name of Owner of premises.~.~./~. .~....l~r ........... ~..~'....~/...~..~..Address.~...~Z'..f~.~../..~Z~..,./PhoneNO.~-~4
Name of Architect ........................ .~.~.../~..~:;r~.... .......... 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 ir,
property lines. Give street and block numbers or description according to deed, and show street names and
whether ir~terior or corner lot.
s'r^T OF 0 ,)
' ' .............................. being du,y swam deposes soys that he the
(Name of indivld~al signing application)
above non'ed. He is the ...................................................... ..C,~.?.....~...?....~...~..~.~ i~ ~..,?., ...~.,,../~'....~,..~_..~. ...............
! (Contractor, agent, corporate"tffficer etc.) .............. ["
of said OW'her or owners, and is duly authorized to perform or have performed the said w%rk and to make and file
this application; that all statements contained in this application are true to the best of h~s knowledge and be ~f;
and that tt~e work will ~e performed in the manner set forth in the application filed therewith,
Sworn to before me this ,~ / / /, '}Z'~ _ ~.~,
........... ~z~.......-- aay .......... ~c, ~....~r~,,..~r~.~rr ......... .-.~... ' / v
' ~ / (Singature of applicant)
Notary Public,~..~,-~.~.~.~...:.~,gunt~,, z
' ~'Notary ~HstTa'teBo~l~ENNew York .,.~ .-
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined
Approved ....................... / ' ./...~../..../...~...1 .9~....-~...Permit No .......... ..~....~...'..~....~..~....~..
Disapproved a/c ............................................................................................
APPLICATION FOR BUILDING PERMIT
Date LOC~ , ;/ .
INSTRUCTIONS
a. This applicotio~ mus~ 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 odioining premises or public streets
or areas, and giving a detaffed description of layout of property must be drawn on the diagram whi.ch 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 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 shah be occupied or used in whole or in port for any purpose whatever until o 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 build}ngs, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
............... ..................... = ........................
/~' (Signature of agpJicant,Vor name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder.
· .o. ............................................................................................
Name of owner of premises Jo) ~'Z ~' '~' (7
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 ................................... Block ..................................
Street and Number ............. b~ ....... -; .....................................................................................................
2. State existing use and occupancy of premieses and intended use and occupancy of proposed cohstruCtiOn:
o. Existing use and occupancy .......................................................................................................
b. Intended use and occupancy ................................................................................................................................
3. Nature of work (check which applicable): New Building ' . ....Add t on ~ J Alteration ...............
Repair ....~ ............... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost ..... J..~..K..)...Q .................................. Fee ......................................................................................
(to be paid on filing this application)
FEES:
5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........................
If garage, number of cars ....................................................................................................................................
6. If business, commerical or mixed occupancy, specify nature and extent of each type of use ...........................
7. Dimensions of existing structures, if any: Front .......... .~...~.. ......... Rear ........ ..~.L.~. ............ Depth ......~.2~ .......
Height ............................ Number of Stories ....~ .......................................................................................
Dimensions of same structure with alterations or additions: Front _.~..~ ................... Rear ..../~..~L..Z~ ......
Depth '~
..... ~ ......................Height .............................. Number of Stories
8. Dirflensions of entire new construction: Front ........... J..~...~ ..... Rear ...... ./...~...~ .......... Depth ...J.~.z..~'. ......
Height ............................ Number of Stories ..... C~.?~../.'. ....... /,O / ¢ /
9. Siz~ of lot: Front ...... /..../....~.. ........... Rear ..... /~!.':..~....~.... Depth ......... :~.'..O.. ............
10. Zoqe or use district in which premises are situated ....................................................................
1 1. Do~s proposed construction violate any zoning law, ordinance or regulation? .............. M.C?. ........................
12. Name of Owner of premises.~.¢. .~?.. _____~ ~../~.~.J.~.~.4XAddress.~,','~,,Z..~.O/~'2~'~2/]~.~..~.,.PhoneNO,~OO'?~~
Na~ne of Architect ........................ ..~.../)....4:,~..,~ .............. Address ............................................ Phone NO .................
Name of Contractor .................... ..~.~...~.....z~.../,~ ............. Address ............................................ Phone NO .................
PLOT DIAGRAM
Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions fr(
property lipes. Give street and block numbers or description according to deed, and show street names and indic(
whether iriterior or corner lot.
......... //6,
/ __
COUNTY OF ..?~:...~;U~....:.:..~....,.)
...... ~ .............. t ....... ~..~. ~ ............................... being duly sworn, deposes and says that he ~s the appl~ca
(Nome of individual signing opplicotion)
above named. He is the ..................................................... ~.~;~ ~ ~.~J~.~..~.~..~..~.~.~.~. .................................
(Controctor, ooent, corpor~t~fficer, etc.)
o~ sold ownor or owners, ond is duly outhorized to perform or hove porformed the sold work ond to moke-~nd
thls ~pplicotion~ thor oll stotements torito[ned
ond that t~e work will be pefformod in the monner ~et {orth in the opplicatien filed thorewith.
5worn to b~fore mo this
............ ~ ......... day of ................
(Singature of applicant)
'
Notary Pubhc,..?:.:....,.M.:.,..~,,.. ........