HomeMy WebLinkAbout2223-zFOH~ NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
............................ date .................. F. ehura~. ....... 2.0 ...... , 19.6.~..
THIS CERTIFIES that the building located at ......... ~Tetlto. ir/~s..~o~.d .............................. Street
conforms substantially to the Application for Building Permit heretofore filed in this office doted
dated ........................... 0(~,to~e~'.....~8..., 19...63, was issued, and conforms to oil of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ........
The certificate is issued to ....Eelwq;r,.d.....l~e3.a.t,k& ................... O~rll~l~. ..........................: ................
(owner, lessee or tenant)
of the aforesaid building.
H.D.Approval Feb. 18, 196% by R. Villa
FOI~I~ NO. 2
TOWN OF SOUTHOLD
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? 2223, Z
Dote ................
Permission is hereby granted to:
..~d~a~..Czel~tka .........................................
................. Gz~e~en.po~ .........................................
to ..... Bu~- .i.d...ne~a.. one..~. ~.~&.~r...d~e.i:14.t~g .................................................................................
at premises located at ..~o~...8~.....Oal~l*i~g~,..l~l,~.~!lS' .....................................................................
........................................... J~nnir~ s...tload., ......... ~ oughollil .......................................................
pursuant to application dated ............................... ~'~O't~e~'""t;l~' ......19.6,,~.., and approved by' the
Building Inspector
Fee $./.~ .....
Building Inspector
FOI~M NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUT,O,D, N. ¥.
Approved ........................................ , 19 ........ Permit Ho .................................
Disapproved ale ......... ~~ '--~'~ ~~~"']'"~-
Application No .............................
APPLICATION FOR BUILDING PERMIT
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 appiicant. 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 g~anted 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
ReguJotions, 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, ordin~,/~ and re~gulations/,~) .,~ ,,~
"'~~(Signature ~ i'~]'i~' ~"~i~i .........
State whether applicant is o~yner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
....................................... (~~.. .................. ®~ ....................................................................................
Name of owner of premises ....... ..~(.'.~.,~.-~.....~.~...~.~/c~..~.<~C~.. ...........................................................
If applicant is a corporate, signature of duly authorized officer.
................... i'~;' ~'¥i~i;';F~7~';~'~'~';"~'f~i~;i ................... ~'~~, .- .~ z4~
,. ,oc~at,on of'and on wh,* proposed work w"' bede. ~ep No: ........ ~,~.,~.-~ .......... "or ~o' ~-~
Street on" N.mber ..... ~¢~.~.~.~....¢~..,...' ~:~:~ ................................
Municipal fry
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exstng use and occupancy . .~'.4Z.~ ~ ~",,~42~? ...................................................................
b. ntended use and occupancy ....................... ~ ..................................................................
3. Nature of work (check which applicable): New Building t~' Addition Alteration
Repair ........... ,~.... Removal .................... Demolition ................ ~.~; Other Work (Describe) ........................
4. [st i m at ed Cost Z7~.~..f~.~. ............................................. Fee /~...-..'~... .......................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units .............................. Number of dwelling units on each floor ........................
If g~rage, number of cars .............. ...~......C..~...~Z...~...,..~.~..~......~..~..~..7.~..~.........~..~
6. If business, commercial or mixed occupancy, sl~ecify 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 ....... .~!..~x~..../.. ......... Depth .....~..~....~. ..........
Height ............. .~..~.. ..... Number of Stories ............ ./, ....................
9. Size of lot: Front~J......./..-~....~. ....Rear /,5'~ Depth /
10. Date of Purchase ................ .(./.u./.c ............................. Nam. of Former Owner
11. Zone or use district in which premises are sit~
12. Does proposed construction wolate any zor~ng law, ordinance or reguJat~or~ ........ .~....,.~.. ...................
13. Name of Owner of pre, n~5~s~.J..~..L.~...~.~ddress ~/~?~Z~....Z~.':.~z-.¢.-~)~. Phone No.
Name of Contractor ...~./..~,,t:~ ........................... Address ............................................ Phone No.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr
property lines. Give street and block numbers or description according to deed, and show street names and indic
whether interior or corner lot.
STATE oF NEW Y,~)P,,~ ,~z/ ) o ~ /
COUNTY' OF ...~...) o.~.
............ .~....~,¢~,.~~.~.. ................................ being duly sworn, deposes and soys that he is the applic nt
(No:me of indir~dual signing application)
of said owner or owners, and is duly authorized to ~[~orm or have performed the said work and to make and ~i~
this a.pplication; that all statements cont~i~rc~'~p~r~ation are true to the best of his knowledge and bel f;
and that the work w I be performed '~'~ t~'~'~e~ ~ f~,i~he application filed therewith.
Sworn to ~,efo~e me this ~ Cosiness,on Lxp __ __ ,
........................ ' ....
SCHD
SUFFOLK COUNTY DER~IRT~'E OF IL~LTH
Date
Bldg. Permit No. .~ ~ '~ [~ ~
TO ~-IOH IT iI~.Y CONCE?~:
The se~wage disposa% facilities f~or a structure located at
'~' ' ~ ~ )~ ...... (~-~Ve' ~F I~6%~:ffJn)-~ --~ ..... / .........
have been inspected by this Department and found to be satisfactory.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ........................................ , ]9 ........ Permit No .................................
Disapproved a/c ...........
Application No. ~' ~')''"' ~
(Building Inspe~:tor)
APPL~CATION FOR BUILDING PERMIT
Date ................................. ./..~ .~...../..~.. ........ 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 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 cbmmenced 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 ~he
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, ordinances and regulations.
(Signa u ~~ name, if a corporation)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................... ...........................................................................................................
Name of owner of premises
If applicant is a corporate, signature of duly authorized officer.
1. Location of land on w~ ch pr, osed work will be done ,~Mep No' .. ¢'-'~ .~:~ "~'~- Lot No
Street and Number .......... ~...~...~.~..?z?.~ .~.......-~ .~..~.~.../:...~.:......~.....~.....~.z.:~(~ ~ ~-~' ' ..................... Municipality '
2. State existing use and occupancy of premises and intended use and occupancy oF proposed construction:
a. Existing use and occupancy ......... .~ ........... : ................ .~ ..............................................................................
b. Intended use and occupancy ....... L~¢~.~ .,~z..Z~4..~...~.:-¢~-,~¢...:..~.~..;~ ................................................
3. Nature of work (check which applicable): New Building v Addition Alteration
Repair ...................~Removal .................... Demolition ...................~, Other Work (Describe) ........................
4. Estimated Cost ...... .C..z,....O...~..'?.. .................................... .............................................................................
(fo be paid on filing this application)
5. If dwelling, number of dwellin9 units .............................. Number of dwelling units on each~loor ........................
If garage, number of cars ........... ...~.....~....~~.....~..~¢.~=:~...Z:~........~:.L,.;~--
6. If business, commercial or mixed occupancy, ~pecify 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 at__entire new construction: Front .......... ~...~../. ............ Rear ~ / Depth '-~
Height ......... ~...~.....: ....... Number of Stories .......... /. ......................
9. Size of lot: Fron~t ...../.:.~.~..~..~l .......... J ...... Rear ..... ../h~ ............ Depth ...... ../..~ ....................
//__
10. Date of Purchase ............ ~../...~./...~ .......................... Nam~ of Former Own~"~'"~f~..~.'~-~,..~..~.~...~.
11. Zone or use d str ct n wh ch prem ses ares tuated ~.?.¥~...'f':~.....~....~~ ...............................
12. Dabs proposed constructjon,~violate any zonine law, ordnance or regu atio/f~?
· ....................
13. Narne of Owner of pre~:~s~.(~.cr4.: ............. ::~....,y~:~.~adress ~,~.....~..~..'-;..~,/-~...~..?.. Phone
Name of Architec(~..~..~.~?."... ~....'~.~ ...... Addres~-~.'.~~.~f~,.i...z~.~/ Phone No.
Name of Contractor .................................................... Address ............................................ Phone No.
PLOT DIAGRAM
Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate oil set-bock dimensions fr
property lines. Give street and block numbers or description according to deed,~nd show street names and indic
whether irfferi~,~,~,~or corner~,lot. Z a~ ~/ ~ Z o~ ~ ~ ~ .~
STATE OF NEW ~Z)R~,/~
COUNTY OF .~..) ~'~'
............... ~..~' ~'g' "~ ........................ being duly sworn, deposes and says that he is the
(Name of individ~ signing application)
above 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
this application; that all statemen}~jl~a~in this application are true to the best of his knowledge and bel
and lhat the work will be pe[x~Q~m~hdpS~0~ set/forth in the application filed therewith.
Sworn to ~ me this
............................