HomeMy WebLinkAbout2256-zFO~M NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at ...j~/.S...~ro~:..C~.~l:..~Dr~.e ................ Street
Map No....~. ............ Block No .......... ~ ..... Lot No. ~ ......... J~t~o.~,~,~...~,. .................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
................................... ~0.~.~1i~,1~1~......22., ]c).~,~.. pursuant to which Building Permit No..~2~.~..~
dated ..................... ~.~..~.~.~..?.~.....2.~. ...... , 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 ........
...... htm .ne s.s..huildin ........................................................................................ ...........................
The certificate is issued to ...(~,,:~,~L~h..&..~fl~..~l~ .................... 0.~ ................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
FOF~f NO. 2
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST B~.K~PT ON THI~ PR~:MISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
2256 Z
Permission is hereby granted to:
,O~-~/.~..,~l~.~.~ms...~ .......................
........... ~tn..~e~ ...............................................
............... ~t~t.~o~ ............................................
to ..... .~ 341...ne~ ..l~&.ne~ s...1~$:Lel$~ ......................................................................................
at premises located at ..~/~.,.~o~..~e~..]D~,~L,~.e ............................. ,~ ............... ~?~. ...................
................. .. .......................... ~o~z~l~ld ~.....~,.;f.o ..................................................................................
pursuant to application dated ................................ ~OM~i~TD~,~'.....~ 19...~, and approved by the
Building Inspector
Fee $...~.Q~,.OQ.....;..
Building Inspector
FORi~I NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUT,O,D, N. ¥.
Approved ........................................ , 19 .....Permit No ............
Disapproved o/~~
(Bui~din~//Inspector)
Application No. ~.~- S' ~
APPLICATION FOR BUILDING PERMIT
Date .~:...?.~...~. ................... t9~.~. .........
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 appiicotion mey 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 avaibble 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 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, as herein described.
The applicant agrees to comply with all appllcable laws, ordinances and regulations. ~/
(Si~ature of applicant, 9~name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.............................. ........... ......................................................................................
opp,cont ,s o corpo. t /g ..2'e of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on whic~proposedwork will be done. Map No: ....................... ~ ........... .~.~ Lot No: ....................
Street and Nu tuber .. ~. '~C~.~... ~.~,.~.. ~..~.. ....... ~ .~...~..~~...~.. ~ ................
y/ /,.. uni¢ipality
2. State existing useX~fnd occupancy ~f~premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...~//.~ ........ ~-r ................................ ./ ...............................................
b. Intended use and occupancy,..~.~'.-~......."~...~...:?..~ ..........................................
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ..............
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................
4,
Estimated
Cost
(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 l:;usiness, commercial or mixed occupancy, specify natureand extent of each type of use ~...~...
7, Dimensions of existing structures, if any: Front .......................... Rear .......................... Depth
Height ............................ I~umber of Stories
Dimensions of same structure with alterations or additions: Front ................................ Rear
Depth ............................ Height ................................ Number of Stories ............... :? .......................
8. Dimensions of entire new canstruction: Front .......... ~.,¢ ............Rear ..~,..~... ............... Depth .,~
Height ............................ Number of Stories ..................................
10, Date of Purchase ./~..~..- .~..f Name of Former Owner .~.~.....,~..~:~..
11. Zone or use district in which premises are situated.....~..(<~..~..~...~.. ...........
Phone
No,
Name of Architect~__....,~ ~ ,~ ,~ ,~ ~ ,~ ,'~' .......... .~ ......... Address ....... ~, ................................... Phone No.
Name of Contractor/~.~.¢~-?~,~/4!:.~~..Address~ ............... Phone No.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
properl'y lines. Give street and block numl~r.~r~ription according to deed, and show street names and indic~
whether interior or corner I . - '
COUNTY O~F. ~.) ~"~' .~.
mbove rimmed. He is the ...................... ~~ .................................................................................................
(C9ntrmctor regent, corpormte officer, etc.)
of staid owner or owners, rand is duly muthorized to perform or hmv'e performed the staid work mhd to mmke mhd ]
this mpplication; thmt mil stmtements contmined in this mppIicmtion pre true to the best of his knowledge rand be[i
rand thmt t~e work ~ill be performed i~ ~he mmnp~ ~ in the mpplicmtion filed therewith.~
Sworn to before me this ~ ,~ t~rv p~bgc st;re of New Y~r~ / "~
FORM NO. 1
TOWN O,F SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUT,OLD, N. ¥.
Examined ....... ...~...~:~....i~L ?.:...., 19...~?
Approved ........................................ , ]9 ........ Perm t No .................................
Disapproved ~~
.............. ...........................................
(Building/nspector)
APPLICATION FOR BUILDING PERMIT
Application No .............................
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 o Building Permit to ,the applicant. Such
permit shall be kept on the premi~e..s available for inspection throughout the progress of the work.
e. No building shall be occulSi~8 ~r used in whole or in pa rt 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
Regulations, for the constr~ction of buildings, additions or alterations, or for removal or d~molition, as herein described.
The applicant agrees to comply with all applicable laws, ordinanc~,s and regulations. ,~' ~
(Signature of applicant,,,(~, name, if a corporation)
....
(Address of applicant) '~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.....................................
If applicant,~.s~o corporate~ignat~e_ ,~ ~-~ of ~uthorized officer·
(Name and title of corporate officer)
.. ........................ ........................ :: .....................
'" ~".. ,:,~" ,fi
3. Nature of work (check which applicable): New Building ..... Addition ........ Alterahon
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ......................
4. Estimated Cost .............. .,~.~.~.~..~ ................. Fee ,....~.~.~.__ ~
......
(to be paid on filing this application)
If garage, number of cars ................ ,.~.~rm.,~:. ,],,~
6. If I~usiness, commercialor 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 ................................ Rear
Depth ............................ Height ................................ Number of Stories ........................................
8. Dim'ensions of entire new construction: Front ..........~'..~.__ ........ :... Rear ...~..~ ............... Depth ...~....
Height ............................ Number of Stories ..................................
9. Size of lot: Front .................. .~'~....J.. Rear ....... .7.,~..'"~...../. ..... Depth .~'O~l...~ ........................
10. Date of Purchase ...... /..~.~...~.:__! .................................. Name of Former Owner .~,...~.~
11. Zone or use district in which premises ore situated...._4~'~,.,~_~'.~.;
12. Does proposed construction~ '~ ~vi°late ony~zonin,q law, ordinance_~._~_._.~_......or regulation? ..,,~
13. Name of Owner of premise,~l~,.~~Address ~
Phone
No.
Name of Architect .......................... ....~....._.....~ ......... Address ............................... Phone No.
Name
Con tra ct o r~-/~.. ~/~.. Add tess ,~.~~ ............... Phone No.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions er,
property lines. Give street and black numbers or description according to and show street names and indi,
whether interior or corner Io~ /~ . ~ deed,
,/
STATE OF NEW
COUNTY OF ~,~¢;.r. S.S.
~g duly sworn, deposes and says that he is the applica~
slgmng
above named. He is thb ....................... '~ ...................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to oerform or have performed the said work and to make and f
this application; that all statements contained in tt~is application are true to the best of his knowledge and bell
and t]at the work will be performed in the raqnn,~fu~ To~f~Fh th~ app cation f ed therewith
~wom to D~tore me ~IS ~o~ 52.,:3449~3, StllJolk Comity
.......... ,~,~.~,.. day of ........ ~.~,,%,~..,,~.~,,.~.~.~,..~ ...... 196~.,r, ,
...... . ? / ,~---~./ /- , . ............. ~~~ ......................