HomeMy WebLinkAbout2892-zFOI~M l~O. 4
TOWN OF SOUTHOLD
~UILDING DEPARTMENT
TOWN CL'ERK'S OFFICE
SOUTHOLD. N.Y.
THIS CERTIFIES that the building located at .F~.~. tlOr.~Ol~l..Large .......... Street
Map No. XXXX. .... ....... Block No. ........XX~ .... Lot No. .Xx .... .... 8..o.u.~.l.~p~d. ,..~.,.~.,. .........
conforms substantially to the Applicati~on for Building Permit heretofore filed in this office
dated .......... .Se~t. 22 ...... 196~. pu.rsuant to which Building Permit No. 2~]92..~.
dated ............... D~..8.., 19.6~, was issued, and conforms to all of the require-
ments .of the .applicable provisions of the law. The .occupancy for which this certificate is
issued is . .Private .one. f. ami'~y' dwe'~klirlg ..........................................
The certificate is issued t~o .A.~.be~..~.,..A{be(P~$ol~. ~r .... · ......0v~r .............
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Appr~oval . .Pet'~dit~g ..............................
,, .............
Building InspectoI
FORM NO, 2
TOWN OF $OOTHOLD
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? 2892 z
Permission is hereby granted to:
........... A.,lq~.~er.t~..,Tr ..............................
..................... ~.~.u~ho;Ld .......................................
to ... ~a:l.].d.. neg..one...£aa;[3,~-.. 41~e ~..'14,~ ...................................................................................
at premises located at ..... ~.....]~:~-t~]~..~/,~ ......................................................................................
....................................................... ~,o~li;ho~d t...N,.Z, ..........................................................................
pursuant to application dated ................................ ~p-t..~, ............ 19...~ and approved by the
Building Inspector
Fee $....~.0. a.~ ........
FORM NO. I
I~OWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined G~'~ ~ 19....~..j''-'
Approved '! 19.....~... Permit No
Application No..~......~...~....-~... ...........
Disapproved a/c ....................... ~.:;~..-,~ .....................................................
............................... ................ ......... .<' '
(Building Inspectbr)
APPLICATION FOR BUILDING PERMIT
Date ............................ ~..9. P.~.~ ~ ~'...,~..., 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 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 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 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 applicable laws, ordinances, building code and regulations.
A/C A.W.Albertson Jr
(Signature of applicant, or name, if a corporation)
................. S~u~tho3.d.,.....N.~ .............................................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder.
Name of owner of premises ...A'I he:~.t..,~l~zt..tso~..~. ..................................................................................................
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.: ........ ~ ........................ Lot No.: ..:~,7~ ...............
Street and Number .~./.~.....]-].q~.tQ~..I~3.~ ....... ~OZ%~c~ld.t..,~,.~/ ........................................................................
Municipality
2. State existi'ng use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...... .¥.~.~i~-g,.~...].~1~.~L .................................................................................................
b. Intended use and occupancy ....... o~lg...£amJ_].~'...d.1~e~li_~ ............................................................................
3. Nature of work (check which applicable): New Building .................. Addition .................. ^Iteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................
4. Estimated Cost .......................................... : ................. Fee ......... ,. ...............................................................................
(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 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. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................
Height .................... Number of Stories ......................................................................................................................
9. Size of lot: Front ............................ Rear .................................... Depth ................................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
! 1. Zone or use district in which premises are situated .....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................
13. Name of Owner of premises ........................................ Address ............................................ Phone No .....................
Name of Architect ...................................................... 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 from
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW YO.RI~, /) } S S
couN
......................... · ~...'..: .............................................................. being duly sworn, deposes and says that he is the applicant
(Name of individual 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 file
this application; that all statements contained in this application are true to the best of his knowledge and belief; and
that the work will be performed in the manner set forth in the application filed therewith.
Sworn tobefore me this
.......................· .~... day of ..C~I~.~ .~ .................. , 19...~..)
Notary Public, ?.~~~.~:ounty,~~,_~~ (S,gnatureofapphcant)
FORM NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
~//~( 5 cb/' r ,t No.
Disapproved a/c .............................................................. ~ ......... ~~,ff~ ~/,,~ff~.~ ~'
............... .......................
(Building Inspector) {
APPLICATION FOR BUILDING PERMIT
Date .................... ~.....~...! ........ ,9.~...~j
', a.ec:2is application must be completely filled in LT~:~:rite22Sr i:~:d ~i~n~d~te to th~
~ Pl~t plan showing I~ation of lot and of buildings on premises, relationshi~ng premises or public str,ts
or areas, and giving a detailed description of layout of prope~y must be drawn~e diagram which is part of-this location.
c ~e work covered by this a~lication may not be commenced befor ss~nce of Building Permit.
d. Upon approval of this application, the Building Inspector ~~;~i~dr~it to the applicant. Such
permit shall be kept on the premises available for inspectio~~ thwarts
e. No building shall be occupied or used in whole or in ~y pu~hate~r until a Ce~ificate of Occupancy
shall have been granted by the Duilding Inspector. ~ _
APPLICATION IS HEREBY MADE to the Bu~~f a Building Permit pursuant to the
Building Zone Ordinance of the Town of So~h~~k~nd other applicable Laws, Ordinances or
Regulations, for the construction of buildi~ns, or fo~e~val or demolitJ~, as ~rein de~ribed.
The applicant agree~ to comply with all a~able laws~ances and r~ulatLons.
,~l~~,., ~ ~ ~ ~ ~' LI~ (Sig~nt'~;'n:~c~tion)
~ ~ . ~' ~'x ).-~,' . ' ~e-~. ~ , (Address of a~ficant) ~ ~ -/
r. 9O-
State whet~r applicant is ~~t, architect, engineer, general contractor,~lectrJcJan, plumbeL or builder.
o, ow,,r o, .....................................................................
... / ~
If applicant is a corporate, signature of duly authorized office(.
(Name and title of corporate officer)
1. Location of land on which pro osed work will be done. Map No: ...~:..~...,.....!.~.....o~.....~.. ..... Lot No: ./..~...b....~..!..O...(.
Street and Number ....... ..................... ~~~ ..........................
~ / ~ ~ ,.~ ~) Municipality
2. State existing use and occupancy of premises,?~,jntended use and oc~ncy~f proposed construction:
a. Existing use and occupancy ................................ ~~,~ ...................... .~.. ..............................................
b. Intended use and occupancy ............................. ~..z ...........................................................
3. Nature of work (chick which applicable): New Building .................... Addition .................... Alteration ·
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost....J~..
~...:....~'Z. ........................................ Fee ..L..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 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. Dimensions of entire new construction: Front .......... .,~....~.. ......... Rear ......... ..~,,,,O. ............ Depth .... .~,..,~. .................
Height ~ 13 '/' % -
................. "C .......... Number of Stories ...... ~. ...................
Zone or use district in which premises are situated ....... 2~C......~..~c~.... .............. "'"'"'"'"'"'"'"'"]'"'"."."-."'"'"'"'"'"'..'
Does proposed construct On~l~)~'[ a ii;, ~v'o te an zon n I,aw, ord nonce or regulation~ ~'~
Name of OWner of prem ses.~....~.....x~....,.~,. ...... Address ........................... ' '*'"'"'*'*"'"'"'" *'*"' '""'*'"'"'"'"''..."'"'"'*'*'ph°ne'NO.'"""'"*'"'"*':"
+Name of Architect ........................... [.! .......................... Address ............................................ Phone NO .....................
Name of Contractor ......... .~ .............................. Address ............................................ Phone NO
" ' PLOT DIAGRAM
Locate clearly end distinctly all buildings, whether existing or proposed, end indicate all set-bock dimensions from
'property lines. Give street and block numbers or description according to deed, and show street names and indicate
whether interior ox Corner lot. t O~ t
9.
10.
11.
12.
13.
STATE OF NEW~Y(D~,jl/ ) S S
COUNTY OF ....,~s~/~'~....'~.......)
(Name of individual 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 mak~ and file
this application; that'all statements contained iD this application are true to,,l, he best of h~i krlowll~'~xand belief;
and that the work will be performed in the maffllll~%~figrth in the applicat~n~tilec~/l~erew~l~, / /Y ~ \
Sworn to before me this
· ,, ,.,
....... ~m.L.*.~.. day of .......~ ..............
Notary Public, .?-.~&~...~....~..T.~o~[~/'~
FOI~M NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
T~O~.~Z
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located atl~/.~.....Ho~.~.ll..L~ll~ .................................. Street
Map No....ZX ..............Block No .......~ ..........Lot No. ~ ......... ~0~.0.~.~.......~..,..~...* ...............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
........................................ E,e.lpt**,.,,..~;~..,., t9..~., pursuent to which Building Permit No...~.~.~....~.
dated ................................. Oat**......8......, 19..,6~., 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~.:tv.a~e..one..i:.im.$1~..ct.we3,1t. nt. ..............................................................................................
The certificate is issued to ..... Al.her.~ ..~. Alhe.~..~so~ ~. ....... ~..e.~ .............
(owner, lessee or tencnt)
of the aforesaid building.
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOUTHOLD, N. Y. 11971
TF_.L. 765-1802
March 13, 1981
A. W. Albertson Jr.
Horton ~ane,
Southold
Dear Mr. Albertson,
This is to advise you that the job unde? Building Permit
No. 2892Z issued to A.W. Alber~son er. on
~ ~. 1Q6~ for New family dwelling appears to be
co~IS~Sa a& oF bur last inspection. Before you can legally
use or occupy this structure a Certificate of Occupancy must
be issued.
Please fill out the enclosed form and return same to
the above office. There is a fee of $5.00 for a Certificate
of 0ccupaucy
Thank you for your prompt attention.
Very truly yours,
GEORGE H. FISHER
Sr. Building Inspector
GHF: sm
encl.