HomeMy WebLinkAbout3799-zTOWN OF SOUTHOLD
BUILDING DEPART/~tENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. ~...~.1,1-.5 ............. Date .......................... ~.~,~.e....,,J,.~., ......... , 19..~.1~..
oad .1tT
THIS CERTIFIES that the building located at ....(.~g~..~l~.Q~,;J,.~l.~,..~.O.~,l~ ........ Street
Mop No ....................... Black No ....................... Lot No..O:I:'.~eD, t,~...N,/~.~...*/'G,~ ...............................
conform~ substantially to the Application for Building Permit heretofore filed in this office dated
........................ J~.~.f~.~lgt~'.....,~,~ ............. , 19.~.7.,.. pursuant to which Building Permit No.
dated ............ ..~..a.~',.C..~........~.~.., .................. , 19...~.(~., was issued, and conforms to all of the requirements
of the app!icable provisions of the law. The occupancy for which this certificate is issued is ........
...............................................................
The certificate is issued ~o .,..~.~..~...,~.e..tc.~.~.,..~,t.,.~[~.~.~,,....(.~.~lJ.ei¢'] .............................................
(owner, lessee or tenant)
of the aforesaid building. J~g~T~C[' tO iilgt;e, ile, t,;[o~ of ]g~'o]~ez' d,:L~'~L~z,s ~ toilet, room
~OH~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD,' N. Y.
BUILDING PERMFr
(THIS PERMIT MUST BE KEPT OI'4 TRE PREMISES UNTIL FULL
COMPLETION Ot: THE WORK ^UTHORIZED)
Permission is hereby granted to:,
.............. ~Le~. ...... ~:....:.....: ...............
,., ~..~.)..,....C.~.:,:~ ........ ) ..................................
Build!ng Inspector. :
.Fee $.,.~ ................ ;.
- ~ Build ng nspector ~
FO~M NO.I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
,,
Approved ........................................ , 19...~!... Permit No ........... : .................
Application No..~....?,...?...2 ...........
Disapproved a/c .........~ ........ ~, .......................... .=:~.,< ......................
.................. ....................... .........
(Building I nspe(/'tor)
APPLICATION FOR BUILDING PERMIT
Date .................... ...~,., ,~.. ~C~...~. ,. ~,..~... .......... , ] 9..~...~... ....
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 Jn part for any purpose whatever until a Certificate of Occupancy
shall have beengranted 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, building code and re/g, ulations.
(Address of applicant~i/
Store whether applicant is owner, lessee, agent, architect, engineer, generol contractor, electrician, plumber or builder.
Name of owner of premises ...J ........................................... ~. ......................................................................
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.: ........................
Street and Number ..f~.~.~'~.....~'. ............................ .~..?.~...~'.~...~ ...........................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....~.....4(~:.~.. ...............................................................................................................
b. Intended use and occupancy -J~
3. Nature of work (check which applicable): New Building .................. Addition ~ Alteration
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 ................................................................................................................ ~l~...~.
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use
7. Dimens,ons of ex,shng structures, ,f any: Front ....... ./~./ ............... Rear ..... ~.. ........................ Depth .......~:'....~.. .......
Height ../..~.! ............... Number of Stories ..... /. ............................................................................................... ' ...........
Dimensions of some structure with alterations or additions: Front ........ ~.~..~.. ..................... Rear .¢~'?. ........................
................................ /'~* /
Depth ,~,~" I Height .......... ~... ............... Number of Stories ................................
8, Dimensions of entire new construction: Front ..... /~..'.f. ....................... Rear ....;~.'?.-..L ............... Depth ....~..~.~ ...........
Height ....../...6..I. ........ Number of Stories J
9. Size of lot: Front ........ ~.~ ............ Rear ~ Z- ~ Depth .................... : .....
10. Date of Purchase ........................................................ Name of Former Owner .~..~ ..................
1 1. Zone or use district in which premises are situated ..... i~x(¢¢,~..: ..............................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ...[..~..../~... .............................................
13. Name of Owner of premises~......:...~...~..Address ~......??.Z¢..~ ...... Phone No
Name of Architect ................................ ~_.~ ......... Address ............................................ Phone No .....................
Name of Contractor .:.~.~;~...~..~.....Address ..... ..~...~......'~..~¢,... Phone No.~...~..~...Z.?:.~...~:/
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.
G, IFT'
5'1¢0P
STATE OF NEW YORK,
COUNTY OF
-f,
Ir'
If' P,
..................... ~.~...~./..~'.. ....... ./J~.~./.[./.~/./CZ.. ............................. 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 to before me this
...... ~.~.~.:~.... day of ........ .~.~..~.. .......................... , 19.~''.''7'.
r'~'/~/~////~/¢/; . , , . ........ l....'r:'. .........../Ct.. ~.x./.......%...~Z.../~...,.,.,.,.,.,.,.,.,.~C....~ ...............................
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S O~:F~CE
SOUTHOLD, N. Y.
Examined ........................................ , 19 ............
Approved ........................................ , 19 .......Permit No .............................
Application No..'~..~...~..?. ..........
Disapproved a/c ........... :G:>,, ~ ,,~,7.7.',~. ?::',x ........................ ~,,~,.~, ..................... ,~.
................... ..?.::::: ..............................
...................... ................................
(Building Inspe~or)
APPLICATION FOR BUILDING PERMIT
Date ~ C~.. ~.- ~'" 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 pur.suant 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, Ss herein described.
The applicant agrees to comply with all applicable laws, ordinances, building' code and reza~?lations.
(Sight, re of 6pplicant, or name, if a corporation)
........................
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
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.: ........................
Street and Number ..~(~....~'~..., ............................ ,~,,~,,,~,,~,...~,.,~ ...........................................
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 ...~..~.,,-~,(,,~ .............................................................................................................
3. Nature of work (check which applicable)! New Building Addition t,~ Alteration ~'~
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 oars ................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..~~
7. Dimensions of existing structures, Jf any: Front ....... .~.L ............... Rear ..... 4. ........................ 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 I~ ~ Number of Stories
9. Size of lot: Front ........~.~..~ ......... Rear ...... ~.~...~ ................... Depth ....~ ........................
10. Date of Purchase ........................................................ N~e of Former Owner .~.~..Z~C~..~~ ...........
11. Zone or use distr ct in which premises are situated . ~..¢ ..............................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ....~ .............................................
13. Name of Owner of premises ~...~..~~..Address .~...~'~.~ ...... ~hone ~o.~.~/.Q.~
........................................... .......... ..... ......... : ..........
· .......................................
~omo of Controctor ......... Address ,"' . ..................
PkOT DIAGRA~
~ocoto cleorly ~nd distinctly oll buildinos, whother oxistino or proposed, ~nd indicote oll sot-B~ck dimensions from
property lines. Giro street ond block number or description occordin0 to deed, ~nd show street homes ond
whotbor inforior or cornor ~ot.
35'
,
~1 IZT
STATE OF NEW 'YORK,
COUNTY OF ...~....~.~'~/~..'.Z.~. ............
......................... .~.~..~..~.....~.~'....~,~..~..~.. ............................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is the ................................. ~...~...~...7..~.~.~.~.d...~. ............................................................................ ' ............
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or hove performed the said work and to m,ake and file
this application; that all statements conto, ined 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 to before me this "~/~,~.-z~,/~ ~,~'~
....... ~.'..~...7'...~...... day of ........... ~.~..C, ........................ , 19.~!..'.7.. '
Notary Public, .....~,~.y.~.~',..!,.,~ (]~unt.y Signature of applicant)