HomeMy WebLinkAbout3549-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, ti. Y.
CERTIFICATE OF OCCUPANCY
No..~...~i.~.~.3. ............ Date ...................... ~.~g.U.~.~...~.7., .......... , 19..6..~...
THIS CERTIFIES that the building located at ...~.i~...~,~D.,.~.Q~,.~ ................................... Street
Map No ....................... Block No ....................... Lot No ..... .CUt~O.C~U~,...,~e.~....Y.~'~ ...................
conform~ substantially to the Application for Building Permit heretofore filed in this office dated
................................. ~u.].~...2D.~ .............. , 19..6.7.. pursuant to which Building Permit No..3..5.~?.....Z...
dated ...................... ~T~,1.~...2.~, ............. , 19.~.5.7.., 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 ........
............. ~lv.&te...one.. ~amily..,~wel lin~ .................................................................................
The certificate is issued to . .. f~.~t~J),~.~...~.~.~.~,e. .................................................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
FOI~I NO. '~
TOWN OF SOUTHOLD
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? 35~19 Z ~ ¢~D~-e ....: .................... .~..~ .......... ~. ...... , 19~....
Permission is hereby granted to:
...... ~..~t~,L.:..: ......................................
Bu!lding '. Inspector.
pursuo~ to gpplication dated .................. ~; ........... ~/l~.~*-.J~ ......... , 194~..., and approved by the
' rB;il';ling
NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y,
Disapproved a~.~,.~ ...............
(B~llding Inspector)
Application No.
APPLICATION FOR BUILDING PERMIT
Date ............................... ~,IJ~Y. ....... ~ ....... , 19.6Z ......
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 adjo n ng prem sas or pub c 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 sh~ll 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 Perm t pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other app cab · Lows, 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.
~ ~ ) Sidney Beebe
(Signature of applicant, or name, if a corporation)
Main Rd Cutchogue
/~//'~ ~ ~r_.>.~_ d~,,,~J_~L (Address of applicant)
State whether applicant is owner, I~see, agent, architect, engineer, general contractor, electrician, plum~r or builder.
Owner
Nome of owner of premises Sidne.y. Beebe
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.: ;:QCX Lot No.: X.3QC
Street and Number N~.S Main Road Cutchogue
Municipality
2. State existing use and occupancy of promises and intended use and occupancy of prapo~ed construction:
a. ~i~ting me and occul:mnc¥ .............. dl~'.~l'l.~,l~ ..................................................................................................
b. Intended use and occupancy same with an addition
3. Nature of work (check which applicable): New Building .................. Addition ..................;:XZ3Q[ Alteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................
4. Estimated Cost L~O0 P//~ .................................. Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units ..D. t3e ................... 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 ....~.0. .......................... Rear ....... '10 ................ Depth ...... ~.2. ............
Height .................... Number of Stories ........ .o.~..e. .......................................................................................................
9. Size of lot: Front ............................ Rear .................................... Depth ................................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
11. Zone or use district in which premises are situated 'tB' dist
12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ~.q .........................
13. Name of Owner of premises ....~k~'rke.~...~f~.e.~ ........ Address ............. (~ChQ~'O.f~ .......... Phone No .....................
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ......... .s.~..~..e.. Address ....c.~t;¢ho~ue ... 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..YORK ~__
COUNTY OF ............
.................................. .~..~....~..~...~...e..~.~..e. .................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is the ow-z3.ez'
(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
.................... .2..O. day of ................... ......... ,