HomeMy WebLinkAbout4707-z FOR~! NO. 2
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? _ 707 Z
Permission is hereby granted to:
.............. Ce~e~o~ue ............................................
to
pursuon.t to application dated ........................... ~'~ ....... ~I- ........ , 19..~.0., and approved by the
Building Inspector.
Fee $.t.9..,...00. ...........
Building Ihspector /
FORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
THIS CERTIFIES that the building located at .Ba~atel.m .&. ]'l~l~tlt~ .~ Street
Map No. ]~SSaU .!~. Block No ........... Lot No...?~...(~l~t~lM~e ..............
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ...... Apl'... ~ ...... , 19.7.0 pursuant to which Building Permit No...~.
dated ...... ~1~'~1--.. $~- , 19 70., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is .. -l~,lvate. ~®'. fem~ly. 5~el-l.~ .....................................
The certificate is issued to . ¥~Lll~all .llea],e~- .... 0~$F. ............................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . ~O~.,. ~.~. ~ ~.. l~..lie..~.~,ll& ....
.... ............
Building Inspectbr
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certi c' Occupancy
THIS CERTIFIES that the building locat~&.t;e~'~..&..~a~.t~.n...]M[ ...... Street
Map No. ]~.a.~.,..1~ .... Block No ........... Lot No. ~ ..... ~t.~...h~..1[~. ..... ~[~.Y.., ....
conforms substantially to the Application for Building Permit heretofore filed in this offiCe
dated .......... &.p.l'..~.. .... ,~9 .... pu~uant to which Building Permit No...~
dated ....................... , 19 , was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
The certificate is issued to ........................................................
of the aforesaid building.
/
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date ........ . ........ .?./.~....~/..../..~...~. ...................... ,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 ~
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 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 Occupand~
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,nbuilding code, h_ou~ing code, and regulations.
(Sign ure of applicant, or name, if a corporation)
, ................. .........
(Address of applicant)"~
State whether applicant is owner, lessee, agent, architect, engi~ne~r, general contractor, electrician, plumber or builder.
Name of owner of premises .......................................................................................................
If applicant is(~J corporat~,si/~ture of duly/~thorized officer.'
(Nameffand title of corporate officer)
1.
Location of land on which proposed~ work...~..~will be done. Map./~ No.:....~..~ ........................... ~'~ ........... ~----~-o.~.4.~L°t' N°':'"'~'"'~"' '~" .........
Street and Number .......................... ,~y~.,.;~.~, ..................... .; .................................................
State existing use and occupancy or premises and in~ occupancy of proposed construction:
a. Existing use and occupancy ............................... .,~r...~w."~
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 ..........~.//...~ .................................. 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 ................ ~, ................................................................................................ j .........................
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 ....... ./...7..O....Z. .......... Rear ............... ..~..~ ............. Depth .......... ~..~. .............
10. Date of Purchase ........................................................ Name of Former Owner .......................................................
11. 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 .~..;~.~..~..~.~.~.~...~...c~...~..e../.~..~--. Phone No. ~'.f.~...~...~..~..
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ...~...~..../~.~//.~..~... ............................ Address ...Z.~°.....C'..°..~'...~..c-.....~..~..~/.~...~..~'.eC. Phone No...7..3...,~......~'..O/..~.
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' (~DRJ~_4A IS,&
COUNTY OF .~..~
......................... ~..¢~-,c~....~/~. .............................................. .~eing duly sworn, deposes and says that he s the app cant
(Name of ind~idual signing applicatio~,~
above named. He is the ................................... ..~M.~.~ ............... ¥ ............................................................................
(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.
Swo~? toz,)//~l~jf~,before me this ,-~ ~
19.~.~.
~._ ///I
of ....... ............. : ........ ,. .
,o,o ............................
NOTARY PUBLIC, State of New York
No. 5R-8~25850 SuffOlk Co~t
Term Expres March 30,
S-9
SCHD
RECEIVfT[1
NOV -2 Pil 3:50
BEPAR1'~4EI',ir OF ht.l,t. Iii
RI 7:[tl;[:t~FFOLK COUNTY
DEPARTMENT OF HEALTH
Date November 2~ 1970
Bldg. Permit No.
TO WHOM IT MAY
at
CONCERN:
The sewage disposal facilitiles for a structure located
(Give d~ed location) i
have been inspected by this department and fbund to be satisfactory.
District Engineer