HomeMy WebLinkAbout9224-ZI~B.M NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificnte Of Occupnncy
19.~. 7
Date
· ......... ....
THIS CERTIFIES that the building located at .~,. ~.( .~.. Street
MapNo ..... ~ ..... BlockNo...~ ...... ~.otNo ...... ~:.~..-- .~..'~:
conforms substantially to the Application for Building Permit heretofore fried in this office
dated ~'~.~..Ff/. ~7,~... ~ ?/?.~..7./'..., 19., was issued, and conforms to all of the reqmre-
ments of the ap, plicable provisions of the law. The occupancy for which this certificate is
issued is .F~..~......~...ff.c.~..~...~....O~.` [...CL/.~ .~....~..~.~.~.,~.~ ~
The certificate is issued to . .~ .... . .'~...~. ~.~:~..c..~. ...........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health A{~proval, fy/' /~ ~
UNDERWRITERS CERTIFICATE No. ~:..~'f~..! ..................................
HOUSE NUMBER ~ ~ ~ ! 9"- Street '-'~ ~ ~ ~ ~
Building Inspector
FOBM NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N~ Y.
BUZL~ING PERMIT
CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
9224 ~ -. Oo,e .......... ~fL...~.........~........~. ............ ,,..7~'
Permission is hereby granted to: ~
.............................. , ...................... ~:...~ .......
,o ~ ............. ~ .... ~i ........ ~ '"~' ............ - ~
..~ ....... ~,.....C...~......~ .............. 8....~,~ ..........................
c~ :~mm ses ocated at .~...'J~..'~' ~ ~ ~~
Building Inspector.
r
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ........................................, 19 ........
Approved ........................................, 19 ........ Permit No .....................................
Disapproved a/c ............................................................................................
Application No .................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building
Inspector, with 3 sets of plans, accurote plot plan to scale. Fee according to schedule.
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 ofproperty must be drawn on the diagram which is port 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 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 o 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, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
(Signature of applicant, or name, if a corporation)
............. ..................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumbe~ or builder.
............................................................................................
Name of owner of premises
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .....................................................
Plumber's License No ....................... ? .....................
Electrician's License No. ~'~..~.
Other Trade's License No ...............................................
Location of land on which4~roposed woJLk wil! be done Map No ............... Lot No
Street and Number .~.~.,O.~ .'-~....~]~ ......... (~.~..~ ............ ~_~..........~.....~... ................... '.iiiiiiiiiiiiiiiiiiiiiiii
Municipality
State existing use and occupancy of premises and intended use and occuponcy of proposed construction:
a. Exisiting use and occuponcy,~.~J~l~...~...~..~....~. Y~ //~-'""'"' '" '~'"" '~'" '" ~:;'"'~:i"i''~'~ ..........................................................
b. Intended use and occupancy ...................................................................................
3. Nature of work (check which applicable): New Building'. ......... Addition Alteration ...............
Repair .................. Removal .................. Demolition .................... Other Work .....................................................
(Description)
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 ............ /...0. .................... Rear ....J.~ ................... Depth .....~...!. ..............
Height .....~. ............ Number of Stories ....... {. ............................................................................................................
Size of lot: Front ........................................................ Rear .......................................... Depth ................................
Date of Purchase ........................................................ Name of Former Owner ........................................................
Zone or use district in which premises are situated .....................................................................................................
Does proposed construction violate any zoning law, ordinance or regulation: ........................................................
Will lot be regraded ....... .~....O. .............. Will excess fill be removed from premises: ( ) Yes ( ) 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 end indicate
whether interior or corner lot.
10.
11.
12.
13.
14.
~]... ........................................ being dul,~ sworn, deposes and says that he is the applicam.
' (Name of individual signing contracf)
aoove 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 ,~ ~ /'/
dx~ .'7;(t4- ~" ~.~. ..... , 19~.~. ..........................
Nato ublic .~ ~i. /c~U~/' ~ ..........................
, ...//, . .ZCo,,nty --:
Comml~i~F. xplmml~1978
IPOKB~ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ........................................ , 19 ........
Approved ......................................... 19 ........ Permit No .....................................
Disapproved a/c ............................................................................................
Application No .................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
.................................. . ....
INSTRUCTIONS
a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building
Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets oF
areas, and giving a detailed description of layout ofproperty 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 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 a]terations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
(Signature of applicant, or name, if a corporation)
....... ......................................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
..................................... ............................................................................................................................................
Name of owner of premises .....~....~.....V..J/.Lte~.?....?. ..........................................................................................................
if applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .....................................................
Plumber's License No .................................................
Electrician's License No. ~ ~' ~-~
Other Zrade's License No ...............................................
1. Location of land on wh ch ~oposec~wo~ w be do,ne Map No ............ Lot No .........
Street and Number ................
2. Sto~e existin~ uso ond occuponcy o~ premises ond intended uso ~nd occuponcy of proposed construction:
e~ [xisitin~ use ond occupancy ........
....................................
3. Nature of work (check which applicable): New Building ...... ~ ........ Addition .................. Alteration ................
Repair .................. Removal .................. Demolitior ..................... Other Work ................................................ .
(Description)
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 ........................................................
11. Zone or use district in which premises are situated .....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................
13. Will lot be regraded ...... .~.~. ............... Will excess fill be removed from p_remises: ( ) Yes ( ) No
14. Name of Owner of premises .~,~....~.....~/Z~.~..~ ................. Address ..~,.F.._~........~..~ ......... Phone No..~.~.~.Z..~..7.,/?...
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 YORK, ['c S
COUNTY OF ................................
................. ; ................. . ............................................................. being duly sworn, deposes and says that he is the applicant
~Name of ~ndividual signing contracf)
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 end belief; and
tha~ the work will be performed in the manner set forth in the application filed th~,rewith.
Sworn to before me this
Notary Public,,~c~~ I1~#1~' ...................................... & ~ ~.~County .................................................................................