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HomeMy WebLinkAbout19-zFORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECiFiCATiONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No...~. :L~). ............. Date ................... ;' "~tl~""~ ................. ... Permission is hereby granted to: ............ ...................................... to ........... 1~c~16.. new,, dwelling... ~. p.~Za...ft.:Left, .a~.~l~ c~at~ ~, o1~. ........................................................ at premises {acated at .......~/.S....(~'t, tt~llO]*.~o~ ...... ltIm~..~,~'~'=],lt(,....}l,.~, ................................... pursuant to application dated ................................... ~l'lllCte...~,¢ .............. ]9~..., and approved by the Building Inspector, Building Inspector Fo,r~vf N;O. 4 TOWI~ OF IMJiLDIN~ SOUT~OLD, N. CERTIFICATE OF' OCCUPANCY No ....... Z...8~9 ..... Date ..................... Octo~ar..2O ............. 1960.' THIS CERTIFIES that the building located al ~lrat;h~oI~l ..Rd...~...~ew...Su£folk.... Street Map No .......... ,.,~__~ Block No ....... ....~.~..Lot No ....... ~,, ................................................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............... ~..u!A..9....~ ................ 1~.7...... pursuant to which Building Permit No ..... I~...1.9 ......... dated ............... ,~une...g .................. 19..I!;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 ~RIVATE O~ FAMILY D~LLIN~ This certifmate is issued to ...Ale~andez ~..~r. ie..Liv, i~gsto~e,...o~er~ ..................... (owner, lessee or tenant) of ~he aforesaid building. FOI~I~I NO. 1 TOWN OF $OUTHOLD BUILDIHG DEPARTMElqT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. Approved ........................................ 19...~..ZPerm,t No ....... Disapproved o/c ............ ...... (Building Inspector) / Application No ............................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in inlq and submitted in duplicate to~?e Build!ng Inspector. ,. b. gl0t p~bn' shdwing ~ocatic~n 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 location. 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 Budding Department for the iss~ence 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 removar or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances and regulations. ....... (Address ~[,,Cfpplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Name of owner of prem ses ....... A~..~.~'. ~.d...~..~......~....V..~`..`~.~'~.~.~..~.~.~..~.~.~`~¢`"`~.~`~`~`..~~ .................... If applicant is a corporate, signature of dul¢ authorized officer. (Name and title-6f cdrporate officer) Libe~ 3742 ;~age, 522 1. Location of rand on which proposed work wiri be done. Map No ................................... J~locl¢ .................................. Street and Number .G.:~....~.~.W..O....~.. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Ex,sting use and occupancy..~{~,~C'c~,:b/&~l~. .......... . .................... b. Intended use and occupancy R..e..8..~.~.e...~.oe . 3. Nature of ~rk' (check which applicable): New Building ..;~ ............... Addition .................... Alteration .................... Repair .................... ~Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Co~t ........ IJ~(~)O*O0 ................................. Fee ..~,/...~..'..,~ ..................................................................... (to be paid on filing this application) FEES: 5. If dwelling, number of dwelling units....~l~O. ................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................... 6. If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if anyl Front ............................ Rear ............................ Depth ............................ Height ..................... ....... Number of' Stories .................................................................... , ......................................... Dimensions of same structure with alterations or additions: Front ...................... .........: Rear ................................ Depth .......... . .................... Height .............................. Nurqber,~of Stories 8. Dimensions of entire new construction: Front....~J~.! ................. Rear ...41i~t~ .................. Depth .~,,~6.~. ............. Height ....~.0 .............. N,~b~er of Stories ...01~. ................. ...... 9. Size of lot: Front ..... ~O~....: ........... Rear ..... .~'/~/I ................ Depth ...... ~O.! ............. J0. Zone or use district in which premises are situated ........ .l~ ..................................................................................... 11. 12. Does proposed constructic¢~ violate any zoning law, ordinance or regulation? .......... ~ ..................................... AXe. azalea. & lla~Ae 81-4~ I8~ 8~ ~X~ ~ Name of Owner of premises...~~e ......... Address ~,~:,~., ............. Phonb NO. ;.~j ....... Name of Architect..&~~ .................... Address ............ ~: ................. ~ ............ Phone N~ ...... ~.~ ........... Name of Contractor.....[ .........~. .................................. Address ............ ~ .................... ~.: ........ Phone NO ..... ~. ............ PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK,. COUNTY OF ;~..; ........ ,~1~II1~11~..~,~.~1~ ............................................. being duly sworn, deposes and says that ~e is t~e oppllcont (Name of individual signing application) above named. He is the....~~ ............................................. ~ ................................................................................ ' (Contractor, agent, corporate officer, etc.) o~.sald owner or owne~s,,~nd Js duly authorized to perform or hove performed the said work and to make and file th~s application; that oil statements contained in thi~ application are*~rue to the best of his knowledge and-belief; and that the wo~ will be performed in the manner se~ forth in the application filed therewith. Sworn to before me this (Singature of applicant) ................................. FOR~ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined...~...i.~... ........... 19...~..Z · , A r '~ '~ pp oved ...........................~. ........... ]9....Zpermit No.....~..~../.~...~.'. ....... = ..... Disapproved a/c ..................... ' ........ (Building Inspector) Application ixlo ............................ APPLICATION FOR BUILDING PERMIT Date .J.%~-"~....~. ~ .1...g. ~ ............................ 19 ............ INSTRUCTIONS o. This application must be completely_filled in by typewriter or in ink and submitted in duplicate to the Building Inspector.' - ~ · r b. Plot plan showing location df Iht (%nd of buildings on premises, /elation~hip tO adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn aA the diagrar~ which is port of this location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Up. on 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 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 ¥orl% 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 and regulations. ~ (Signature of applicant,tt°~J~ame',if a corporation) / (Addr s~,6f applica~i .............. 7'" State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Name of owner of pram sas Al$.~ndeP Divingstone a~ w~fe ~.a~ie Livin($stone If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) c '~ , Libel' 3742 Page 522 1. Location of land on which proposed work will be done. Map No ................................... Block .................................. Street and Number ............. .~'&1~A~`~.~.~..~.~..~.~,`.~`.e..~..~.~...~.~.~..~..~.~t~`~t~ .................................................. 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~g.~,~.~..~,.~.~..~..~ .............................................................................................. b. Intended use and occupancy ...... ~,~d~o.~ .......................................................... ; ......................................... 3. Nature of work (check which applicable): New Building ..~, ............... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ........ ~.00.0.,~.0 ................................. Fee ..~.. ................................................................................... (to be paid on filing this application) FEES: 5. If dwelling, number of dwelling units....0'O,~ ................. Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................................................................ 6. If business, commerical 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 some structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front.....~.~ ................. Rear ...~8.1, .................. Depth .3].!..-..8~ ............. Hefght ....~......0. .......... :... Number of Stories ...D~ .................. ]0. 7one or use district in which premises are situated ............. ~ .............. ~ ......................................... 11. 12. Does proposed constructicm violate any zoning law, ordinance or regulation? .......... ~.O. ..................................... ~.~x&nde~ & M~ie 81-43 189th St Hollis 5 Name of Owner of premises..~i.~.tIl,~l.tO~,e ........... Address ~,I~&I.c~,N...Y .................. Phone NO...~..~.~ ........ ....................................... Phone NO ..................... Name of Architect..A.~.1~'~,~OZ~ ....... ,-.,. ............ Address ..... ~' ti 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 numbers or description according to deed, and show street names end indicate whether interior or corner lot. STATE OF NEW, YORK, ). , , COUNTY OF ..Q,'~e.e.n~ ............ ) S S.' ' . ~'1 ~.X ~0,C~ ~'.. T.J..~. ~.~ OZ~ ~ ............................................ being duly (Name of i~'dividual signing application) sworn, deposes and says that he is the applicant above named. He is the.....¢.O~,~.&l~.~O~. ............................................................................................................................. .~,~ (Contractor, agent, corporate officer, etc.) of said owner or oWners,~end'~s duly authorized to perform or have performed the said work and to make and file this application; that all~tatements 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~~"~ .... ~" ~ r '_ _ , ~ ..... ~ ~~ ........................ day of .......................... ] 9 ............ ~ ' (Sing~ture of opph~anf~ ........ .........