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HomeMy WebLinkAbout65-zFOI~I ~O. 4 TOWN OF SOUTHOLD ~UILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, C~-R'I'IFICATE OF OCCUPAI~CY No ....... Z...91~8 .... Date ...................... November..25 .......... 19..60 THIS CERTIFIES that the building located at la./.8...N~lcJl~a. Dr,.,...Mat-t:&ttlc~treet Map Xo ..............*..~f.... Block No ....... .*..?..*. .......... Lot No ...... ~..? ....................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....................... AugUSt...3 ....... ~.7. ..... pursuant to which Building Permit No..~...iSlf ........ dated ........................ Atl~li~t~-.$....., 19.$.7.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ssued is ................................... .tlq~U$~RId~L. ~ .............................................................................. This eeetificate is issued to ...~.~..l!....F~...r~..9~...9~..e..~.. ....................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FORM ~0. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES ~'4~,hb~N~B~t~fD~¢~ APPROVED P, LANS A,blD S~E~/FL~CA~.JO~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No ....... Z"~"5 ......... Date ....................... t~!, . .~....'~.~ ............. 9~.... Permission is hereby granted to: · T o~n..~;~p~:~ g~7~. ............................................................. ........... ~ v, tt ~.t ~(~l~ ,... ~I, X ~ ................................ to .D~il.~b..~ o~,,ho.uc, e.. r,,n~:!..1.o ~.~.;L~ ~!:~.. ~lz~,t f o~.~.~ ....................................................................... at premises located at ~d~.~f/.~}~?dZ~.~?&~v~e.~`~;~.~.k~&~.~:~..~ ......................... pursuant to application dated .................. '~rct~?~.~'%'""~ ........ I'E)~'~r'''''19 ........ , and approved by the Building Inspector. Fee $ ~10 ~.Q~.) ............ Building Inspector FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. F×~mlned ........ ~......~.. .........19.~...~ ,.~ ,, ~ ~-~ ~ ~ No....~?....'. ............. Approved ........................................ 1 9 ........ Permit (Building Inspector) Application No....~.?.'..~ ......... APPLICATION FOR BUILDING PERMIT Do e ............................... (~ ......................... ,~ ............ 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 adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram 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 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 buildin9 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 Buildin9 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 qpplicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remoka[ or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. 3 ................ ..Y.. ............. .................... ~~of applicant, or name, if a corporation) .............. ......... ............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Name of owner of premises.~~.......~.~....~frr~....~:~~ If applicant is a corporate, ~iCature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. ~V~ap No ..................... ~:.......~"[. Blocc ................ Street and Number ,.~_Z~.' ~..~,...,I:~¢"~'~ b~''~-~ ~ ~~L.~ '~'~' '~' ..... .............................. (I ................................. ./ .............. .':.m.,.'r,~ ~.,¢. ......~,....4..T..:;,.zT.,...~,.. State existing use and occupancy of premieses end intended use and occupancy of proposed construction: a. Existing use and occupancy .................~.c~.....~T...~ ........ ~..C%_..Z ..................... Intended use and occupancy ...... ~--~....x.~..~.[._2~ .~u-- ~.,¢~-t/r~ ........................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration... Repair .................... Removal .................... Demolition ................... ~,ther ~Work (Describe) ....... 4. Estimated Cost ............ ~.~.. ............................................ Fee .../...~...~. .............. (to be pei " "fiii ' .................... FEES: 5. If dwelling, number of dwelling unifs...~...Number of dwelling units on each floor ............................ if garage, number of cars ........................... 6. business, or mixed occupancy, specify nature end extent of each type of commerical 7. Dimensions of existing structures, if any: Front ......... ~ .............. Rear ............................ Depth ............................ Height ............................ Number of Stories .............................................................................................................. D(mensions of same structure with alterations or odditions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ./....2~. ............. Rear ............../~" D pth" ................ Height ........... .~. .............. Number of Stories .......J. ................... ~J~ 9. Size of lot: Front / ¢ Rear x ,¢~ Depth ~ O--0 10. Zone or use district in which premises are s tuated ......................................................................................... ] ]. Does proposed construetlon v o ate any zen ng ow, etd nonce or regu at on? ....... ~ ................................... 12. Nome of Owner of prem ses J/"-~ .~.~A//~0l,!-.~...~ddress ~~~- PhoneNO Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor ......................... '.:. ........................ Address ' ~ ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly end 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 and indicate whether interior or corner lot. STATE OF NEW YORK, ~ ........ ~....*,~...~~ .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) (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 Jn 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 applicatlon filed therewith. Sworn to before me this ............... da¥o ....... ............... No,tory P u b I i c, .'~¢~¢Y'~v-~.. ,¢ ~:.~.~ .-~.-R.-~· ........... CounTy ~dl#~ll~..FIl#lc, Stere of I, ie~v (Singature of applicant) FOI'~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examlned.......~..~..~.. ......:.~.. ....... 19...~'~i.~.. Approved ........................................ 1 9 ........ Permit No ................................. (Building Inspector) Application I'~o ........................... 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 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 tS 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 and regulations. ........ i,,no re of .............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. 'sas .~. -~,D ~..,,-~ : .................... .._.. Name of owner of prem. ................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No ................................... Block ........... ~ ...................... Street and Number ........... z,.....%. .................... ~....~ .: .............. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................. ~ .. .~ ............................................................................................... ...........ntended use and occupancy ~ ~ ~.'~:...c.~.~. ~,~/'C.~.~ . b 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) FEES: 5. If dwelling, number of dwelling units ....... ~ ......... Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................................................................ 6. If business, commericol 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 ......... .~....~E. ............ Rear ......'(...'..':~'. ............ ~epth ..../..'.~ ............ Height .......... ~ .............. Number of Stories ......../.' ................... 9. Size of lot: Front ........... ./...~......~/ ...... Rear ............................ Depth ...... ...~......<~...<~...i... 10. Zone or use district in which premises are situated .............. 1 1. Does proposed constructio~ violate any zoning law, ordinance or regulation? ................ ~. ........................... 12. Name of Owner of premises..~...~.~.....ff.....~..~...'~...~....b..~...CAddress ...~!.~~..f ....... Phone NO ..................... Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor ........ ..~..~../.1~......14~.....~ ..................... 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 and indicate whether interior or corner lot. *STATE OF NEW YORK, Sworn to be~ore me this .... .............. day of ................... Notary P u b I i c..~. ~ ~'M.~9~ ?..~ .......... County ~ ~/ (Singature of applicant) OUNTY OF ...... ...................... ) /~ (Name of individual signing opplication) above named. He is the .................. ~ ...................................................................................................... (Contractor, agent, corporate officer, et,c:) 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.