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HomeMy WebLinkAbout75-zFORM NO, 4 TOWN OF SOUTHOLD BUILD~HG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ....~.~.~J~J, lke.....Z~,e ............................... Street Map No .......... ~(]g~,X~, ............ Block No ............. XXX3fX ............ , ]J~g~J~..~.t,~l.tU~]~......N~.~. conforms substantially to the Application for Building Permit heretofore filed in this office dated ................... ,/~,ll,~u~.t,.....9 ............... 19.~'~'..., pursuant to which Building Permit No ......... ~...'~..~. ......... , dated ........................ A~l~f~J,~t~...~Lz] ........... 19.~.~. ....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 ............ .............................................. [?~ ~.?.A~.~.. ttW~,I~t.~G ............................................................................ This certificete is issued to ...... .~.,~/t~..~.....~,~)~.~. ............................................................................... (owner, lessee or tenant) of the aforesaid building. FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES41NkTAk ►lErf9GAw�F �APP.gC .W-- UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. ......Z.15......... Date ....................... 13.4........19.57... Permission is hereby granted to: Gorr' ,r .................. ...................................................... ;.r.Y.*................................. to '>1 �. ..t�rY�'..dhtlB�a'�27F............................................................................................................... ................................................................................................................................................................ .. at premises located at .r..u.....C.I:2.iPf...�,2.'!1€...................................................................................... apt t.ituck PI.Y. .... �...............►............... ................................................................................ ................................................. ................................................................................ ................................................................................ pursuant to application doted .............................!' )d'.. ..... .............19. 7..., and approved by the Building Inspector. Fee $..Xr?it99.....x?Aid Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING P[RMIT 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 edjoining premises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this location. c, The work covered by this epplicotion mey not be commenced before issuance of Building Permit. d. Up~)n approval of this app[ication, the Building Inspector wil[ issue o Bui[din9 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 Build!,n,g'. 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'removalior demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulati0~s.i. (Signature of?~plicant:, or nome, if a corporation) , (Address (/ State whether applicant is owner, lessee, (:gent, architect, engineer, general contractor, electrican, plumber or builder. ............................................................ ..................................................................................................... p re m ]se s.....~...,~ .~..~..~--~1., ~ ~./.. l.-~.,?- Name of owner of ....... J.~.l..~'::r..~ff..~..o...~.L~,..¥.N)..J..~...,.].~ .................................................. 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. Mep No ................................... Block .................................. Street and Number ../~/r.~..,. ~../fl.[f~...L~.tO..~L- ....... ~...~..b..~...~L~..~......~'~.~,:.~.......~...O..~.....~...~...~..~'~,~ ~ ' ' ....................... State existing use and occupancy of premieses and intended use and occupancy of prOposed construction: a. Existing use and occupancy . . .~./sr.~.~r~ ~.. ,L~..O ~ ........................................... b. Intended use and ............................................... ~. ................. .~ .......~. ............ 3. Nature of work (check which applicable): New Building ...... ~ .......Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost~..l~.~,~.~.O...,~.C~O.~.~./9..~....,,L~...~.~...Fee ................. ~..LO.~.O..O ....................................................... (to be paid on filing this application) FEES: 5. If dwelling, number of dwelling units.....O./kJ.~,. ........... Number of dwelling units on each floor...~:~..N'.~. ............. If garage, number of cars ......... ~..T.T'~.C/-~.F~J).......'~......O.A/Z~...C~J.~. ................................................. .................. 6. If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................ property whether lines, interior or < STATE OF NEW YORK, COUNTY OF ..~E~.~ ....... ) S S.' ......... ........ (Name of individual signing application) 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 ..~...T~..~.L ...... / Height ............ ~. ............. Number of Stories .....~/~.~,, ............. I 9. Size of lot: Front ....... /.~.O. ............. Rear ..... /..~.~.~.~..~.( ..... Depth [.~.~..,.Z.~..'..~.O.../..~..~,3;Z ' 10. Zone or use district in which premises are s~tuoted .............. /~ ............................................................................. ~ 1. Does proposed construction violate any zoning law, ordinance or regulation? ................... /~..~. ......................... 12. Name of Owne,~/~l~Nc~/~i~ ,,~premises'~'"'C~"~'J~J'~/~'" ........ Address ../t/.~..T...'~.l..-[.0.~.~rf~.p.../~..;.~..Phone NO..?/..~..~././.~... Name of ,~,~¢m~:t...~j~,.~.~.~L~-.~.S..7.~ ................ Address ~b'J~t¢l~,/~,~N~,~.C/¢5...t~J~ .~..~..Phone NO. ~,..~.~.~,~..~.. Nome of Contractor.~.~.....~.,..J~.l~.L.~..~,, .............. Address ~./t:-,-,-,-,-,-,-,-,~.l.~.¢.~..~..V..../~/..~..~...Phone NO..~..~...~.)./.~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from street and block numbers or description according to deed, and show street names and indicate says that he is the applicant above named. He is the .................. ~..~.~../.,t4'.~....~./~.. ................... ' . . . (Contractor, agent, corporate officer, etc.) ,of ~aid 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; arid' that the Work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........ ...... ...... ........ ^ ,, ~1(/ ^ ~ ' -- (Singature of applicant) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19.:.~..i~.~ Approved ........................................ 19 ........ Perm,t No ................................ ................ ............................... ............. .......... ........... (Building Inspector) / Application No -~'~S APPLICATION FOR BUILDING PERMIT Date ........ 2~...U..~...g..~.~J.-. ............. .~. ............. 19.~...~.. .... 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 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 shah 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 Bu~!di:hg Department for the issuan.c~e of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southo~ld, Suffolk County, New Yorl% arid other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or £or remdV~bl or demolition, as herein described. The applicant agrees to comply with all applicable laws, oFdinances and r~gulatjon~I ..... . (Signotdrei~f applicant, or na~, if a corporation) .... j (A. dd tess ~f/appli~:'~-n/;i ........ ; ~'~'- State whether applicant is owner, lessee, agent, architect, engineer, general con?~actor, electrican, plumber or builder· ............................................................. ...................................................................................................... Name of owner of prem ses .~.~.~.J.4~..~.~. ..~.~., .~.-.~.../ l~ l~..,~..~.-.l~.t(.~.~.c~ ..~..,/.L~.~ If applicant Js 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 ................................... Block .................................. Street and Number .~.~i.~..b..~..~.......~..N....~. ....... ~./~j.~...~l.~..~. ~ ~i ..~.~ .~l, 0...F. ~ .~'..~.,'~.t, fi': . 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: ,a, Existing use and occupancy ...................... .V.~-~rJ:~..T..,...~..~.~. j.~ .................... ,b. Intended use and occupancy ,:~,'J ~V....~.?, .~.. ,.~,..~'.~.,~ ,/LV....~. . ,~. .~. ?~".Z/~...,.,~..C3.'.,,(,~...~.Z). c,~,(~..~,~..,,,',., ~'_ ,~. /~/afure of work (check which applicable): New Building ....... ~i.....Addition .................... Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ~.~.(;~'.O.O......,t[T~..~.~P.~.././9~../~.N.l)..Fee .......... ~.J.O.,.O...O ................................. (to be paid on filing this application) FEES: 5. If dwelling, number oF dwelling units ......... O..6)..1~ ........ Number of dwelling units on each floor.....~l.()/.~ .............. If garage, number of cars ~..~..TA .QIJ~.J)....-m...O..N..~....Q..~k~. ................................................ 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 same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ / ~1~ 8. Dimensions of entire new construction: Front ...... ,.~..~..! ............ Rear .......~...~ ................ Depth .Z,~....~. .............. Height ........... /~ ............ Number of Stories ....~.~ ............ 9. Size of lot: Front .....Z..~..~ .......... Rear ..... L.~.~.~.... Depth (.~,.7~..~..Z~7,~Z~ 10. Zone or use district in which premises are s fuated . .~._..~..~. ................................................................... 11. Does proposed constructi~ violate any zoning law, ordinance or regulation? ........... ~.Q ................................. 12. Name of Owner of premises~.....~.....~.~.(~.....Address ....~ZTl. fi~.~.~...~,.~...Phone NO. Name of~....~.~.~6~../..~ ........ Address~.~....~..~Phone NO. ~.~.~..~.. Name of Contractor..~.....~.,....~.L.l.~ ......... Address ..~.~2~.~...~.~.X.,...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 and show street names and indicate whether interior~or co~ner lot. N sou- hol4 ) SS.' STATE OF NEW YOR COUNT, OF ...... ) (Name of individual signing application) above named. He is the ........... ~.~..~.....~. ~.Z~....,~'....-~.~.Z~ . . (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 ........................ day of ........................................ 19 ............ Notary Public,. ............................................................. County (Slngature of applicant)