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HomeMy WebLinkAbout123-zFO*I~M~ ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. CERTIFICA'KE OF OCCUPANCY THIS CERTIFIES that the building located al .S/~..GrO~.~..D=;Lv. ee...W~oUthOl~ ..... Street _Map No~..~.~& No ......... .~.~.... Lot No ........ ~.~ ......................................................... conforms sabst~ntially to the Application for Building Permit heretofore filed in this office dated ~e~e~er 28 1~.~... pursuant to which Building Pe~it No. ~ 12~ ~lated ............. ~e~ 28 , 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 P~A~ O~ P~Y ~iNG KU=t O. G~ona~, o~er This certificate is issued to .......................................................................................................................... (owner, lessee or tenant) of ~he ~oresaid 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 PREMISES /4P,~q~fz%V~d[D,~k~4,~l~4J~[~,S~P~g~kf~N~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No ..... ~'"]:~'3 ........ Date .......... September.....28 ................. ] 9..~.7... Permission is hereby granted to: Ku~.t...O....Gr. ona~ ................................................ ................. GJ~ve-.-D~ive .................................... ..................... $outho;~l ~...... ~. ~. ....................... to ......... buit4., an...ad~$.ti~n...to...e.~is.tle~..dwe.tt~.ng ........................................................ at premises located at ...S/8....G.~o.v.~..~z~.~v~r..Heyd~n...~h~r~~ .............................................. ................................................................ ~u.~hetd.~-.-..tf,.~ ............................................................... pursuant to application dated ................ S.e~te~ber.....,38 ................. ~..ff.7..., and approved by the Building Inspector. Fee $'"~.00 ............ FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~'-~ '~...~.... ~9~5'7 ', " .......... Approved ........................................ 1 9 ........ Permit Application .............. Disapproved a/c ......... · ......... Z..... .............. .g.. ...................... ...................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............. ~ ........................... ~ 9 ............ 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 adioining 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, Up,on approval of this application, the Building Inspector wiJl 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 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. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eJectrican, plumber or builder. Name of owner of premises ....... Z~ ....... ...O......~. ................................................................................................. If applicant is o 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. ~.~.'~:~'B~ .................................. Street and Number .~....(~.,.~'....~ ................'~'J' ~:~.~~...~.. ....... ./'....L~..7 .~...'.:,., 2. State existing use and occupancy of premiesef~ond intended use and occupancy of proposed construction: a. Existing use end occupancy .................... ~.,,~ .......................................................................... b. Intended use and occupancy ................................................................................................................................ f Alteration ' 3. Nature of work (check which applicable): New Building .................... Addition ........................................ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ..~../...0....Q..~.....~ ...................................... 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, commerical or mixed occupancy, specify nature and extent of each type of use ................................ 3 ...... 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 af Stories ~ ................... 8. Dimensions of entire new construction: Front ........... ./....~. ......... Rear ...... ./...~. ............. Depth Height ............................ Number of Stories ...... ~.. 9. Size of lot: Front .........~...'.~. ........... Rear ' Depth ...../......~..?. ........... 10. Zone or use district in which premises are situated ........ ~. ............................................................................ ~ 1 1. Does proposed construction violate any zoning law, ordinance or regulation? ............ ~ ............................ 12. Name of Owner of premises.~....~..~ddress ............................................ Phone NO ..................... Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... Locate clearly and distinctly property lines. Give street and whether interior or corner lot. PLOT DIAGRAM all buildings, whether existing or proposec block numbers or description according to 7 and indicate all set-back dimensions from eed, and show street names and indicate STATE OF NEV~ COUNTY OF.,Z~f~.....) S S.' ........~F, ~.....'~/,¢~t~ .............................................. be ng duly sworn, deposes (]nd says that he is the applicant (Name of individual signing application) above named. He is the ................................... ~ ................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that oil statements contained in this application ore 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 ........ .............. , ~1.015E BOWD£N ~ Public, State o! Hew Residin8 in Suffolk County No. 59-0:!67800 ' My Camm;s: ~ ! ~ ~ :',~erch 30~ (Singature of applicant) I~01~I NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ^p~aved ...................... ~..! ............... 1 9...~...Permit ~o ................................. Application No ............................ Disapproved a/c ......................... ............ ....... .............. (Building Inspector) 1 APPLICATION FOR BUILDING PERMIT Date ............................ .~...0~.~,,~,,' ~-'Z......~... ................. 19 '~' i ~ .... 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 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 alterations, ar for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature 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 prem'ses ........ ../.,r.~..~.~...~..~ ........ ~., ........ ~.,~)~!./.!.~.!...~..~..../....~......~....~...: ................................ iiiiiiiiiiiii. If applicant is 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 ~2:Y: .... Street and Number .~.:~ ~ ~f~ ~ ~ . . ~ ................. ~TM",~?~....~, ....... (..~.~...~..~,, 2. State existing use and occupancy of premiese~.,~nd intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~:~:'~'~;~'.~:' :' ~ ................... b. Intended use and occupancy .................................................................................................... .~, 3. Nature of work (check which applicable): New Buildino .................... Addltion ......... ~..A,,~ro~ ................ i..i..i I Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ..... ~..>,:......f .......................................... ~-ee .................................................... (to be paid on filing this application) FEES: 5. if dwelling, number of dwelling units ............................ Number of dweliing 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 same structure with alterations'or additions: Front ............ ~" ................... ')-~' Rear . ........ ~.....'.'?m.. ............ Depth ......,~. .................... Height .............................. Number of Stories .~ .................. 8. Dimensions of entire new construction: Front ........... ./....~ ......... Rear ....... Z/....(~. ............. Depth ...../....~ .......... Height ............................ Number of Stories ....... 9. Size of lot: Front ......... ].~..z~. ........... Rear ............................ Depth ..../..£.~.?~ ........... 10. Zone or use district in which premises ore situated .............. lfi. i&..~:l ........... :~.~.:::~; ............................... ] 1. Does proposed eonstrucfic~n violate any zoning law, ordinance or regulation? ............ ~....~ ............................. 12. Name of Owner of premises./~,,-~.,~...c....~.......~.L,cO.¥...~?Address ............................................ Phone NO ..................... Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... STATE OF NEW YORK, ) COUNW ~e~f.~l,Lvi, j~.l sig~i~]"~'~ii~;;i;~i ............... being duly sworn, deposes and says that he is the applicant above named· He is the ................................. (~./~...'~.~..,,~j-~,~,:... ........ .:~J~2~,,' ................................................................................................ . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that oll statements contained in this application ore true to the best of his knowledge ~ belief; and that the work will be performed in the manner set forth in the applicat on f led therewith. ~:'~ '~ % Sworn to before me this .... 2?. ............ day of ....... ............... Notary Publi¢~ ....... Court y ELO1SE I]OWDEN ir ROt~ Public State of New York esding in Suffolk County No, 52-0267800 Commiss.or]