The URL can be used to link to this page

Home My WebLink About399-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi~ticate O[ Occupancy No. ~.h'. .69.3 ....... Date ............. ~%~®.. 29 ..... , 19. THIS CERTIFIES that the building located at . Idolt~d. t',eael~. .Dr:Ire ...... Street Map No. G .apt; .Ktdcl .El~t~ck No ........... Lot No. 38 ...... k~e:%'~.i'~&lc'a%' i~ iX ',, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. glXty.. 28 19..~9 pursuant to which Building Permit No. ~9~2 dated .......... g. llly .... 28.., 19.~9., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .Pr~.vage. o~e. £ami].y' a,,,~a]:~'i1~g ....................................... The certificate is issued to . F'ra~Ac 'l~:ko;q~'F.y .... O;~e~ ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . H.,R, .............................. UNDERWRITERS CERTIFICATE No...l~. ,][~,, ........................................... IIOUSE NUMBER..'1.~.5'0. ...... Street.. 8.O~:~.ct. ~.eacl~. D.~ .............................. Building lnspeci~r' ....... TOWN OF $OUTHOLD DUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST I~E KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 399 Z Dote ...................... .~'~.¥ ....... ~8 .............. ~9...53. Permission is hereby granted to: George T ~,y l. or......~,/g,- .....F~. ~nk.....;.~;~,~ws~r. ...................... .............. ~ ~.t ]. ~,~.~.c~ ¥ · .-- - ~,~.~..Y., ............................ to .....Ma~e...~...t~.],t~.~.~.ti¢.~ ..... a,ld.i.¢.t.o~, en...~...e~.is.ti~..~w~ll.i:ag ......................... .................................... (... em c.~,.o ee.. ~n...ex.i ~.ti~g...~o.~,e h...w.i.~b., per~$ ~.~ .. eon~,~ %.~.u~.t ~on ) at prcmises located at ...... ,~?~,e~...E~]~r~ ............................................................................................ ...................................................... .C,~D~.. ~( JAd...e.~ .%~.t,e.~ ................................................................. ................................................................ ,~a.C.t ~,.t.~c.~.~ ........ ~.,.~:% ........................................................ pursuant to application dated .......................... ,~Z.:}~.....~_Ef ................... 19....~8, and approved by the Building Inspector Fee $...~.,~.01~. ........... Building Inspector TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ ~ 9 ........ Permit ~o, Application No. ~ ~'' :i Disapproved a/c ....:.~ ............. ~-,'~ .............. ~ ..,:~Z....'~ .............. . .~....~ ............. ............................... ....... ........ ........... ...... .............. l, (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 pui*pose whatever until a Certificafe of Occupancy shall hav~ been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc.e 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 Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. b ........ .................................... · (Signature of appli~,~nt, or name, if a corporation) (Address of applicant) State whether applicant is owner lessee agent, archite_ct, engineer, general contractor, electrician, plumber or builder. Name of owner of premises... "~...~.'/' ~ .......... ' ................................................................... If applicant is a cerporate, signature af duly authorized officer. (Name and title of corporate officer) 1. Location of land on whichFt vill~/.~proposed work will e done. Map No'...:~.~ ........................... N : .... Street and Number ...~~.....~,~...~...&~r&...~~...~..l .................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o Ex~shng use and occupancy .... ~,...., ...................... ~ ...................................................................................... b. Intended use and occupancy ................................................................................................................................ 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) 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 ........................................................ 12. Does proposed construction violate any zonJ~q law, ordinance or regulation? ............ ~ .............................. Name of Architect ........................................................ ~dress ............................................ Phone NO ..................... Name of Contractor....~) ....... ~ ............. Address ............................................ Phone NO. PLOT DIAGRAM Locate clearly qnd 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 whefho~ ~nfey~oy or comer Jot. STATF OF NEW ¢~OI~K~,~),~ ) S S COUNTY OF ....¢~...~...v..~ ' ................................................................V~_.~ ~~~...being duly sworn, deposes ,and says that he is the applicant (Name of individual signing applicd~on) above named. He is the .................................. ~~...~'~..'~...~.::7.':..r ................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have p~rformed the said work and to make and file this application; that all statements contained in this application are true fo the best of his knowledge and belief; and that the work will be performed in the manner ~eL{.orth in the appiig~tion filed there,with. Sworn to before me this m ~, i~ ~j?o~/~l~ '~,~, ~-, ~, Il '--J~, ~ ~ ,g f,q m'/~ t r of o nt ~)~ 9 ~k nou e ) ........................ day of ........................... l. ,~..,~..~, co~ PP Notary Pub m,~../~-.-~'~,-'~-,~,~...~C~oudt9s ~rrh go, zg ~ -/ FORM NO. TOWN OF SOUTBOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. Examined ~ ~. ~ .[_./._/..:...~... ..g. ......... 19.:.~:- .... Approved ....... !J. ............ t,..' .............. lc).,!.....Permit No. ,.~...'~....?...: ...... Disapproved a/c ........................................................... (Building Inspector) ! Application No ........~.~......~..i~ ....... APPLICATION FOR BUILDING P[RMIT Date .......... .~.~ ......... ':i~.....~'....(~ ........... 19... s ....... / I~STRUCTIONS o. This opplic~tion must be completely filled in by typewriter or in ink ~nd submitted in duplicote to the Inspector. b. Plot plon showin0 locotion of lot ond of buildings on premises, rel~tionshlp to*d~oinin~ premises or public streets or oreos~ ond Oivln~ o detoiled description o{ I~yout o{ property must be dr*wn on the di~0rom which is port o{ th~s c. The work co~ered by this opplic~tion moy not be commenced before issuance o{ Buildino Permit. d. Upon opprowl o{ thls ~pplicotlon~ tho Buildln~ Inspector will issue o Buildin~ Permit to the opplicont. Such permit sh~ll 'be Bept on tho premises ovoil~ble for inspoction lhrou0hout tho pro~ress of tho work. e. Mo buildln~ sh~ll bo occupied or used in wholo or [n p orr {or on~ purpose whatever until a Certifico*e of Occupancy sholl h~ve been ~ronted by the Build~n~ Inspector. APPklCATION 1S H[R[BY MAD[ to the Buildin~ Deportment {or the issuon*e o~ ~ Buffdin~ Permit pursuont to the Buildln0 Zone Ordinonco of the Town o{ Southold, Suffolk Countg, Mew York, ond other opplicoble k~ws, Ordinances or Re0ulotions, for tho construction of bu0din0s, ~dditions or olterofions, or for romovol or demolition~ os horein describod. Tho opplic~nt o~rees to comply with oll opplicablo lows, ordinoncos/~nd regulations. .......... ~4-~&=~.....~ ......... ,~ ..................................................... (Signature of applicant, or,name, if a corporation) (Address of applicant) State whether applicant is owner~ lessee, agent, arc~i.t.egt, engineer, general contractor, electrician, plumber or builder. ........................................... ,.~.:...~ .......... X... '.T....;'I .............................................................................................. Nome of owner of premlse$.,,,~, I{ applicant is a corporate, signatura o{ dulv authorized o~ficer. (Name and title of corporate officer) 1. Location of landon which proposed work willie done. Mop No: ..(.,~!!~,~L{ ,~.:?..~........~.?:..,:;,~./,~' ' J',' ...... Lot No: ....................~ Street and Number ....~2...,~..~ ........................................................................................................................ Municipality 2. State existing use and occupancy o( premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ................. ,~.~. ~..X?. ;.,~... ~.. ?.:~......'~. ..................................................................................... 't b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition ......... ..2'"~'........Alterotion .....~. ....... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ....... .~....~....~........T.,~.. ................................. 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 O Depth Height ............................ Number of Stories 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name o,f Fo;q'ner Owner ........................................................ 11. Zone or use d~stnct In which premises are situated ........... 12. Does proposed' construction violate any zort~rtg law, ordinance or regulation? .................................................... 13. Name of Owner of premises.~,..~.~T....~..C~,~.~:.....~.i,,...~...:.~..~.~,/~dress~'~,U '~ ............................................ Phone NO ,I. Name of Architect ........................................................ ASdress ............................................ Phone NO ..................... ~.~: Te .. ,,~.,_, Name of Controctor.....'~.~ ........................... 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 ~OR~. j~)~ ) S S COUNTY OF .... r.~¢~. ~.T~., ?: ~ .~,. ;) ' ................................................ i ....... ~ ........... .~..~.~..~.~:.h.~,~-.~..being duly sworn, deposos and s~gs thor he is the ~pplicont (Name of individual signing app~icdtfon) above named. He is the .................................. ~~~7:;~: ........................................................ (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 containe~ in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set ~orth in the application filed therewith. '-~ Sworn to before me th's ~.. iz~,~?~ ~t~' ,~ .~ ~ ,~ ~ . ~ . ,.-,,, ~; ~?~ /, . ~x ~ ............... .... ........... , Notary PuNic, ~...~'~~...(..Co~,,~ ~; - ~ ,/