HomeMy WebLinkAbout466-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. .......Z..5.7.Q..... Date ..............................June 7...........,
THIS CERTIFIES that the building located at .cor of Halcvon &Equestrian Ayeeet
ip3shen...IR1itya-' .Nev..To.rk.....
Map No. ...**,r............. Block No. ....................**tot No. ........***...................................................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
25 1192'8..' pursuant to which Building Permit No. ..Z„ 66
58
dated ...................Se... p
............tember.........29........... 19........,wos issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ................
PRIVATF. ONS FAMILYDWELLING
...................................................................................................................................................................
This certificate is issued to ...9ini red S. Clark (.Kra. Frank J. Clarkj, owner
. .................................................................................................
(owner, lessee or tenant)
of the aforesaid building.
''✓�..
...............................:................................................
Building Inspector
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 UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N° 466 Z Date ..............September.....2.9............ lid....
Permission is hereby granted to:
Mrs .wsnttrad...BA...CUOK......................................
.........Vishers...Is]aad......................................
.....................N.Y...................................................
to ...Duild..in-addMOTl..0A..AM..RT,' N.Ung..S1XVIUMs......................................................
................................................................................ ................................................................................
at premises located at . aleyon..d:..&g1LRatr1✓sn-kV..6..................................................................
.................................................Fishers..I stand.,........N..Y............................................................
.................................................................................................................................................................
pursuant to application dated ................-6.0vull l6r..... 5...............1954..., and approved by the
Building Inspector
Fee $$,OO••yaid••
l.... ... ........... ... .. .`v�.......�.
Building. Inspector
FOl~l~l NO. 1
TOWN 0~ $OUTHOLD
BUILDING D[PARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Exam,ned ........ ........ .........
pproved ........................................ 19 ........ Permit No .................................
Disopproved o/c ..../ ........ ~ .............. ;~ ............... .~ ............ ~ ...................
...................... .........................
APPLICATION FOR BUILDING PERMIT
Date ~. ~. D ~ .e..m..b,..e. ~..~.~ ....................... 1958 ....
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in in]< 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, 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, electrican, plumber or builder.
ol~iGe~
Name of owner of premises..~..i.n.:L.~.ecl..~,.O.'L~z'.]~ ............. (.~z~.~.,~.r.~n~..,.T.o,O3.az~k.) ...................................................
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 ................................... Block ..................................
Street and Number c,o~@~.
2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction:
a. Existing use and occupancy...p~C..i. 7?.~..t..~...~C.~.~..l.~kq.O..e.. ......................................................................................
b. Intended use and occupancy.pr.i.v.8.~b.e..r, es.ids~o.e ......................................................................................
Nature of work (check which applicable): New Building .................... Addition ....~; .............. Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..............
4. Estimated Cost 9~,O0...OID ........................................... Fee ..........................................................................................
(to be paid on filing this application)
FEES:
5. If dwelling, number of dwelling units....~.l't8 ...............Number of dwelling units on each floor ....... ~.~e .............
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...il~ .................... Rear .1~3. ...................... Depth ..~.3 ......................
Height ...1.6 ..................... Number of Stories t,w¢ .......................................................................................................
Dimensions of same structure with alterations or additions: Front ................................ Rear ................................
Depth .............................. Height .............................. Number of Stories ...o~e ......................
8. Dimensions of entire new construction: Front ........... L.4. ............. Rear ..... '1.~ ................... Depth ...1....6. .....................
Height ...... 8 .................... Number of Stories ..~.~..e. ...................
9. Size of lot: Front ~:...~t, or~f ......... Rear ............................ Depth ............................
10. Zone or use district in which premises are situated ...... A ........................................................................................
11. Does proposed constructiocn violate any zoning law, ordinance or regulation? ....... no. ........................................
~.inifred B.Clark Fishers Island,N.Y. 519
12. Name of Owner of prem.ses ........................................ Address ............................................ Phone NO .....................
Name of Architect ...................................................... Address ............................................ Phone NO .....................
Name of Contractor......A..:..J.g.~.~.....O.~..~.~. .................... Addres~.1.~?:..e.~..8.....Z.~.]:~..~...~..'.~.:..~..:..Phone NO....2.~..3: ...........
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.
Sworn to before me this
..................... a ¥.J ;...; ....... ./: ......
Nc~l~'~'~u~~.~d.~~y' . ............. ; ...i.., '.; .~. ............
STATE OF NEW. YOI~K,/'Z ) /' '
COUNTY OF: ...t~.,~ ........... ),,. , -~
I ) being duly sworn, deposes and says that he is the applicant
............................ .........: ...... . '~ ..... .......: ....................
above named. -kJ,e_ds_~tlm~.q ........... ¢:rI~,¢......./--., f~',.-.,.. ~ .~...'~,~ ...........................................................................................
(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 Qpplication are true to the best of his knowledge and belief;
and that the work will be performed in the manner set forth i,n the application filed therewith.
(Singature of applicant)
FORi~ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUT'OLO, N. Y.
Approved ................. ./. ..................... 19 ........ Permit -- ~
Disapproved
a/c
(Building Inspector)
Application No b/~f~ G
APPLICATION FOR BUILDING PERMIT
D. ~eptember 25, 58
ore ..................: ............... ; ......................... 19 ............
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 adic~ini'ng 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 issuanceof Building Permit.
d. Upon 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 ~ptc.rpose wha.tever 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)
Fishers ~lan~ Ne~ ~ork
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder.
owner
Name of owner of prem ses..~'.t(..&.~f...~.?.~....B..'..d...]:~.k ............. f.~.%~..~..~..~.~.?..*.~..~.~.~...~..). ............................ ' ......................
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 ................................... Block ..................................
corner of P~ and Equestrian Avenues
Street and Number ............................... ;...; ................................................................................................................
2, State existing use and occupancy of premieses and intended use end occupancy of proposed construction:
Drivat e real~enee
o. Existing use and occupancy
private residence
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building .................... Addition .....3~ ............. Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost .1~,00.~,.00 .......................................... Fee ..........................................................................................
(to be paid on filing this application)
FEES:
5. If dwelling, number of dwelling units ...... ~1~, .............. Number of dwelling units on each floor ......... t~ ...........
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 ...'l.~ .................... Depth ...5~ ....................
Height .....'1,6 ................... Number of Stories ..t,.'~ .....................................................................................................
Dimensions of same structure with alterations or additions: Front ................................ Rear ................................
Depth; ............................. Height .............................. Number of Stories ..... Olde ....................
8. Dimensions of entire new construction: Front ............ ~./.~ ........... Rear ...... .'la ................. Depth ....'~ ...................
Height ....... ~ .................. Number of Stories ....ot~ll .................
9. Size of lot: Front ..~..~O~e~ ........ Rear ............................ Depth ............................
10. Zone or use district in which premises are situated ....... .,~ .......................................................................................
11. Does proposed constructic~ violate any zoning law, ordinance or regulation? ........ I~O .......................................
12. Name of Owner of prem~s~..~..~..?..~.....~..'...~..~.~.~..~.. ....... Address ....~.~.~.~.~.~..?...~.?..]:.?.?..~...~..~..:.~'l~one NO..~..~.?. ............
Name of Architect ...................................................... Address ............................................ Phone NO .....................
Name of Contractor...._/~.,.~.l~l!l...~fl.~[~ ................... Addres~.$.~b.~..~...~.fl~..~.~.~..~.~.*.Phone NO....~.-~ ..........
PLOT DIAGRAM eJ/a
kocote clearly and distinctly oll buildings, whether existing or proposed, ond indicat II s~t-bock dimensions from
property lines. Give street ond block numbers or description according to ond s~reet homes ond indicote
whether interior or corner lot.
STATE OF NEW£YOI~z, z"/ )
' ~ .~,..T. Zz~,~~ ~,~ S,S'.
COUNTY OF '~....v*) 7
(Name of individual ~gning a~plication)
above named. ~....~.~..~.~ ....................................................................................................
(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 f~led therewith,
Sworn :~ore me this ~(~
..... ~...~ .... day of ... 19.~
(Singature of applicant)
No.or~.w..~~-...;;:.;...;~;~ Y