HomeMy WebLinkAbout475-zTOWH OF $OUTHOLD
BUII. DSHG D[PARTMENT '
'TOWN CLERK'S OFFICE,
SOUTHOLD, ~, Y.
No. Z 26~ '-'ate ', '~ ~ch 30 ~g F9
......................................... '~' ......... ~ ' ~'~' ' '~e~ ~' '
THiS CERTIfieS thor the building Iocoted at.~.....g.~.~g...~.J...~.~...~'~e,t
Map No.~.~..~o..,.~ ............. Lot No ...... ~ .................................................... , .....
conforms substantially to the Application for Building Permit heretofore filed in this office dated
..................... ..0..~..t...O.~.~....~. ............. , 19.~.., pursuant to which Building Permit No..~.....~'.~,~. ................
dated ....................... 0.~.~Q..~..~.~..,,~ .......... , 19.~..~...., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is
PRI%rATE O~E-FAMIL~ DWELLING
This certificate is issued to ....~.~t~f~.l~...~t...~.~.,~..~%$...Q.~..~,~..~. ..............................................................
(owner, Jessee or tenant)
of the aforesaid building.
Building Inspector
Howard ~. ~erry
FOI~M NO. 2
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLt;RK'S O;:I:iCE
SOUTHOLD, N. Y.
BUiLDiNG PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 175 Z
Dote ................ OC~.tO.'D~r...-.-~ .................. 19.~8...
Permission is hereby granted to:
A. ~.~,l,~Z..:~..~.q:....A/..g.....:.T..~m~.~.-E,,..~.-~-~,b,
................. M~t ~,l%~clc~.....~.o;~, .........................
to ....~ l~...~e~': ..d~e.Ll t~g ............................................................................................................
at premises located at ...... ~/P,.....0S.S~....~.e ..................................................................................
Leu~hing W~ter~. .....................................
.................................................... S.o~.~d,.....~f ~.~., .........................................................................
pursuant ~o opplico¢io~ dated .......................... 0.~0~. ....... ~ ............ 1~....., and approved by the
Budding inspector
...~:......~::...~.. .............................................. ~ ...............
Budding Inspector
FORI~I NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN C RK'S OmC
SOUTHOLD, N. Y.
Examined ........................................ 19 ........
Approved ........................................ ]9 ........ Permit No ...............................
......... ............
(Building Inspector)
Application No...t.(.'.?..C ...........
APPLICATION FOR BUILDING PERMIT
............... ...... ............ ..........
Date ........ ~ 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, relotlonship to adjoining premises or public streets
or areas, and giving o detailed description of layout of property must be drawn on the diagram which is part of this Iocotlon.
c. The work covered by this applicotlon may not be commenced before issuance of 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 port for any purpose whatever until o Certificate of Occupancv
shall hove been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuonoe of o Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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 oll applicable lows, ordinences and reg,~ulotions.
../.,.-!, v ......................
............... /,..~f] .........................................................................
(Address of applicqnt)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premls .... ..~....~.
If applicant is a corporat ,el?signature of duly authorized officer.
(Name and title of corporate officer) ~..~.~_~
1. Location of land on which proposed work will be done. MaD No: ............. ~ ............................ Lot No: ~,~
Street and Number .
Municipality
2. State existing use and occupancy of pr,emi:.~,d 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 Building f Addition .................... Alteration
Repair ............ ~.....Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost.../..~......~...(~ ................................... Fee ../...Q ..................................................................................
(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 ........ Z..~...~....~.. ..... Rear ........ ~..~ ......... Depth ...../..'..~T.....~/../~..'../...~
10. Date of Purchase ........................................................Name of Former Owner ..~...¢.~..'..~...~.'..~.'.~.~ ...........
11. Zone or use district in which premises are situated ............. ('~........~...~.~..~.....'. ........................................................
12. Does proposed construction violate any zoning law, ordinance or regulatlon? ...... ~.~. ....................................
13. Name of Owner of premise~.'.~..'...~....~...Address ....... i .................................... Phone NO
Name of Architect......./,~ ....................... : ..................... Address ........................................... Phone NO .....................
Nome of Contractor../~..l~,.,.~,.~.' ................. Address ,.,~.,./4..~: ................. 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 ..YO~,I~, r~lC ) S S
COUNTY OF ....~.~......) '
above .................................. n a m( eN~ mHee ::~t~ed. wld ~a~l s i~ ,ca~n.~ .~i~i.iI,.....:..: ...... :....: .... :.....; ................... ' ~.~:.. ~ . ~.~ . ~.~. . ~ . ~]. he applicant'
(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 tl~at the work will be performed in the manner ~o~b.~,[n the applica~filed th~with.
Sworn to before me th~s ~ ~,,~; ~,,~ . -,~ ~,., ~_ . .J (~
..,~,. day of ,~ , ~9'~, ," %~ ,~r~/~e~-~,cant)
Notor Public '~ ~ ~'County ' ':~)rh /
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD~ N. Y.
Approved ........................................ 19 ........ Permit No ..............................
Disapproved a/c .................... , ....
(Building Inspector) t
Application No...?...~...~,. ...............
APPLICATION FOR BUILDING PERMIT
Date ............................................................ 19 ............
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink end 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 Southotd, 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 end regu, lations.
' (Signature of applicant, or name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premisesj;~?U:':v.:.:~::'.%~-¢ ........... '.0.,~.-'.<.'.:;....'~.-'..;..~,: ........................................................................................
If applicant is a corp~mt~signmur~ of duly ~uthori~ed of licit.
(Name and title of corporate officer) {.) ·
1. Location of land on wh~ch~roposed work w~ll be done. Map No: ............. ~,,, ............................ o No .....................
Street and Number ....... ~...'.....~.~.....;....':..:...: .......................................
Municipality
2. State existing use and occupancy of p~emises ~d 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 Building ....... ~.....Additio] ................. Alteration
Repair .................... Removal .................... Demolition .................... Other Worl~ (l::}escribe) ....................
4. Estimated Cost..J..~.....;2~..(~..O ................... Fee ...L.L) ...................................................................
(to be paid on filing this application)
·
5. If dwelling, number of dwelling umts ........ ~ ...............Number of dwelling units on each floor ............................
If garage, number of cars .............. £~...."r~..:.~.........~..:~..~ .......................................................................................
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 ..... (.r.~.?.,;~;: ...........
9. Size of lot: Front ........ -.~.~..6'.~.:..~..~.. .... Rear ........ 4'..C~';:;T~' ......... Depth ..../..~....~./..../.../..Z
10. Date of Purchase ........................................................ Name of Former Owner ..~_,,':./~.:..~J].,,",..~,,./r,,.-.~.~;.-~..~. ...........
11. Zone or use district in'which premises are situated .............. ./..~........J:~...: ........................................................
12. Does proposed construction_~ ~ , --'~vi°late any)zo~,g~, .., law, ordinance or regulation? ...... ,/.~.~*.':d'. ....................................
13. Name of Owner of premiseS/2~o,~¥~...q.....(/.~....~...~Address ............................................ Phone NO .....................
Name of Arch.tact.......~.. ....... v ............... ~ ...................... Address ................ ~ ........................... ne NO .....................
Jl i ' ~/. g] ',~' ', C' .,'
.,~. ~/ t
Name of Contractor../'...L.(C.,~....-~...;~p.../~.-~. ................. Address ..-:/J:U.'./,,~,:"f.~...,,.~.: ................. 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, ,)~ ) S S
...................................... ~ ....... ./..~....~!C.,*,,¢~.,d.'..~........~':.).. .............. being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He ~s the ............................................ {~f~.'.;..~;.>ni~ ..............................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duty 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 w be performed in the manner sg} for~h,,~n the application filed therewith.
Sworn to before me th~s ~;7~,; '~,~, ~- )z ~ {x~ ,~
.... ~ day of .. L~,~.]~. ~v, ~'' 5,, , ~ coun~ r/~ (Signature of apulia t)