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HomeMy WebLinkAbout556-zFO~ll~ NiO. 4 TOWN OF SOUTI~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOU~'IOLD, N, Y, CEBT1F~CATE OF'OCCUPANCY THIS CERTIFIES that the building located a,(~..~.a...~...h~.o.h!....R..d.,..,._..N..~W....~.£~.o.~.k. ..... Street Map No ....................... Block No ..................... Lot No .............................................................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ................. 19.~..9... pursuant to which Bunding ?ermit No ..... .Z.......~..~.6.. .... Jam a iS , was issued, and conforms to all of the requirements ~lated ...................................................... of the applicable provisions of the law. The occupancy for which this certificate is issued is PRi~ATE O~ FAMILY DWELLING This certificate is issued to .F...r..a...~..k.....~..°..]g~..~....J.-r..:.~...~.~. .............................................................. (owner, lessee or tenant) of the aforesaid building. TOWN OF SOUT~OLD BUILDING DEPARTMENT TOWN CLERK'S O]:FICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 556 Z Permission is hereby granted to: ...... ~.~i~.L.~.~!?..~..,....~./...e....~...~..o.t~.~ zr. ...... ~.e~..?,.ff..o.~....~.e.~..;~.e.r~ ....................... to....~..~.~.~.~.~..~.~.~:~..~.r.~.~.e.~.~..~....e..~.~..~.e.~.~. ................................................... at prem~e~ bcoted ot ...~/.~...~..r.~.~.~.~.~..~.:.~..1....:~.~.~.~...~.e:~...~.u..~..;~....~..e.~..~.q~ ...................... pursuont to opplicotion doted ............................ .~,.~..~...~..~..~...~.....]:..3.. ............. ] 9....~...9., °nd °pproved by the Building Inspector Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST 13E KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission to: is hereby granted ........ ::~:~:..~.~~z~:.':.'.':::.':.'.'.'.'.'.'.'..:: ~ ................................. ~:~ ..~.~.?~.....:.~.~ ....... ~~:: :~ ~ : ~ ~ ........................................ ~ / ~:" ~ ~ ~.~: ..... . ................................ ............................................................. ~....~.~~:~:~ :::::::::::::::::::::::::::::::::::::::::::::::: ........................................................... ,~: ........................ ~:~ ..... Bu~[d~n~ Inspector ~ · ~ ~..l.O ................. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................................ 19 ........ Approved ........................................ 19 ........ Permit No ...... ~....,~.~ ~' ....... Disapproved a/c .............................................................................................. Application No ....... ...~...M.~..~.. ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT ote ........ ................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and sui~mitted 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 o Building Permit to the applicant. Such permit shall be 1,apt 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 puFpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe 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 aH applicable laws, ordinances and regulations. .... ....... .................. (Signature of applicant, or name, if a corporation) ................................... .............................. '~'X~i~i;::,ZE ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ....................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which pr, oposed, work will be done. Map No: ............................................ Lot No: .................... 2. State existing use and occupancy of pr,e~rnises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .,.~ ........ Repair ............... ~...Removal .................... Demolition .................... Other Work (Describe) .................... Esti ~ 0 0 ~ 4. mated 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 ............. ..~t'.....~. ..... 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 ........ ./....q... ............. Depth ....~.,...~. ................. Height ............................ Number of Stories ....~ ......... 9. Size of lot: Front ..... j..~../~ ............ Rear ........ ./..,..~...,~. ......... Depth ...../...~...,~-~.. ............ 10. Date of Purchase ........................................................ N~me of Former Owner ........................................................ 11. Zone or use district in which premises are situated .................... Z~.....~,~...~ ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises...~.~.~..~.~.:Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... 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 NE,~ YCi~K,0]- _ ) S S COUNTY OF ~...o:~......) · ......................................................................................[/// be ng duly sworn, deposes and says that he is the applicant (Name of individual signing appJicotio, n~ above named. He ~s the ............................. ~ ....................................................................................................... (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 tMs application ore true to the best of his knowledge and belief; and that the work will be performed in the manner, set f~J~ in the applicotign filed therewi~t,h. Sworn..../...~..t° before me this ...~~(-'X r~?:.,~,~,,~'~-~ ~,,', ~' ?i/,~?,, ,~ .,;~ ,~'v~ ' ( ignat~ ,~I~~~'~'~S~° f~~. day of ........ .. J~ ,L ) /J, ~, ~ ~,, '"'"'~,~ - //' // Notary Pub c, ...~/~......./~...C:cfuNty -'~ so, z~' ~' FOR~ NO. I TOWN O,F SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ ]9 ........ Perm t No ............................... Application No ..... ~..'~... ~ ........... Disapproved a/c .............................................................................................. .........i ................................. APPLICATION FOR BUILDING PI~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 end of buildings on premises, relationship to odioining premises or public streets or areas, and giving o detailed description of layout of property must be drown on the diagram which is port of this location. c. The work cowered by this applicotlan 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 shell 'be kept on the premises available {or 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 a Certificate of ©ccuponcy shall hove 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, electrician, plumber or builder. Nome of owner or premises ........ ~ ........ ~,' ........................ (~ ................... i~" ! If applicant is o corporate, signature of dut~ authorixed officer. .......... (Name and title of corporate officer) 1. Location of land on which pr,,opose~work will be done. Map No: ............................................Lo No: .................... Street aha r~umDer .........L~.: ;.;::, ....... ~':r ....... '~..~.....;.,,'.,,, .......... ~ .................................................................................... Municipality 2. State existing use and occupancy of pr, e~mises~ arld,.,inte, nded use and occupancy of proposed construction: a. Existing use and occupancy ............. ~.~:~_¢jM_~.~,~,,,.~.~,~,.::,.,..,~- ...................................................................................... b. Intended use and occupancy ................ ~ ......................... ~....~.~¢ff...,'~ ........... .~ ...... ......dt.,¢~- ...................... 3. Nature of work (check which applicable): New Building .................... Addition ........ ../,~.........Alteration ....~i ...... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... // 4. Estimated Cost......(~,..6).4). ........................................... 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 ............ ~q....~ ..... Rear ............. t;~'"',~ ...... Depth ...~..~ ................... Height ............................ Number of Stories ........ octm;~;~ .................................................................................... Dimensions of same structure with alterations or additions: Front ....... ~'"Z;.; ................ Rear .~..)_.~.. ..................... Depth .......... ZZ;)..~jt ........... Height ......................... ;Lc. Number of Stories "~5~"~ .............. ¥ 8. Dimensions of entire new construction: Front.....(p~;t.~,_ ....... Rear ............................ Depth ............................ Height ............................ Number of Stories ..... .2..;(,..}~; ............ / O ~' 9. Size of lot: Front '/ [~ ~ Rear Depth ...: ........................ 10. Date of Purchase ........................................................ Name of Forrrmr Ovener ........................................................ 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of prem.ses....I.d' ~,-~.,~-/6 ................. O,.:....t.~' -~.,-~ri:Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................Phone NO ..................... Name of Contractor ............ J ....................................... 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 NE~C(~JJ~.~C.~ ) COUNTY oF ...... #'f ................ ) s s. ................................................................................................. being duly sworn, deposes .and says that he is the applicant (Name of individual signing apl~.Cication/~ ......... above named. He is the ............................................................................................................................................................. (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 p¢¢formed in the manner~ f~kh in the application filed therewith. Sworn tok~re me th,s ~.~ e&/;~",¢ o ~ot~,,~ .' ,/~ ..... ~ ~ . .............. E2% ...... %..,.. Notaw Pubhc~..~..~ounty ~ 4~ore/~ ~ .~ f //