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HomeMy WebLinkAbout687-zFO~R~ N,0. 4 TOWN OF SOUTHOLD TOWN CLERK'S OFFICE SOUTI-IOLD. N. Y. CERTIFICATE OF' OCCUPAI~CY No. Z.,~27.. .......... Date .....................00,~obe~--...~.0 ........... 19,60' THIS CERTIFIES that the building located af .~/~_ Rll~h "RO~d ..................................... Street _Map No...X~-~ .......... Block No...~ ........ Lot No. ~ ........... ~4~;'~i~'uek~'"'-'N'~¥~ ..................... conforms substsntially to the Application for Building Permit heretofore filed in this office dated ............... ~-.-...~. .............. 19..~9.. pursuant to which Building Permit No. Z~.7. ............ -lated .................... I~l~r....-~.~ .........19..~9., was issued, and conforms to all of the requirements o~ the applicable provisions of the law. The occupancy for which this C~erti£icate is issued is ............. P,r.i.v.a.~ e.. ~e...i'.ara~.~y.. ~we~[.~ng .......................................................................................... This certificate is issued to ...~,ga~tey~-~eet.~eSki ........... (.o~meF~ ............. ~ ......... .,.[ .................... (owner, lessee or ~enan~j of the aforesaid building. ..... ........... : .......... ............. ........................... Building Inspector FOI~M NO. ~ 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.° 687 Z Date ............................. ila~r....l9 ............... 19~ .... Permission is hereby gronted to: ~'.~',~al~....A/f,....~l~.....~l~i~i ........................ .............. ~**'.~ :t '~:~***~,....~.:T.: .................................. to ,..~1..~i ne~ one fa~i.t~ dwelling ot ~remises located ~t -..~/~-....R~,t~.R~,~d ............................................................................................. ~r~o~t to a~lic~tio~ d~ted .................................... ~....~ .............1~....., ond opproved by the ~i~di~g ~ns~ector Fee $. ~,Q ,.O.Q ............ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............... Approved ........................................ 19 ........ Permit No ............................... Application No .......~....~...~ ............ Disapproved a/c .....~~ ........... .................................. ( u'lding 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 cov. ered 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 p art for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o 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 regula~j~lns. ......... ......... (Address of applicant) State whether applicant is ownl~ssee,~~agent, .architect, engineer, general contractor, electrician, plumber or builder. Name of own re of premises' ...... ~~..~......~.~~ ~ ~ ................................................................................ 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. Ma~ No: ............................................Lot No: .................... Street and Number ..~..Z;~ ~.~ ~..~....?. ~ ............ ...~......~~.C~.. ............................... Municipality 2. State existing use and occupancy ~f pr, emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy .............................. .~.y.~-.} .............................. 3. Nature of work (check which applicable): New Building ...... ..~'.. ......... Addition .................... Alteration .................... Repair ............ ~.....Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost...../-~..O...O.. ........................................... Fee .../....~..~ ......................................................................... (to be paid on filing this application) §. 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 ...... i~...C. ............... Depth .~.~..~ ..................... Height ............................ Number of Stories ..... (~..~ .......... 9. Size of lot: Front .........~/....'~.....C7... ...... Rear .......... .~....~. .......... Depth ...../..~..~.~.~..'~. ,~ 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 regulation? ............ .~...Q ................................ 13. Name of Owner of premises...~/.~ .~.~..~..?.~.~. ...... Address ....... .~...~.~..~...~..~ ...... Phone NO ..................... Name of Architect .........,~.c~......~.~.~..?.~d~ ""~ ............... Address .................... '~ ....................... Phone NO ..................... Name of Contractor.....~:....~...~r~.. .................... Address .......... .t! ................................ 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 ev-ORl~,/ (~]~) S S cou "r',' oF ..... r~- .~.' ~.'( .~..~ ....... being duly sworn, deposes and says that he is the applicant aboVe'named"He' s the"' . ........... ~.~~ .................................................................... (Contractor, ~gent, cor~borate off cer, 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 ,theI best of his knowledge and belief; and that the work will be performed in the manner set forth in the applicatiqfl fiJe,d~h.ere, with. Sworn to before me th is ............... ~...~. day of ............... ~......~....~. 19..7-5~../... ~. ]ffol~ff z.~n~ure of applicant~ ~-~--. o.,bli~ ~~~,..~ounty .o. 52;,~4,,963, ~uffo]k Count FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................. (...ii Cl. '~ ~ 19 ~ ! Application No. ~ /' APPLICATION FOR BUILDING PERMIT 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 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 port 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'ap[blicant, or name, ff a corporation) (Address of applicant) State whether applicant is owner,,.lessee, age,hr, architect, engineer, general contractor, electrc on, plumber or builder. Name of owner of premises ........ ~...;;....:..;...:.:T;:J ............ ::;.....';~....,.T...;; t If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wil be done Mal~,No .... ., .......... Lot No: ........... · v ,-~ 1/ . , I , ......... Street and Number .................. ~. r ;..' Municipality 2. State existing use and occupancy of premises and intended use anjJ occupancy of proposed construction: ~. Existing use and occupancy ........................................................................... ~ .......... ~ ........ , .................................. b. Intended use and occupancy .............. v 10. 11. 12. 13. property lines. Give street and block numbers or description according to deed, whether interior or corner lot. Nature of work check which applicable): New Building ....... .)~, ........ Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... ~" ~ Fee Estimated Cost....~.~.~.:~ ................................................ r/. ~).~ ........................................................................ (to be paid on filing this application) If dwelling, number of dwelling units .......... ~ ....... Number of dwelling units on each floor ............................ If garage, number of cars .......................... ~ ............................................................................................................ if business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 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 ................................ Dimensions of entire new construction: Front ............ ~,~.~. ........ Rear ....... .~...c. .............. Depth .'~-"1. .................... Height ............................ Number of Stories ...... ~4~. ......... Size of lot: Front .......... ~/..~l,~..~. ..... Rear ........... .~....~ .......... Depth ....,(..,,~.3.~../...2,..%.~' Date of Purchase ........................................................ Name of Former Owner .... ~'..,:~4~j:~.~'.J~.~,~...~ ............... ,,~,~ r' ,I Zone or use district in which premises are situated ...........................,~1....~,-'~, ................... ~' ............................. Does proposed construction violate any zoning law, ordinance or regulation? ............. .~/..~) ............................... Name of Owner of premises...,~. ? ...... Address ......... ~.l.¢,..~..~.~,..x, ....... Phone NO ..................... * ~' ~'~ ~ - / ~t?r~~'~' -"res .................... Name of ,~rcmtect .........,~,,..,,c.~.;......,.....~.,..c. ................. /~aa s ............................................ Phone NO. ............................................ Phone NO. Name of Contractor.....m~ ..... b-~-~,-.~...¢~, ................... Address ~' .................... ? PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from and show street names and indicate STATE OF NEW YORK.,,_,,, ~, ) S S ,..(~2.~ Ct/~... ~.~ beng sworn, deposesand says that he the applicant (Name of indiviCua~l~igning apphcat,on) above named. He is the ................................................... -- di'~'"~ ................................................................... (Contra~'or, ~lient, co_rlborate 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 fi)'edL~therewith. Sworn to before me this L,~./,K~'.,//~__~ p.~_~ ~,x (S~a"'(ure of applican}'~