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HomeMy WebLinkAbout717-z FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 717, z Dote ................................. ~Ttzne....~l 6 ......... 19..~19... Permission is hereby granted to: ~t~r...~hl....I~ .................................................... .............. ~.~.~ ~ .~:e,:t.~, ~....?f ,X ..................................... to ~.t.l.4..V.~.~...d.~.e..Z.~..~t..g ............................................................................................ '? ......................... at premises located at ..~:xt,..~...%g.....0:c.:Le~C,..~...~he..~a .................................................................... ..................................................................... ............................ pursuant to application dated ................................ ~..~?......1..6.. ............... 19.?.9....., and approved by the Building Inspector Fee $...]:..0. ,..q .0. ............ Building Inspector FORM NO. 4 TOWN OF SOUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z 582 Date October 20 ~ , 19...6...0.. THIS CERTIFIES that the building located at .~qo.%%n?.[...V.i~.~...~r,.,...~r~.er~%~..i~... Street Orient By 5['he Sea ........................ Lot No ....... ..].9 ....................................................... Map No ......................... Block No. *~e conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................ .J..q.~.c:,...~..~ ............... , 19..~.~., pursu.ant to which Building Permit No ...... ~....7..1..~ ......... dated J'~.n~ LG 5 9 ...................................................... 19..L;..., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupa, ncy for which this certificate is issued is ................ PR£VA']~ ONE F2~.ILY D~ELLING This certificate Js issued to .?.?.~..~.e...r...~)].h..1..,.....o.~.?..n..e...r. .......................................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ~ .~.~.. Approved...._...d/~ ./...~. l~..'..Permit No ~..~../..~... D' APPLICATION FOR BUILDING PERMIT Date ....... 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 co~ered by this application may not be commenced before issuance of Building Permit. d. Upon appr6val 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 Certiflcafe 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 all applicable laws, ordinances and regulations. (Signature ~-f appucbnf, or name, it ~, corporation) .......... .'~"~,.'/x.~:.¥,,.~.. ~?.~ ...................................................... ~/ ~'(Address of applicant) State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ ............................................................................... Name of owner of prem.ses......~(~...~:/.:L.....t...d./.,;4.,..' r V ,x~> /., .~;,' ., ....................................................................................................... . . 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 do~e. Mai) No: ((~;~,.~:/:./~;~q],~?..¢~Lot No: .... /..~ ........ Street and Number ...... ~'~,r,~.~. · ~X~ .... :. '.~'. ~ ................................................. i~umc~pauzy ' 2. State existing use and occupancy of premises a~d i n~ended use and occupancy of proposed construction: ........ ........................................................................... b. ................................................ 3. Nature of work (check which applicable): New Building ........ .~.......Addltlon .................... Alteration ....,~11~..~...~..... Repair ................... ,.Removal ........ .~ ....... Demolition ............ ~: ...... Ot~her Work (Describe) .................... 4. Estimated Cost /'.~. .~(Z..: .......................... Fee .J..~.~ (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 ........ ~.~.~....2. ...... Rear ....~..~,..: ............ Depth ...~../_~.../. .......... Height ............................ ,,,, ~, ~Number of Stories .............. 't ............ 9. Size of lot: Front ..... .z..~...~...i. .......... Rear ....../....d~...~.. ............. Depth ....~'~....~....." ...... 10. Date of Purchase ....... L.~.~.~..~'.~... ............................. Name of Former Owner~.~..~'.~..~..?..~....~.~,'' ;z .,~'.<~../ ... 11. Zone or use district in which premises are situated .............. Z~./.. ...... ::L.'~)'..-.../..':';~x'..~.~...4.''" "'- ' ....................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ,/.~..~.. ................................... 13. Name of Owner of premise .'Ok',. Z~.'/~'ICJ, Address ........ · .... hone NO.............,.......' Name of Architect ............... .~ ................ ;.,..,; ................ Address ............................................ Phone NO ..................... Name of Contractor .~,.. ..,~...:..Address ......... ...'~d..~z'~.~,.~..C.. NO ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil 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. ,-'.'.~ot,~/') C~/ STA'r~ O~ N~ ~9 S S COUNTY 0~':'.~' ' J .............. ,~:'~(~..~~ ............. being duly sworn, deposes and says thor he is the opplicont (Name of individua~,¢gning~pplicatio~p a~ove m .............................................................................. . ................ : ................................... ~ .... (Contractor, agent, corporate officer, etc.) of ~a d oweer or o~er~ ~ed Js duly fl~thorJzed to perform or have performed the said work aed to make ~ed file this application; that a statements contained Jn this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth Jn the ap~tig~fi]ed therewith. ....................... ~ Nota~ puNi~~~o~nty~ ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomined ....... ~..,/~.. 19~.... Approved ...... ~..../~.~....19..~....Permit~") No....~..~../...,;,~.... ........ Disapproved a/c ............. ~~ ......................... ~ ................. Application No .........~.~ ........ · (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............ 7--"(/"~(~ .~.~*~,1~ ~' ..... ,~.'... 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 sholl 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulbtions. ........... ....................... (,Sj~nature .ofgpplicant, gr name, if a~orporat~ .......... ~:.~.:.c~: ~ ~ ..... 7 ..... ~,~T~"~b'~'ii~b ............................... qtate whether a,,Nicant is owner lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .............................. zz..~..:7., d..,:?.. .~:.~. ..<~ ............................................................................... Name of owner of premises ................................................................................................................................................. If applicant is a corporate, signature of duly outhodzed officer. (Name and title of corporate officer) 1. Location of land on which proposed work ~vill be dolce. Map No: ~.f~../.~.'~.~.~,./.~.~.~...~.?kot No: ..... ./.~.~. ....... Street and Number ....... .~-~'..<~..~.. .............. ,~ ....... ~ .......... ) ...................................................... Municipality 2. State existing use and occupancy of/?.,~ .~L~ /',,,/p~emises and intended use and occupancy of proposed construction: o. Ex,sting useo.doccupa.cy ......... .......................................................................... ........... .................... .............................................. b. Intended 3. Nature of work (check which applicable): New Building ......... /,...~....'..Addltion .................... Alteration .................... Repair .................... Removal .................... Demolition .............. ,.....O$'h.er Work (Describe) .................... 4. Estimated Cost ....... ~.~'./..~ ........................................ Fee ..../... .................................................................................. (to be paid on filing this application) // .... Number of dwelling units on each floor ............. .~. .......... 5. If dwelling, number of dwelling unJts.......~, ...................... 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: Frqnt ......... ~..~'..../. .... Rear ..... ...N~..~...../.. ........ Depth .....',~.~...../. ........ Height ............................ Number of Stories ............................ 9. Size of lot: Front ......./...~..~..( .......... Rear ..... .~....~...~.....~ ....... Depth ..... ¢.~.~..~..~...../. ..... Date of Purchase ............,~.~..~_... ............................ Nome of ?~rr~/er-~ ~o ,z/~Owner ~...~../....';~-.~.:...~.....~/.... ............... Zone or use district in which Premises are situated ............... /~........r.:LT.?..'~'..-T..~../.~/ ....................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ~..~..~..... .............................. 13. Name of Owner of premises .~..~./.'./.~..~..../-~'.~./..,~F-,zAddress__ ---- ii..~-~ ......... ~..'.~..(;/,,.~2.~...~.C.~one 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. 10. 11. STATE OF N~W~,~,. ~}. S S cousin= · -- ............... . ........... beln~ duly sworn, deposes ond s~ys thor he is the opplic~nt (Name of individual~gping gpplicatlon) .... ~ho,,~ 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 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 applJ~tion filed therewith. Sworn to before e this ~ ~,~ ~.,~ ~o~ , /~ ~v of _ ..~. 19..~.~,~v ~'~s~ure of applicant) ............ , ..........