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HomeMy WebLinkAbout761-zFO~R~ NfO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTHOLD, N. Y. CZRTIFICAT~ OF OCCUPANCY No ........... ~...~7.51. Date ............................... 0~ul~. 21 .......... , i9.150. THIS CERTIFIES that the building located at .w/s..Halr~te.l~li, Rcl,.r...C~taqc~,~e Street I~[~' 'POialt ........ Block No .......,~, ...... Lot N~,/.3 .......................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. ..~..~...8_ ................. i9.$...9..., pursuant to which Building Permit No ....... .Z.....?~. (. ~lated .............. ~13.~...0. ................... 19.5.9_, w.as issued, and conforms to all of the requirements of the app!ieable provisions of the law. The occupancy for which this certificate is issued is ................................................. : ............... IPR*XrO'Arin~'' O['q15' ' 'FAIvI l'liY' 'DW~I~NC, ....................................... This certificate is issued to ............. R~il~rtOtl~..l~.,....F.&llll~&i:~.:l.~k,....Owl:l~ ................................. (owner, lessee or tenant) of the aforesaid building. Building Inspettor FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 761' Z Permission is hereby granted to: to..~....'.....n....~.....~...f.~...d.~..Z.~.-. .............................................................................. at premises located at ¥/~ l~t~FI !~!.~ ~tO i/st. m/ 0.~ CO~ i~01~!, '" I~'p" ~ff ' ll~i'~'iiii'~" P6lf~t: ;" ~e,~; "'1~';" 373 .......................................... pursuant to application dated ..................................... ~1~....~. ............ 19...~..~., and approved by the Building Inspector FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL~RK'$ OFI:,CE SOUTHOLD, N. Y. Examined ........~::~ 19..,~.: Approved ........:.:...~..~:~., 19.C..~ .~..Permit~ No ...... ,--V~Z~'" ./... ....... Disapproved a/c ...... v ................ ............. ........... APPLICATION FOR BUILDING PERMIT Application No ......../~.../.. ........... 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 pre~nises, 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 ~ocation. 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 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 o 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 applicobte 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 regu[atlons. ............ ................... (Signature of ~pplicant, or name,d~o cqrporati, on) (Address of applicant} State whether applicant is owner,,~ee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................................................................~ : ......................~~:' .............. . ....... :.., ....... >/ ...................................... Name of owner of prom sos ......... .~..~.-:-?-~.~..Z~....~.'...~~.,:...'~./.~-.: .................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate, officer) 1. Location of land on which p,r, oposed ~'ork will be done. Map,No;, at N.o.:.~, Street and Number .... hT/...r;....~.,~-~.~..6~.-'Z.~:/--~....-.~: .............. ~ ............ ~..:;.~.....~...~..~//..~.~.~..(..tr~, Municipality itateEx~:itltni:gus:eo::doc:::pa:::y o~~~:d use and occ:pa::f proposed construction: use and occupancy ..~~ .......... ~~i ................................................ b. Intended / 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Re,~o~al .................... Demolition .......... ~ ....... at. he, r, Work (Describe) .................... (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 ....................... .....~....,N~lurnber of Stories ...,v..._.~ ................... 9. Size of lot: Front ...... .//.,~o.-........ R~ar ......... ..z~r:..z..-~.... Depth ...'~..: ..... 10, Date of Purchase ............. /..~.::?..y.. ......................... Name of Former Q.wne~r _.~.. ............~ .................................... 12. Does proposed construction vigJ, ate any zoj~ law, ordiruaj~ce al reg~,l, ation? ....~:.~"~. ........................................... 13. Name of Owner of premise~.~..'.'~.~..7~..~~o~; NO t ~ Addr Name of Architec ......................... ,~ .......... . ............... ess ..... ~ .............................. : Phone NO ..................... Name of Contractor ~~ ............... Address ...~ ?~.~~O ..................... PLOT DIAGRAM Locate clearly and distinctly all 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. S , ~. f . ., .hl. N'otary Pubhc, Stare el New York Notary Public, (Signature of applicant) sTATE OF NEW rO, s s (Name of ind,vidual sign~g ~p~tion.~ above named. He is the ............ ~ ............................................................................................................ ' (Contractor, agent, corporate officer, etc.) of s~id owner or owners, nnd is duly authorized to perform or hSve performed the snid work and to make and file this application; that alt statements contained in this application ~re true to the best of his knowledge and belief; and that the work will be peFformed in the manner set forth in the application filed therewith. FOF~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~:xamined ............. ~:..~-~...~'..., 19..~.~. ^pproved ........... ~..'.~,~..~'~9.~.7~erm,t ~o ........... ~.?.~: Disapproved a/c ....... ~:;;~ ............... ~..~..__ ............ ~ .................. .................................................... ~,.~.. ............... ::. ............... ~:_.._.:~ ....... (Building Inspector) :-- ~ ^pp,ca,on No ......... ..~....~/.. .......... APPLICATION FOR i~UILDING PER/~IT 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 Bu'ilding Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises ava. Jlable 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 comp y with al app icab e ows, ord nonces and regular ohs. .......... (S.gnoture of applicant, or name,~c~6 corporc~i~i ......... ............. : "' ~Z~:~;;'~",::~'~ ...........'~ State whether ~pplic~nt is owner, levee, ~gent, ~rc~itect, engineer, general contractor, electrician, plumber or builder. ........................ ~~~:.: : ~ :~ ......................................... ~ .............................. o, o, .......... ................................... If ~pplic~nt is ~ corporate, signature of duly ~uthori~ed of(icer. (Name and title of corporate officer) "1. Location of land an which proposedwork will be done. Map.~o;,:~ -~.~.'~..,~-...~. Lot N~o.'..~.../~. Street and Numbe ..... ::.::~:~.:>~_,-. ...... : ......: ........... ~~..~~~ ~. ,.,e.de~ .~ ~.d o~p~.~ ..~::~:~.....:.:':Z.~~ ................................................. property lines. Give street and block numbers or description according to whether interior or corner lot. ,/ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Rej~3o~al .................... Demolition ......... .m ....... Ot. he~ Work (Describe) .................... 4. Estimoted Cost ............ .,.~..: ......................................... Fee ....... ,~....M..~ .................................................................. (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 .............................. ......,..~F-Jumber of Stories ...... ....... 8. Dimensions of entre new construction: Front .......... ____~. ............. Rear ........ . .'?ET...~. .......... Depth ............................ Height .......... /..~..... ......... Number of Stories ........./.. ..................... 9. Size of lot: Front ......./'(,~,~.........:~ ~,_~ar ......... ..~.~-.-..~....~.... Depth 10. Date of Purchase ............ ~...~....~?..'./..... ........................ Name of Former O.wne~r...../.. ................................................. 11. Zone or use district in which premises are situated ................... ~......./..~.~......~...'. ............................... 12. Does proposed construction~,~ ~' ~Z'~ ~.'~/~'~'~ ~.~, zf'~,~'./~-.~O~?te any z~,~_g~law, or,d~ ,~ce ~,~ .reg~otion? '" '~'~/~",'"'"'7~ .............................. 13. Name of Owner of premise~'Z-~f~z4~.~...'.-iT,~-~k~'~.../~~~z4~ne NO ..................... Name of Architect .............. ;~.....,..~ ........ .~ .............. Add e s ........ .~ ...... ~ ......................... Phone NO ..................... Name of Contractor~~.~~../.. .................. Address ,.~~?~~e O ..................... 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~.gi~j~/')~ S S ....................................... ~.~ .................... being duly sworn, deposes and says that he is the applicant above naName°f ndvidua s ~atio~(med_Heisithie,..~._.l.._i.~~ ............................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to per~orm or have performed the said work and to make and file this application; that all statements contained in this apRlication are true to the best of his knowledge and belief; and that the work will be performed in the manner set f~ ~ the application filed therewith. ~'o ~ Sworn to bef~ me this~ ~' ~ c ~ x ~ ~ ............. ....................