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HomeMy WebLinkAbout765-zFOR~ NOo 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...~./e car, PAne Neck Rtl, & oa~l&wn Avenue ~.~.~ i.~[ ;...r~ ~ · · ¥~Z~J~ .................... Street Map No. *we Block No. **w Lot No. ww* conforms substantially to the Application for Building Permit heretofore filed in this office doted July 13 59 z 765 ........................................................ , 19 ........ , pursu,ant to which Building Permit No ............................ dated ................. JtZl~...l~ .................... lC).....~)wais issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ................ ~RIVAT~ ONE FAMILY D WELLING This certificate is issued to ......~.~.e.A...&,....~.[,b.e..~.,~..~..~..°.A.a.~.~..°...~...~.,°.!....o ."~...e.~ .............................. (owner, lessee or tenant) of the aforesaid building. Building Inspector' ~ ........... FOI~i~I NO. 2 TOWN OF SGUYHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS I~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 765 Z Permission is hereby granted to: Alber.%..Pa~a~tor~g ............................................... Pi~e Neek& Oak~awn Ave ....................................... ~.o.~..~.~ .o..!~,.....~...~:. ....... to .~tl¢..~...~i.~..t..o~..f....e.~.~..z..o.~.e...~r.e.~.e.~.)..~.~...~.~.~ ..~.e.~ .............................. at premises located at S/.S Pi~ nN~k R~..~ ~.8 .~k~4%RJ~ ..~.~ ....................... .............................................. ~mthc~.,.. N.,~., ......................................................... pursuant to application dated .................................. ~'1~ ........ ~ .......... 19.~..., and approved by the Building Inspector Fee $..5~00 .............. FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............. ~.../.'~.., 19.~ .~.. Approved ........... ~...../.~., 19.~...Permit No .......... ..~.....~....~..~... Disapproved a/c ........................... ~zz:~.~.~.~ ........................................... ~-,/ / (Building Inspector) Application No ........~...~...~....~.. ......... APPLICATION FOR IBUiLDIHG PERMIT Date ................... .,..~.~6/~...../~,.~. ~.., 19.:~...~~ 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 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 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 w th a Iapp cab e laws, ord nonces and regulations. .... .................... (Signature of applicant, or name, it a corporation) (Address of apl~licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................... ............................................................................................................... N a me of owner of pre mis es......~./~..~....~.. ~.~.~.~.~..?f~ ~.~..~.~¢'~..~'.-~ ~ ............................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate, officer) 1. Location of land on which proposed work will be done. Map No: ........................ '.'.'~i~'i ............. Lot No ..:~. ......... Municipality ~.~_~ ~. d..~ -~'~'~'~-z"~-~ 2.State existing use and occupancy of premi~s/~s]and intended ~?se and occupancy of proposed construction: a Existinfl use and occupancy ~~ b~ Intended use and occupancy; ;; ...~~.~-.~___~.~_~...~~..~c~~.~~ 3. Nature of work (check which applicable): New Building .................... Addition ........ ~.Alteration ......... Repair .................... R,~.moval .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ......... .~.'~..~...: ................................... Fee .......... ~.~..,,,..: .................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..............C'~ ......... 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 ........ ../... ............................................................................................... Dimeh§ions of some structure with olterotions or odditions: Front .................. Reor ....¥.~...~.~.. ................ Depth .......... ~..~ ~?. Heiflht ............................. F_~'~umber of Stories ........... ~" .................... 8. Dimensions of entire new construction: Front ............ /Z...... ........ Rear ............... .~... ........ Depth ........ ~ ............ Height ............................/~z-,,'qNumber of Stories ......... ~....~!...~/~ ..................... . ../. '.(~..' 9. Size of lot: Front ......... ./..~../,z'. ...... Rear .......... Depth ................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ......................... ~......., ./....~'..~..-~.'..Z.~..~ ................................ 12. Does proposed construction violet~ any ~zogLng law, o,rdina, nce or reggJ~ation? ~...~...(--n(~....7 ..................................... 13. Nome of Owner of premises~~'~'~s ....~.. Phone NO ..................... Name of Architect ..................................' .................. Address .......................................... Phone NO ..................... Name of Contractor ........................................... ~.....Address .......................................... Phone NO ..................... P.LOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, property lines. Give street and block numt ,~rs or description according to whether interior or corner lot. ~dicate all set-back dimensions from show street and indicate STATE OF ' COUNTY OF ...)~~:' ' ........................... ~~..~~.....being duly sworn, deposes and says that he is the applicant (Name aT individual si~lnj~gg application) above name~e 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 performed Jn the manner set forth in th~plicotion filed therewith. Sworn to before ~e this L:"~, ,Z~" /" FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ........... ^pp,,cat,onNo ....... ....... ^pp=ed .......... No ............ · a/c ~" ('/'//'~"~-"'~/ ........ · ~:'-" .................... '/' ............. ':-'>" '/"'::'rq ................. Disapproved ........... -. APPLI~ATIO~ FOR BUILDIN~ P£R~IT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. .t , 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 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. ' t>~gnarure or applicanT, or name, IT a corporarlonl (Address of ap~icant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................................... 6~.:.~.'~.c~<~ ................................................................................................................ Name of owner of prem.ses ...... ~.?..~K4;~Z=P:.'....~'T....,~.t.~&~;.z~.~,~e,a~,~.0 ............................ : ................. 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. Map No: ' r ..... Lot No:..~; ................. 2. State existing use and occupancy of premises and 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 .................... Addition ........ ~..Alteration .......... ..,,~....... Repair ....... i., .......... Removal~,~ ..~- .................... Demolition .................... Other 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 ....,~n~.~. ............. Height ............................ Number of Stories ........ .j.. ............................................................................................... Dimensions of same structure with alterations or additions: Front .......... Rear .......... .~..~.. Height ............................. ~'~Number of Stories ............ ~: ................... Depth 8. Dimensions of entire new construction: Front ............ /,4'...... ........ Rear ............... .,~.. ....... Depth ........ L.... ............ Height ............................ Number of Stories ......... /. ..................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use d,str,ct ,n which prem,ses are s,tuated ......................... .~.......~/.~.::'...~.~.~ 12. Does proposed construction vlolqte,_any/..//./~ '/.4'2 ~' z--/-~ ' .zonj,ng ~a?, oj~dina, nce or regu~ption? ~'.....¢;'~.~'~v~ ........................................ Name of Architect .................................................... Address .......................................... Phone NO..; .................. Name of Contractor ............................................ .~......Address .......................................... Phone NO ..................... PLOT DIAGRAM L.acote clearly and distinctly all buildings, whether existing ar proposed, property lines. Give street and block numb.~rs or description according to de whether interior or corner lot. ~./~ nd iqdicate ali set-back dimensions from ~.~ show street narres and indicate STATE OF NEW Y~R.I~, ~'i~ ;~' s COUNTY OF ~~-'~._~¥~/,~ ~-/~ ~ ~"~ ~' ...................... :..~~~~.....being duly sworn, deposes ond soys ~hot h, is the opplicont (Nome ~ ~dividual ~n~g application) , above home,He is the ........... ~~ .................................................................................................................. (Contractor, agent, corporate, officer, etc.) of said owner or owners, and is duly authorized to perform or hav.e 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 filed therewith. Sworn to before me th~s ,, / ..... , /;- , {~-,,~, ~ ( Notary Public~..~¢.~~ ..... ~~ ~t~~ or appucanb