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HomeMy WebLinkAbout592-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..~..~/+~ ............ Date ............................. ~...~ ................. , lc~..~. .... THIS CERTIFIES that the building located ot.J~/~..S:~Be..O~l,8...,T~'Le..~[~lle ....................... Stree~t Map No .......~ac~c. ........... Block No .......... ~',~t ......... Lot No..:ac....J~.t,~,i~l~ok.~....N~Y~ ........................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................... ~.:~e~...~ ........ ~ 195~1...., pursuant to which Building Permit No....Z.§.9~, ................ dated ................................ .J~r¢~......;3..., 19..fi.9.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .............. ................. P.~.~,~te..o~e..~:~,m:Ll~'..~well&~ ......................................................................................... This certificate is issued to ...j~6.t,~,~Lc~,.J..~['~',C~r .............. ~ne~) ....................................................... (owner, lessee or tenant) of the aforesaid building. TOWN OF ~OUTHOI D TOWN ¢IERIC$ OFFI¢£ SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 592 Z 1 ~..~. .... Date .......................... r~ ............................. Permission is hereby granted to: s%~z~y ~. s,,~f~..t..k...~~..~....~/~....~..~.ff.~Fy Shirley, L.I. Build ne~ dwe!li~g M~reh 2 1959 , pursuant to application dated ........................................................................ and approved by the Building Inspector 10.00 Fee $ ........................ I~uilding Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam i ned.. :i:.~. ·.: .c.~ .'C..~... ;.~'.'.~:.: ...... 19..?...~.. Approved ........................................ 19 ........ Permit No.....,':~,,'...~....Z...~T:.... Disapproved a/c .............................................................................................. Application No ..........~.....?...~ .... (Building Inspector) APPLICATION FOR BUILDING PERMIT ................................................. ..: ............ 19...'¢...f.... 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 drown 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 bui,lding 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 Department for the issuanc.e of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other oppllcoble Lows, Ordinances or Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applic.able laws, ordinances and regula~ons. J Add res~'~"~l~'iic~')' ........................... State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. ............................................................................................................................... ............ u..,.:,?, ........................................................................ If applicant is a corporate, ~g~j~nature of duly aut,~f~orized officer. 0 ,. ~' (l~me and title of corporate officer) Ion onwh.ch ro osedworkw, ibedone Ma No ~)'~'~'~'~ LotNo 1. Location of d ' P P ~ '~ ~-x ';, p : .?.~) ............ ~]...?e../.....' ........ .. : .................... Street and Number ....,..'.r...;: ........... ~,.,:.~ .......... /..t..:..:..,: ............. ~..~ ............................................................................ Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: ....... o. Existing use and occupancy .................................................................................................................................. b. Intended use and occupancy ................. .~..'....~.~.~:f~~'~ .............................................................................. 3. Nature of wot Repa i r ....... 4. Estimated C~s' 5. ('~heck ~hich applicable): New Building ....... ..~.. ......... Addition .................... Alteration .................... ...... Rem0va .................... Demolition .................... Other Work (Describe) .................... L.~.:~. ~.~.. ........................................ Fee ...L,0..~ .......................................................................... ,~ (to be paid on filing this application) If dwelling, fiumber 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 ......... ~...~..i' ......... Rear ......... ,~.Z ........... Depth ......~...~..i ............... Height ............................ Number of Stories ...... ~.~i ........ 9. Size of lot: Front ....... /....o[.~.0. ........... Rear ......... .?...:~.~. ........ Depth ....../.,Rf..:?.~......~i ..... 10. Date of Purchase ....'~.~k..~.L....~.....~i ............................. Name of Former Owner .... .~Z..".....~2;~..~2.~.7.'Z~.~ ..................... proposed construction violate any zoning law, ordinance or r~gulation? .......... ~?. ................................. 12. Does 13. Name of Owner of premises..~.c.~..~:.......~i .~...~-/.~.. .......... Address NO ..................... Name of Architect....-~C;~:;;b..~.'...?;m.....E.~L~:: ............Address ....... 'L.';';.....~.::~, .................... Phone NO ..................... Nome of Contractor.~?.~;.-;.:~!1;:..!".~./.....;!~.~.~;:¥:.!.: .......... Address ......... :.: ................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from properly lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEV~¥..~.,~,~(~ ) S S. COUNTY OF ...,~)Cff.~.~: ....... ) .................................................................................................~ being duly sworn, deposes ~nd s~ys t~t he is the ~pplic~nt (Name of individual signina~pplicatiQn) ...... . ..... above named. ~e Is the ....................... ~m ......... ; ............................................................................................................. (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 ~ the best of his know, ge and belief; and that the work will be performed in the manner set forth in the appli~ filed therewith. ~/ Sworn to before me this ~ ~01~ ~Ow~- "~~ ~j / ~~ ~ · -/0, '~ ty . '"' ? ~ ' ,, ,. ~7a~0 AppJJcation No ......... .~.. · ...?.. · ..~....... (Building Inspector) 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.adioining 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 p art for any purpose whatever until o Certificat,e of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe 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 applicrable laws, ordinances and regula,~ons. ~ _ (S~nat~ of ~pl/SJicant, or hartke, if a corporation) ........... ............ C ddress of ogplicant) 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, 9j~lnature of duly aut~rized of ic . ~ 7 (,~me and title of corporate officer) Ma No c>(~ Lot No "'~ Location of land on which proposed work wiU be done. p : ..~,~......¢'..,'..-........... : .................... 1. Street and Number ...~....~.. ......... ~..Z..~......~....-~........' .......... ~ ................................................... '/' ~ Municipality 2. State existing use and occupancy bf premises and intended use and occupancy of proposed construction: a. Existing use and occupancy...'.i....;..~,.i....-~..O.~..~../. ................................................................................. b. Intended use and occupancY......' .......... k). --¢@-~.... ................ "~ .............................................................................. 3. Nature of work (check which applicable): New Building ........... ~.........Addltlon .................... Alteration .................... Repair .................... Removal .................... Demolitlon .................... Other Work (Describe) .................... .......................................................................... 4. Estimated Cost..i..,~..~..-...=.... ......................................... Fee (to be paid on filing this application) it ~ r 5. If dwelling, number oF dwelling un s ................................ Numbe 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 ......... ..b~...~.. ........... Depth .., ..~....'. ............... Height ............................ Number of Stories ~ 9. Size of lot: Front ....... C....~... ........... Rear ......... ...c,~....~.'~. ......... Depth i...,,/...~...'~'........~. ..... 10. Date of Purchase ...~.....:~.....~.. ............................ Name of Former Owner ......~...r....~~ .................... 11. Zone or use district in which premises are situated ............................................................................................ 12. Does proposed construction violate any zoning law, ordinance or r~gulation? ......... ~ .................................. 13. Name of Owner of premises..~.~....~ .......... Address ..~....~....'~.....%~......~..C(.1..~....Phone NO ..................... Na me of Arc h itect....~....~.....c:~.........~.....~...' ' i .......... 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 YV~.~(,.,~_ ) S S COUNTY OF .~ ....... ) ' .............................. 1' .................................................................. being duly sworn, deposes .and soys that he is the applicant (Name of individual signing~gpplicati~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 this application are true ~ the best of his know,ge and belief; and that thef work will be performed in the m,ann~r set f6rth in the appl~il~d therewith. Sworn to be ore me this ............. ~ ........ uuy u~ ............ ~...~ ................... j. ~ ,- ~.~ ~,? ,~ .~~' ,~ ..... ~ ....... ch 30, I~ o,/