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HomeMy WebLinkAbout961-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCC:UPANC;Y THIS CERTIFIES that the, building located at~$~~9~"~t~e ~assau Fa~s_. , . ~e 43 Map No ......................... ~lac~ mo ......................... Lot No ................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated January 25 .~.~ which Building Permit No. D 961 ........................................................ , 19. .., pursuant to .......................... dated Januar~ 25 60 .................................................... ] 9 ........ , was ~ssued, ond conforms to oil of the requirements o~ the opp[~cob[e provisions of the Jaw. The occuponcy {or which this certJ}Jcote is issued is ................ PR~ATE O~ F~ILY ~LLING This cert]ficote is issued to J' & Elizabe~ Franz, o~ers (owner, lessee or tenant) of the aforesaid building. Building Inspector HOWARD M. TERRY, 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? 961 Z Dote .................... ~e,~.'....~ ................ 19.f~..... Permission is hereby granted to: ~e~ ~..~z~ ....... ~/0....Z,..~.~ ................................ ................. 0.~, ~....~.~ ~ .............. at premises located at~[.#,.~.,,~S~.~ .......................................................................... ....................................... 2~e..T~ee~ .~**.~ ~e ~. ~ =T, .................................... pursuant to application dated ..............: .............. ~....~ ............ 1~....., and approved by the Building Inspector ?'5 FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK~ OFFICE SOUTHOLD, N. Y. Examined ~7~4c~.~7 1 .~....O... Approved .~;~-'~.~.~..~, 19~?...O..Permit No ...... :...~.....~.~./. ......... Disapproved a/c ............................... Application No.....~...~../. ............... (Building Inspector) 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 covered by this application may not be commenced before issuar~e 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 ava.liable 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. (Signature of applicant, or name, if a corporation) (Addre, ss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (Name and title of corporate officer) t. Location of land on which proposed work will be done. Map No: ../..~4..c,.~ff~'~ ~- ..........~'/.;: Lot No' Street and Number ...U.~<~¥.'.~.~......:~..~ ~:' ~.,~:>;';:'. : .:~:~:~: ...... ~...':: ................ Municipali~ ~ 2. State existino use ~nd occuponcy o{ premises ond intended use and occuponcy of ~roposed construction: a. Existing use and occupancy ..... ,~,,~,,.~.,:..~-,,.::,~..,,. ............................................................................................ b. Intendod use ond occuponcy .....................[.~ ................... ~:~......~.?: ~.~ .............................................. 3. Nature of work (check which applicable): New Buildin~l .................... Addition ....... .[_....:....Alteration .................... Repair .................... Removal .................... Demolition .......... ~, ....... Other Work (Describe) .................... 4. Estimated Cost ..... : ...................................................... Fee .......................................................................................... (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 .......... /.....-5 Height .......................... l' Number of Stories....,?..i...- .................. 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Na~,e of Fo,~.er (~wner ........................................................ 1 1. Zone or use d~stnct m wMch premises are s~tuated ........... 3 ........................................................................................ 12. Does proposed construction vic~t?te anyf~ning law, ordinance or regulation? ........................................................ 13. Name of Owner of prem~ses.f~t ............ ~.;2.::...:..~...Address .......................................... Phone NO Name of Architect , . ....................... Address .......................................... Phone NO. ...... ~.~* ....... / ', .............................. .... 3 ....... :.'~ i:::: .~.~.:;:: :..':.*.: ................. Address .......................................... Phone NO ..................... Name of Contractor PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail 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 corne, r lot. STATE OF NEV~,"OR, K,' /} ,~,,. ) ~ q COUNTY OF ...~.vt :~'? ~':~'') ~ ( ................................. ~'~-~':::~..;:?.'...L.X.:.?~::........' ................ being duly sworn, deposes and soys that he is the applicant (Name of ~d~J~ual signing a~lication) ....................... ....................................................................................... (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 opplication; 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 this .~ Jul)ITl{ ¥ ~lq~<!.~ .............. ~. day of ........ f...[.~ .................. .~,...~,~s~'~,~ !,~ct~ ao. too Notary Public, r~ ~(Signature of applicant) FOEM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined~..::l 9..~. ~' Approved ~....~. '.~2-¢..., 19..~..~.Permit No ....... .~.....~:.~'.i .~..i .... Disapproved a/c ....................................................................... :. .......... .<..~...~ r~c~.~r..~..... ~..,fL.. ,...,~?.. ~ .... (Building Inspector) 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 premises, relationship to adjoining premises or public streets or areas, and giving o 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 ava.ilable 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 rathe 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 a Iapp icab e laws, ordinances and regulations. ........ ........ ....................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................................. < ~.c:.:..~ -?,:~. ..................................................................................................... Name of owner of premises ....... ~.~..~.::~....~..~/~ ..~... ........................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate, officer) //j//~c:~. .~.'.~.~'~3 ..~. ?.. l. Location of land on which proposed wor,~ w. ill b~e done. ~ap No: ~?'.'...~.. ..... Lot No: .............. (_..... Street and Number ........................................................................ Municipality ~ State existing use and occupancy of p~mises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~..~. ..................................................................................... '""~'"7 ~. u e cc p cy ............................................. 7~ ......................... -r..,~. ................................................ 3. Nature of work (check which applicable): New Building .................... Addition ....... ..~.....~......Alteration .................... Repair .................... Removal .................... Demolition .......... ~ ........ Other Work (Describe) .................... 4. Estimated Cost ......~.....0...?...?.....~.~.. ................................. Fee .....'~'.. ................................................................................... (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 ......... J.....-~'.. ........... Rear ..... ./...~..~. .............. Depth ...~..~.....~.. ............... Height ............................ Number of Stories....~ ........... 9. Size of lot: Front ......... '~]...~.....i ....... Rear .............. [ ............. Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction vi(~ate anyr, z.~3ing law, ordinance or regulation? ........................................................ 13. Name of Owner of premises.f~ ............ ~...'~..~....Address .......................................... Phone NO ..................... Name of Architect ................................. "'~' '~'~J i ................ Address .......................................... Phone NO ..................... Name of Contractor ..~F....I..~ .................. 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~.d/-,YOI~ ~} I,- ) S S ................................ [/.~..~..l..~~ ................ beino du~y swom~ deposes ond s~ys that he is the opplicon~ (Nam~ infO,ual signing a~lication), above homed. He ,s~ ....................... ~~:...., ................................................................................. (Controctor, agent, corporote officer, etc.) of sold owner or owners, ond is duly authorized to perform or hove performed the said work ond to make ond file this appiicotion; that all statements contained in this opplicotion are true to the best of his knowledge ond belief; and that the work will be performed in the manner set forth in the applicotion filed therewith. Sworn to before me this ~ ~o a~ ~tl~[~ S~~teB~K~w York ~ ~ ~ ~.~ I'~[ 52.03449~3, Suflotk Cmmty l/ ~ ~