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HomeMy WebLinkAbout1026-zFOiP~-~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...... Z...9.~. ..... Date ........................ l~o.~.embe.~...... ~ ...., 19-60 THIS CERTIFIES that the building located Street al ~a~...AVe .& ..Ba.~. t.e¥.-.Rd ..................... _Map No. XX/~X ............ Block No.....yJ.J~.....Lot No. ~ ....... F~tt.~.tuak~..-..l~..t% ....................... conforms subs~sntially to the Application for Building Permit heretofore filed in this office dated ............Ap~.I~L ..........6 ......... 19.6.0.. pursuant to whici% Building Permit No ..... 2;..1~6 .... 4areal ................. A~.~.i .......... (~...., 19..6.0, 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 ........ ]~r]..v.a.~ ~.. c ne,, ,£ami~.. c~e 1.1.in~ ................................................................................................ This certiflcale is issued to ..Zi.gmund......l~lesk.i ............. Swne~ ................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FOI~M NO. 2 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? lO26 Z Date ...................... ~,p~.'l,~ ....... 6 .............. 19~O... Permission is hereby granted to: Zt§mtmc~.....P~lesk~, .......................................... ...... ~s~...A.v.e ......................................................... .............. ~a.tt~tu~k.,.....l~,~. ............................ to ...... ~u~.~,cL .~,d ~.~,.o.m .o.m .fro ...e~.t;,~g .. ~.~g .......................................... [ ....... at premises located at .~.~y...~,.~.~....~..~f~'.t~,l-.e~,,.~.O.~l. ...................................................................... .......................................... ~t,.t~,C,u~ r....~,~ ...................................................... ' ........... [ ...... ~ ....... pursuant to application dated ........ ................... ,~.]~,l~.~ ....... 6 ...............Ig.~0k., and opprov'ed by the Building Inspector Fee $..~.,~0.O ............ ........ .r.,~..~ ........... Building Inspect~?~ ~l FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... '~~ .......~..~., 19...~.~ ~ Approved ............ .~.~..., 1 .~.~,.(9..Permit No ......... ~ .................... Disapproved a/c ....... ~.. ..................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............... ........... , 19.~..°... V 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 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 MADI~ 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 w th all appl cable laws, ordinances and regulations. (Signature of applicant, or name, if a corporatien) ..... / (Address of applicbnt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................ ........................................................................................................................... Name of owner of premises....C~..'[~~..~.. '.(~.~~ ............................................................................. 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: ..... .~.......~..........z~..........7~. ....... Lot No:..2%.....ff~-~ ........ Street and Number .....~.//~...../..~....~7......(~.~..~.~ ........ ~.....~..~.q..~.......~..C.~..~.....~.~,:...~..k.~.~. ...... / Municipality 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 tk ~t 3. Nature of work (check which applicable): New Building .................... Addition ....... ~...~,.....Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ..~..©0 ~ Fee ,,~(~s~3 (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. D mens ans of ent 'e new construct on' Front Rear Depth Height ............................ Number of Stories.,..~;~S .......... 9. Size of lot: Front ......,/.,.~,~ ........... Rear ........ /.~..q ............ Depth ./...~...~./..,.~.'../.~....'~. ..... 10. Date of Purchase .................. /...(.....~....~ ................. Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ............. ~.: ................................................................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ........................................................ 13. Name of Owner of premises....~..' .~.....~. ..~.,.~...~Address ~.....~'.~-~......q~...~... Phone NO. Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor .~..;(~..~.~.~..(J~..~.'.....~...~..' ............ Address .......... I.~ .......... :'. .................. Phone NO PLOT DIAGRAM Locate clearly and distinctly ail 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. __ I )~0~ STATE OF NE~OJ~I/: /) ~,) S S aP · ' ...................... ...~...~./~...'f~....../'...~..'../~....~C....,~...~.../.: ...................... being duly swam, deposes and says that he is the applicant (Name of individual sioning application) ~ above named. He is the ........... .~..~...~.....;.~.~ .................................................................................... (Contractor, agent, corporate, officer, etc.) of said owner or owners, and is duly authorized to perform or hov,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 Jn the application filed therewith. JUDITtl r, B01(EI~ Sworn to before me this N'ot~ry Jlu[)llc, State oF Now Yolk ....................................................... - of Notary Pub~;,~~~Z.. C~ (Signature of applicant) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLER,'S O,ICE SOUTHOLD. N. ¥. ......... ...... Dis~pprovod ~/c .............. ~~ ................................... ............................. ,) .............. 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 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 Buiiding 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 comp y w th all applicable laws, ordinances and regu orions. .................................. ./. 7. /.. .( ........................................ (Signature of applicant, or name, if o corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................... ~'.~... ~ .6~'~:~%~=:.: .......................................................................................................................... Nome of owner of premises ..... ,,,~ ....... ,~ ............................................................................. 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: ...... ,2(x......~......;K, ....... ~. ....... Lot No:..~...~:; ....... Street and Number ..~..~..~........~;~/......~.~,, ..........,~......~..~. ,;~;.~i..~. ....... '~.~,:.':~'z~u~':.'"~'_'... / Municipality · 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .~..~?,~.~ ...... I~ .................................................................... b. Intended use and occupancy .............. *.k ................. : ............................................................................ 3. Nature of work (check which applicable): New Building .................... Addition ........ Y~..~,~...Alteratior~ .................... Repair .................... 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 ................................ 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 ...... ,~....~....~..~...~: Depth ./..~..'./....~..~ .......... Height ............................ Number of Stories....~ .......... 10. Date of Purchase ................../...c~...~,~.~...~ ................. Name of Former Owner ........................................................ 11, Zone or use district in which premises are situated ............. ~L..~i ................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ........................................................ 13. Name of Owner of premises... ~.~...(.~.-~.~.~:~:.~.~ddress ...... /~7~.::./.£ .... ~.~m~... ..... Phone NO ..................... Name of Architect ....................... J.'. .......................... Address .......................................... Phone NO ..................... Name of Contractor .~-~O.m~....~..(J~4.~:~.'~;..~.. ............ Address .......... 2 ........... ' ................... Phone NO PLOT DIAGRAM Locate clearly and distinctly ail 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 come. r lot. STATE OF NEW<,~O~,t/ l) J ) S S COUNTY OF ....'~.R~'j~r~.~..~...~f....) ' ' ...................... /~.4.~...//.: .~..~.../.~.~.~/.'./.F?.~.r-~., ........................ being duly sworn, deposes and says that he is the applicant (Name of individual sig~J,ng application) above named. He is the ........... t~...~;.-..';....:..' ......... Z ............... :..;....: ....................................................................................... (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 application filed therewith. / JUDITH T. BOI(EN Sworn to before me this ~'~ta~ Public, State ef New York No, 52-0344963, Suffolk County , ~ Oomrrs~ £~p~ree March $0, .................. day of ............. ........... ..... Notary Pub h c, .~.¢~ ~. ...... ~...~'~ .':X4;;2,g;~ ,'... (Signature of opplieant)