HomeMy WebLinkAbout1034-z~0~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF'OCCUPANCY
THIS CERTIFIES that the building located a~ ..]~..~ais.e,~:~...l]o.ad ............................... Street
Na au Point Prop ~ ~
Map No ....................... Block No. ~....:E.-..~. .......... Lot No. ~7.8 .......... G. tch~.ue~....,.l~...Z. ....................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............... .A..I~.~.j,.J,......~,~I, ......... 19.6.0.. pursuant to which Building Permit No..Jg~0~l!~ .........
~lated ....................... Apr. l~l,.....;~g.., 19..60., 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.~..~.-.V. ?~..t ~...~e,...f. amt~.y.., dw.~, l~t~.~ ...........................................................................................
This certificale is issued to ....V. iiq¢o~t5 ..Jo~lq..~OEt .............. (.o~l~lor'} ........................................ ; .......
(owner, lessee or tenant)
of the aforesaid building.
FOI%M NO. 2
TOWH OF $OUTHOILD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS F~/:RMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? lo34 Z
~ate ............................ i~fZ.....~ ........ ~.P.. ....
Permission is hereby gronted to:
~tme~t...~,o~ ................................................
..... ~.2,...¢atB~'a~..~-~e ..................................
............. ~e~. ~e..~. ~ .....~.~.~ ................................
to ..... f~en~e~.t;...p~i'~te...g~, age...int~ ..l~i~z~te...~.s~,.~.e~ .e.. ..........................................
at premises located at ~¢l~..~...,.~_~.....~/,~......~.~.....~..~.,~.e.~.....~...o..~..~.. .................................................
........................ : ...... ~a~sa~..~.pt~ ........ ~cheg~e~.... · ~,* ~, ....................................................
pursuant to application dated ........................... ~]b ......... ].~ .......... 19~0.,., and approved by the
Building Inspector
· ~ ~ .... BE~'ding Inspector
FORM
TOWN OF SOUTHOLD
BUILDING D£PAR'rMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
~ 19 ........ Permit No ................................
Approved .................................... ,
Disappraved a/c .................../.~ .............. /.. .................................. ,.. ......
( Building I nj/dp ecto r)
APPLICATION FOI~ BU|/DING PERMIT
Application No ...... i..~...~....Y. ..........
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 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. .tim, ..........
APPLICATION IS HEREBY MADE to the Building Department for the issua,nce 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.
......... .........
(Address of applicant) / ~,
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.................... c.~. ~../.~ ~.,.X .....................................................................................................................................................
Name of owner of p '~
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate, officer) ~f~ ¢~ .'0 ~ ~ ~' ~
1. Location oF land on which proposed work will b~e done. Map No: .~J/.fbL4.~,.~...~.~P. ll?.l'.......~.~(. Lot No:~.~.~ ........
, ~J ~....~..~"', 1
Street and Number .,.,..~t.~..Z~.,.~S:......~.~.~ ............... : .............. : ....... .........................................
Munic(pality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. ~"'~'~ ....... nd o",'u,',anc,,,/'~ 4~_~Z ~ (¢. .~?,~.~.-~..~.~,C. /'~'~'~ .//~..¢~!4/ D-~/--c~_.~z~'4.~/~
b. Intended use a~occupa~y~e.~/ ........ ~...~,..~...~.,~.~ ........ ~....[~...~.~....~,~.~ ................
3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration.,.,~ ......
Repair ......... .~ ...... Removal .................... Demolition ...... i ............. Other Work (Describe) ....................
4. Estimated Cost/zT.~?'..,...~..<) ......................................... Fee ...... ~.(~.).'.~ ............................................................................
~/b,>.~¥~'c~ (to be paid on filing this application)
5. If dwelling~ number of dwelling units.w....~ ....... 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 ....... .~.F7 ............. Depth ..~..~ ......................
Height ...... ~..~.~..[~ .....Number of Stories ....~ .......................................................................................................
Dimensions of same structure with alterations or additions: Front ..... ~ o ~ Rear ~,
Depth .......... ~.~/.../. ......... Height ......Z.~.~ .............Number of Stories ..Z'. ..........................
8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................
Height ............................ Number of Stories ................................
9. Size of lot: Front ...... /.~.4..(. .......... Rear ,,,,~,~,~ ................ Depth ...~..~.F/ ..............
10. Date of Purchase ~.~ .......... ~.~ ..............Name of Former Owner~.~.~.~.~.~ ....... ~.~.q..~C .........
11. Zone or use district in which premises ~re situated ............ ~.~ ........ ~(K..~ .......................................
12, Does propo~d construction violate any zoning law, ordinance or regulation? .... ~ ...........................................
13. Name of ~ner 6~premises .......... ~.fi.~.¢.~.z~ .......... Address ~er~.~.e~.~).~..~ ..... Phone
Name of Architect (7'"; ..............'~"T ........... ; .......... Address/.~.~.~.~.~.~,...~.. Phone NO~,/x / ,, ................
PLOT DIAGRAM
Locate cieady and distinctly oil 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 corne, r lot.
STATE pF NEW,Yg K /) o. ~. / [ ~ ~,,~
..~~~ ....................................... being duly sworn, deposes and says that he is the applicant
(Nominal s~i:3 application)
(Controctor, ~ent~ corporate officer, etc.)
of soid owner or owners, ond is duly outhorized to perform or h,ye performed the s~id work ~nd to moke ~nd file
this ~ppHcotion~ ~h~t oH statements contoined }n this opplicotion ore true to the host of his knowled~o ~nd
ond thor the work will be performed in the monner set forth in the opplic~Hon filed thomwith.
Sworn to before me this
DOROTHY M, DOF'F~'~
day x)f .... ,.%2~.,~..~d,.r.-. ....................... 19. ~.~162~
Notary Public, ..,.~~.~ ,LCZ.~m ~h ~, ~
........... ............ ........ '
(Signature of applicant)
FORM NO. 1
Examined ......."'"'(1'":' .............
Approved ....................................
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N, Y.
19 ........ Permit No .................................
Application No .......1...O....~... [t ..........
Disapproved a/c ............... /....?....,.,~ .........
..................................................................... : _, ................................
............... /, .:,~:, .~ ...... -./ ,: :,, :., r, ,C':.-: .'T,~ ...................................
(Building In~ector)
APPLICATION FOR BUILDING PERMIT
Date ................... ~..~:~.C~ff~ ~ .......... .X~.4., 19...~.~.~..
INSTRUCTIONS
o. 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 available for inspection throughout the progress of the work,
e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy
shall hove been granted by the Building Inspector. ,lh,,i ''' .......
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 ~'plicant, or name, if a corporation)
' : [ (Address of'~'~'l'i'~) ...........
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................. ~.. b~). :~..~.. ~ ...........................................................................................................................................
Name of owner of premises ..... ~.~.~.~.~,x~. .... ~....~.~.~.~ .~.~..~.[....,~..~.....::~t ~:2.(~
If applicant is a corporate, signature of duly authorized officer.
(Nome and title of corporate officer)
i. Location of land on which proposed work will be done. Map No: .:t:L.~.g.../q. ........................... Lot No'~.,y.~. ..........
Street and Number ..].~.~.~.~j.~,.~..e..;r..~, ....... ~.o..~.~..) ............. ~.~:~'J:~.,~ ...... ~.~..I~./Y..?.,. .............................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
3. Nature of work (check which applicable): New Building .................... Addition .................... AIteration..,,,..~......,.,.,,
Repair .................... Removal .................... Demolition ......... i .......... Other Work (Describe) ....................
/^
4.
Estimated
Co s t w./.:~./~.. O ,...(2 .~. ...................................... Fee ..... /..?..' ..............................................................................
/
, .'7 tco~-~ (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 ...... _~..0. ............... Rear ......... ,2~.f/...!. ....... Depth ....~2..~. ..................
Height .../..~.. ................... Number of Stories ........... .~. .............................................................
Dimensions of same structure with alterations or additions: Front ........... e..~.Y...d....: ........ Rear .....~......d...~ ................
Depth ......... .,2L..~.. ............. Height ................................ Number of Stories ..........~ ...................
8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................
Height ............................ Number of Stories ................................
9. Size of lot: Front ............ ./.,~...L'. ...... Rear ........ ./.q...~ .......... Depth ....m~..~....~.. ............
10. Date of Purchase ...~.,¢.-~,,~.~z,~'v~...,/..~..-~z~...~. ........ Name of Former Ow~ner/~.~.~.C.c../~'.~..~.......('...~:~'
11. Zone or use district-- --in which premises ar'e situated ....... ./.~.'~.,,rj,.~..f~. ...... .zf~'l.:zy...~. .......... ~t_)~ .........................................
12. Does preposerJ construction violate any zoning law, ordinance or regulation? ........ ,4./...(2. ........................................
13. Name of Owner of pre/,1~ ~'~'"'"~'"~'"'"-'..~..7~ddress ~.~.~.~..~..~.~g /'"'"'"'
Name of Architect .................................................... Address ......................................... Phone NO .....................
.... L.~.././~. ?..~.'~ ................... Phone ....................
Name of Contractor ~4~.~L¢.z.~.~.....~..'.~.~l~.q../~.. ...... Address /.w
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 la <:
STATE OF NEWV zY,,~R_KR~K ) S S Lo/~ 75/'~/~/'gp/~/~,~r
COUNTY
OY
.,.1' .)~~._.~_.._.~_. ' ' ''"-'- '' '~ ~' '
............ U~..~.~~:..z.: ................ being duly sworn, deposes and says that he is the applicant
above naName°f hdV dual/si~o~n~ ap~ica~on)~(med_Heisithiei._....:.....:~.:~ .......................................................................................................
(Contractor, agent, corporate off~cer, 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.
Sworn to before me this /'~ /- ' ff UUHqTH)f~M DOPFEI~
.......... - _ , C c;,ff bc.z. of
d r .................................... N~wY~IJ
Notary Public, ...~L~..:.. ' ~ ~
(Signature of applicant)