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HomeMy WebLinkAbout1043-zFO, I~iV~ N,O. 4 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLEI~K'S OFFICE SOUTHOLD, 1~, Y, C~-RTIF~CATE OF OCCUPANCY conforms substantially to the Application for Building Pm-mit heretofore flied in this office ' ~ April 22 19.6.~...., 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 Ephraim C~O~S~ owner This certificale is issued to (owner, lessee or tenant) of the aforesaid building. FORI~ 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? 1043 Z. Dete .......................... Ap~'tl.....~ .......... I~.Q .... Permission is hereby granted to: Bake~...6:.. ~,tekels s.e~%.... ~/.G...F~i~b/'~I~%..C~,os s ....... ~o~;ho.lJl ....... ~I. ~ ......................... ........... to ...B~.I~.. eh* .-ad~i.~t'o~.. on...tm..e~ting...~]~e.1..~i.r~g ....................................................... at premises located at ..,..~o~;..~.,.~Cl.....~.eeoll&~...Bo~..,.~.~a.to~ ................................................. ...................................... ~.a~.eho~e.. ;e;~;1 s.....g~aenpoz, t~......~..~T. ................................. pursuont to ~pplicotion dated ...................... ~.p~.~.~. ......... .~....... .......... 19~0..., ond opproved by the BuJJdh~g Inspector Building Inspect~ FORM[ NO. 1 TOWN OF $OUTHOLD BUILDING DI:PARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~xam~ned ....... ~.t..:?:..~ ............ i 9..~.:.?.. Approved ........................................ 19 ........ Perm~ No ............................... Application No, / o ~L ~3 (Building/Inspector) APPLICATION FOR BUILDING PERMIT · '/_ .~ z- 9~o Date .......... ~,~../ ................................ ~ ~. .......... I NSTRUCTI ONS 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 port 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 o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or o Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with oll applicable lows, ordinances and regulations. ..... %- : ...... ; ......... (Signature or oppficant, or name, iT a corporation/ ........... ...................... (Address of applicant) State whether applicant, is owner, lessee, agent, architect, engineer, genera( contractor, electrician, plumber or builder, ................... . ..~,..,..c.~..~..~....~z.~z~ ................................................................................................................................ Name of owner of premises....~.~Z~Z~..,.,.-.-~.~..~, .................................................................................... 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: ............................................Lot No: .................... Street and Number ....~.~.'..~.~..,..,~.,..Z,,~{ ......... .~...~...{~.....~....~. ........ -~,z~....~..?'-'~.P..~../."~....~.~..,~.~,~z'. ...... Municipality 2. State existing use ond occupancy' of premises ond intended use and occuponcy of proposed construction: a. E×isti~guseandoccupaney ....... /.........~..7.~...Z.~,.,~.......~'.Z~.~..~<.:.~.~. ................................... b. Intended use and occupancy ........................... ..~.....~.~...~ ............................................................................ 3. Natdre of work (check which appllcable): New Building .................... AdditioD ...... ~...AIteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... ;~,. (to be paid on filing this application) 5. If dwelling, number of dwelling units ................................ Num er of dwelling units on each floor ............................ If garage, number of cars .................................................................................................... L ...................................... 6: If business, do~mercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dirhensions of existing structures, ~f any: Front ...... ~ ............ Rear ................. Depth .................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth ,i~ ~' , Height ...... ../.,..?....C ............ Number of Stories ~' ' 8. Dimensions of entire new construction: Front,. ......... ~ ...... ~.....;..'. 'Rear ............................ Depth ............................ Height ,. ........................... Number of Stories ................ ~ .......... 10. Date of Purchase /'~ ]2.' 'Dc~es proposed ~onstruction violate any zoning /ow, ordinance or regulation? ............................................ Phone NO ..................... Nome of Architect .................................................... :.,,AdSress ........................................... Phone NO ..................... PLOT DIAGRAM :' . ' Locate'clearly and distinctly all buildings, whether existlng, o~ proposed, and indicate all set-back dimensions from property lines. Give street and block nambers or d~scription acco,rding to deed, a.nd "shaw street names and indicate whether interior or corner tot. STATE OF NEW YORK, ) S S. COU~:~-F~ OF .4. ...................,*,~ ~m':'"'") - , " ' ~ ¢ ~~,-~...d-~¢.~-.~ beif~n duly sworn, deposes .and says that he is the applicant (Name of individual signing application) above named. He is the~.~,~.~ .................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly quthorlz~d to perform or hgve performed the said work and to make end file this application; that afl' 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 a~ication (lied therewith, / Sworn to before me this : ' ' ~ ~ ~ ............. of ................. ....... of FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE sou'moLD,, N. 'r. Examined.......~....~.......%...i.~.. .............. 19.~..°... · . ....... .... Approved ........................................ 19 ........ Perm.t No. Disapproved o/c ....... ................. ............................................... (Building Inspector) Application No....(.~...c.~....~. ............ APPLICATION FOR BUILDING PERMIT Dote .......... /'~...~.'.~.../....~........'~.....~.. .............. 19~,O.. ...... INSTRU.CTIONS 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 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 issuanoe of a Building Permit pursuant to the Building Zone Ordinance of the Town of $outhold, 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 applicable laws, ordinances and regulations. (Signature of applicant, or nome, it a corporation) (Address of ~pplic*nt) State whether applicant.is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. x ................................................................................................................................ Nome of owner of premises....~...~...~,~..~../..~.......~.~..~..-'"~''''~'. ........................................................... If applicant is a corporate, signatur.e of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wi!l be done. Map No: ............................................Lot No: .................... Street and 'NUmber ..... ~...~.~.~....~./..../¢1Z.: ......~;.'4~.~. '.~...:~....~.' ....... ..~.~.~./'.L/..~.....0..~,..~.....~,Z'. ...... ~ ~ ~wunicipality :' 2. State existing use'o~,;d occupancy of pr, emi~es"and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~........~....'~..Z./..~./.....,~. .. ~. .'. .~. · · · · .~:- · .~;. .~T. ./. · .~. ~.~ ................................... b. Intended use and- Occupancy .................... i ...... ..,~..~.'..~..'~,.~.~ .............................................. i.: ........................... 3. Nature of work (check which applicable): New Building .................... Addffion ...... ~...Alteretlon .................... 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........~"......~'....r. ......... Rear ...... ~ .................. ,~, r Depth ............................ ~ ~ HeJght ...../....?. ................ Number of Stories ......... ~ ................................................................................................. Dimensions of same structure with alterations or additions: Front ..... ..2'.....~......i ............. Rear I ~ Depth .~.....~.....~. ................ Height ...... ./....~.. ................ Number of Stories ....... ~ ....................... 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front ........ ~.~..../. ....... Rear ......... ~.i.~...O. ........... Depth ..~.~..~..~,..~ .~..¢.,.../.~S--c) / 10. Date of Purchase ............/...~...~'~....~..' .......................... Name of Former Owner .~.Z-'~'...~....,'~'....,~...5.....~..~..,c~,~..~.Z~.~../~... 11. Zone or use district in which premises ore situated ....... /~.~.~.:../..~..,~..xt~...2Z..~.,t~..~ ....................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...../,?...~....--.. .................................. 13. Name of Owner of premise,~..~.....~...~(....~...5.' ............... Address ~..:~..,~...~.../../.~..~...~..2~.. .......... Phone NO ..................... Name of Architect ................................................... ,.....Address ............................................ Phone NO ..................... Name of Contracto-.~....~...~.A~./:~'...~...~,~./.~..~..i...~...5...~..~ddress '..~.:.~..~,!.'.~..t~..9../z....~......,Z...~...Phone NO"~.~..~..7..~./.. 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 NEW YORK, ) S S. COUNTY OF ...................., ....... ) ~-.~ .~c...~'"~ ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing ,application) above named. He 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 in the manner set forth in the ap, p, Jication,filed~there~'ith./~ Sworn to before me this ~.z ......... o, ....... ..... .....