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HomeMy WebLinkAbout1054-zF,O~R~ N,O. 4 TOWN OF SOUTHOLD I~UILDIN~ DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, CERTIFICATE OF'OCCUPANCY No..Z...7.9,7. .......... Date .............................. Al1~1t8~.....3 ....... 19...60 THIS CERTIFIES that the building located al ..... 13~g... ~l~l[~t;....A~e ............................ Street Map No. ~J~ ~11(t. Block No. X,XS~X ......... Lot No..~3..&.-~ ......... I~ll~;OhO~llO~..-.-.l~,.~.~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................... l~-~r, eh.....1~.., 19..6t3. pursuant to which Building Permit No...~.1.0~11, ........ dated ..................... Al~It. il....2~...., [[9...60, w.as issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .............. ...~....i...v..a...t.~.....0..n..e.,.. ;(:arall7... d~relling ........................................................................................ This certihcale is issued to ....~llo~al~..l~oslak .......... 01~01~'. ................. : .......................................... (owner, lessee or. tenant) of the aforesaid building. 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 PREMtSES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1054 Z Date ............................ . .~..~....~..~.......~.~'.. ....... 19..~...O... Permission is hereby granted to: Atiautie Hc~ea....~/~.... Tho~s.. ~esla~ ...................... .......... ..~....x...~t~ ..................................................... ............. p.~.z.i.Z.~. ~.t..,.,....~.,..~: ................................ to ..~buS,1.4..n~w...one..~..~m~.~....dwe. llJ, ng ................................................................................... at p~emises located at ...,~.t,..~...6~..&,.~.....~l~,.H~ ................................................................ ........................................... Tr. aclc..a~'e~ ............ Ctttehog.ue.~....~.~Z. ........................................... pursuant to application dated .......................... .~.1~.~.~....~..~. ................ 19..6.0.. and approved by the Building Inspector Fee $...~0.00 ......... Building Inspector Examined ................ , App d t ~ rove .................................... , FOEM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19...~...~.. Application No ..... ¢..~.....5~.. / ............. , . ........ 19....Y...Perm~t No. Disopproved e/c ................ .~~~ APPLICATION FOR BUILDING PERMIT Date ...... ~f~ ~ cb, .. ;;L6..,...19.6 O. ............... , 19 ........ INSTRUCTIONS a. '¢~is application must b~ 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 be.fore 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 o 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 Lows, 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 lows, 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. ......................................... ........................................................................................................... .... ~.,,~ .Thomas Roslek' Name of owner of ~, ...................... :............................ r ......................................... ; ................................................................. If applicant is a corporate, signature of duly authorized officer. (Name ~nd title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ....... ~.~;.~.Q ........................... Lot No:.6;~....-....6~.. Street and Number ............ ~.~:~.f.e..:.........C~....~.?.~.o..~...~..e...~....~.?.~..~....~..O...~.~ ................................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............. ~.o...~_e. ......................................................................................................... b. Intended use and occupancy .............. .~W..e..;'l:.~..~:.~..~. ............................................................................................... 3. Nature of work (check which applicable): New Building ...... ~. ........... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ..........~. .9. ~ .0. . .0. .,. . .0. .0. ............................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units.....O,Z~e .............. 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.j ........................... 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 ...... ..~.~i'. ............... Number of Stories.....~ ....................... 9. Size of lot: Front ....~..0...0.....~...~.8.~... Rear ............................ Depth ............................ 10. Date of Purchase ...... .~..O.~.......]:...9.~.9.'. ............................ Name of Former Owner ...... ..~.~§.e...~...~........~.~.~.ct.. ............. 11. Zone or use district in which premises are situated ............................................................ 12. Does proposed constrMction violate any zoning law, ordinance or regulation? ....~..O. ............................................... 13. Name of Owner of premise .s~....O.~-~...~.O.~..]'..8...~. ......... Address ..~...O..~....~.~....~..~..e..O..t?.~...~'l~ne.,_.N~ 80.. ...... ~-~1§8.. .......... Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor At:;].stn. t,.J...~ }~O]~es OOiDS~,,Address ~'il~poZ'¢, ~o¥. Phone NO~.~...?..-..9..0...6..0... P.LOT 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 corne, r lot. STATE OF NEW YORK ) S.S. ............ "....~~.....,~ ....................... bei0g duly sworn' deposes and says that' he is the applicant (~ame of individual signing applicon) above named. He ~s the ............... ~ ............................................................................................................................. (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 application; that oil 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 FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...~,~ ............... Approved ................ ,., ......... :..:....., Na. ........ ................................................................ .................. Application No ......!.. ~...?.~..'Iv/. ............ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be ci~mpletely filled in by type'writer 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. 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 lows, ordinances and regulations· ........ ......................... · 'i~i/'g66ture of ai; ;ii 'ant, or ~'~ if o ~¢~ion) ' " (Address of aiSplicant) ~/' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................... .Gene~al..c~n.~e.c.t~'. ............................................................................................................ Name of owner of premises ............. ~l'tO~,.~..l~.OS'l~k ........................................................................................................ 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) ........................... Lot No:.6~5 .....64,, Street and Number ,~:~~' Municipality 2. State existing use and occupancy of premises and intended use end occupancy of proposed construction: o. Existing use and occupancy ............. ~O,%lf~ .......................................................................................................... b. intended use and occupancy .............. ¢%.W.~.;t,]~:~ ................................................................................................ 3. Nature of work (check which applicable): New Building ...... ]~ ........... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .......... ~9.~0~I,0Q ............................... Fee ....... ~ .................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units.....O~e ..............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 ...... ~l,f~. ................ Number of Stories..,..~4~. ...................... 9. Size of lot: Front ...].l~(~..,~..*l(~.~'.... Rear ............................ Depth ............................ 10. Date of Purchase ..... ..~..~..~..~...~.~.~..~.. ............................ Name of Former Owner ...... ~,~.~,1~..~.~...~.~. .............. 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...~{~ ............................................... 13. Name of Owner of premises~.O~R~...~Q~.~,~, ......... Address ..~..~...~?.....~..~..~..O...~..~..~.....~. ~Sne NO. ~...0.....~.~.~...~..~...~ Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor ..~,.~,~t~.~g..~g/~l~...,~.~.~..~'.*Address ...~...3,...~.p..O...~.~...~.*...~..,. ....... Phone NC~..~....~..~.~...0..6..0... PLOT DIAGRAM Locate clearly and dislinctly oil buildings, whether existing or proposed, end 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 corne, r lot. STATE OF NEW YORK ) 5. S. COUNTY OF ...... . .................. ) ..... .~>~~~~ .......................................... b eingdulysworn, deposes~ndsaysthat he Jstheapp[icant ~' (F, laFne 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 ar have performed the said work and to make and file this application; that all statements contained in this application ore 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.