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HomeMy WebLinkAbout1069-zFOR4~ NO. 4 TOWN OF SOUTHOLD TOWN CLIgRK'S OFFIC~-- SOUTHOLD. N, Y. C~:RTIF](CATIg OF OCCUPANCY No ...... .Z.....8...6.~ ...... Date .................... .0..¢..t.0b.~.~...20. ............. 19_6.0. THIS CERTIFIES that the building located a~B~&y.. Aven~ae.,...M&t~t.t;lt~4; ............... Street. _~-~a.....~.~..1. Bloo~ ~o.....**.~.*.. ........ ~ot ~'o ....... .*..*..*.. ................................................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. M..,a,y. ,,4 ....... I~.Q ..... pursuant to which Building Permit No. ,Z,,10.6,9 ....... 4ated ........................... Ma.y...5 ....... , 19.61:1., was issued, and conforms to all of the requirements o£ the applicable provisions of the law. The occupancy for which this certificate is issued is ............................................................... !?~...9~..~...~.,...~.. X..~.AL..~.~ ......................................... This certif,ca~e is issued to ....J...o.'~.n.....g.r..o..g~...~'. ..................................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FOI~M NO. ~ 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? lO69 z Dote ....................... ~ .......~.~. ....... 196.019 ........ Permission is hereby granted to: ~Ta~o:ld. R... ~eeve..& ..8oas ..A/¢. ~To~...~.O~a~ ....... ~t.~i.~uek ,.....~[,X., ............................................ to ..... Bu~.ld.. ~le.~.. on~..ffam&,ly...d~ell~.~L~ ................................................................................. at premises located at E/.~ B~.a~. Ave ..... (..Y~u~I ~st. I:L) ........................................ pursuant to opplicatioa dated ............................... ~]r,....~ .................. 1~O..., end approved by the Building Inspector Fee $.11~,,0~ ........... FORI~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OF~:ICE SOUTHOLD, N. Y~' Examined ....................... /. ................ 19 ........ ,, " . Approved ........................................ ] 9 ........ Permit No ............................... Disapproved a/c :...,-../.::'~ ........... <..: .'Z.~ ................. r.'::. ....................... : ................ ................................... (Building InspectOr) Application No..../...~.(~...Z ........... 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 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 corn menced before issuance of Building Permit. d. Upon approval of this application, the Buildir)g Inspectqr will issue a Building Permit to the applicant. Such permit shah 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 Certificafe 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 Reg[~lations, for the construction of buildings, additions or a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances and regulations. ......... (Address ~Sf applicant~ State,,,,/ / ~ .~,.,~ ~,,~wheth,er applicant is owner, le~ent, architect, engineer, general contractor, electrician, plumber or builder. ............. ....: ...................................................................................... Name of own,; of premises.....J~.~.~......~..~...~..~,~:~* ................................................................ If applicant is a corporate, signature o'f duly authorized officer. ' (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: .~ ..... .~'7~.~'ot No: .................... Street and Number ...... ,~...~.~l~ ......... .~..~J~:e~:.il~,e[ t~'~'/~"4' ~'~/--~"~'/~"~' ...... :' ....... 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 ....... ..~. ~.~,r:? ...... . ..~?.~_,~.~,,~..~... .............. 3. Nature of work (check which applicable): New Building ...... ~..........AddJtJon .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ................. _.___~,.,,...__ ........Fee ...~__v.....~.. ..................................................................... (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 ........... ............ 9. Size of lot: Front ......~....~?..~.~. ......... Rear ..................... ~,.,~,. Depth ........... ..~. 10. Date of Purchase ~ ' .,¢~..,r."./..~ /~.~'~.?. Nome of Former Owner ~.../J'~/xJ',~ .~'~.~.~¢'~., .~.~...~..~.~/ 11. Zone or use district in which premises are situated....~.. ...... .~?..4;(..~..~""~.-~------------------,~.~. ......................................... 12. Does proposed construction violate, any zoning law, ordinance or regulation? ......... i.,. ....................................... 13. Name of Owner of premises ~..~/ff.~ ~. ~.~¢0~;,'~ Address~r...~:~v:.~'~..~ ~ j~ ~ Phone NO · .... zz ......... .... ....... ;' ................................. Name of Architect..(-~.4~...~.......~ ................. .~,....;~t.....Address~-¥Z~'~'~..~,~.:..~.~..C./~.~.~.~'~-...Phone NO .......... .; ......... Name of Contractor.~.~./~.~"*~..l~..~'../,~. Address ~.~-'~:; .~...'~..~..,~..Phone NQ~...~..~..~....~,,~' Locate dearly and distinc property lines. Give street and whether interior or corner lot. PLOT DIAGRAM Hy apl buildings, whether existing or proposed, and indicate all set-back dimensions from block numbers or description according to deed, and show street names end indicate STATE OF NEW YORK, S S. COUNTY OF ............................ (Name of individual signing application) ~'~ .J~- '~~7 -- , above named. He is the ...................................................... ~.!~../....,~¢..~;.~/..¢,,~¢¢r .......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sold work and to make and fife this application; that oil statements containe~ in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set.f, ortl~r~j~L ~he application filed therewit,b~ Sworn to'~bef~re me this L, ~o~r~ ,~//~s~? ~, ~,~,~ucu~"¥0r~'/~.~. ~'~,,r/ ........ F./.' ..... day of ........ ...~.:',-.".¢ '!-./. .......... '9.~"~b.,x¢ O.L',cOU~r, (~iS~g~ature Notary Public ...........(L._;?,- ;t../2:~.../. ,[ .~,_. 6& ;,., t?./,'..~/..~... Co u n t y ,- TO~N OF $OUTHO/D BUILDING DEPARTMENT TOWN CLERK'S OmCE SOUT.O,D, N. Exam in ed ......... lb..c...~/....~ ........ 19 .~. 7.. Approved ........................................ 19 ........ Permit ~o ............................... ...................... ~'i'l~'i~"i~¢;~;~) ................................. Application No...../...~.~...?. ........... APPLICATION FOR BUILDING PERMIT Date...i'.~./~ ........ ~ ...................... ,9..~...~..... INSTRUC'rlONS o. This application must be complefely 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 port of this location. c. The work cov. ered 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 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 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 name, i o corpora ion~ ........................... (Address,6f applicant) State, whether applicant is owner, lessee, agent, arghitect, engineer, general contractor, electrician, plurnber or builder. .......................................................................... Name of owner of premises ........................................................................... f~ If applicant is a corporate, signature of duly authorized of ~cer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: -~.~.~.~...~...~' */~.~.~7-~ot No: .................... Street and Number ....... ..~xi~.~,~.~. ......... .(4/.. ~.... ~f~. .. .. ~,~(~/.~C~. .. '7 ............... / Mu~'icipalit?' ~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~..~..~.~.~ ................................. .,. ............... Z ...................................... Locate clearly and distJn property lines. Give street an( whether interior or corner Iol 3. Nature of work (check which applicable): New Building .............. Addition .................... Alteration .................... 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, Jf 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,...~.~/~'....,r. ......... Rear ........ .~J~.~..~ ....... Depth ............................ Height ........ . .~..7,~. ....... Number of Stories .......... ~ ............ # 11., Zone or use district in which pre,rnises are situated....~. ...... ¢~.~'f'.~¢,1,~.~,¢'~-~.. ......................................... 12.' Does proposed construction ~;iSlate any zoning law, ordinance or regulation? ........ i.., ......................................... PLOT DIAGRAM dy all buildings, whether existing or proposed, and indicate all set-back dimensions from block numbers or description according to deed, and show street names and indicate STATE OF NEW YORK, ', )' S S. COUNTY OF ............ '.*.; ......... ,.,,,) ' ,..,,.4(,~.,~.,g~./~......~.¢~...~4¢~.'c~.......~.,~¢~... ................ being duly sworn, deposes and soys that he is the applicant (Name of individual signing application) ' ' ab~ve"named. He is the ....................................................... .~.'~" ..~. -¢'~.,~.~--~.~¢'~" ........................................................ (Conffactor, 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 ali 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 Sworn to ~fo~e me this ~' - ......... ~ da of........~4.,.~.~¢ ..................... 19A<.-......¢¢~';'" ~ ' -~/¢_ eo~' ¢~ '" ~' lcd(Signature o~ aCplJc~ ~' ....... ~ ....... Y {',~_ g /~ 2/ Not~W Public,