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HomeMy WebLinkAbout1076-zTOWI~ OF 5OUTHOLD BUILDING DF. PAHTMEt~T TOWN C,L~,HK'$ OFFXCE $OI~THOLD, N, Y. No...~..(~.B ......... Date .................... ~.t~...~ ~ ................. 19.~. THIS CERTIFIES that the building located a~ .~/g., ..~%11~-~i; .......................................... Street _~.~.~.~?:...,. ~loc,, ~o ..................... ~ot ~-o. 3.~.....~..~.. ~..z, ............................. conforms substantially to the Applic,ation for Building Permi~ heretofore filed in this office dated .............. i4ay.....,9 ................ , 19...(~0 pursuant to which Building Permit No......~....11,~,?.6 ..... ~lated ......................... 14aF.....9t ....... 19....(~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 ................ lCr. £~ai;o...ono ...f.a.m.i.17 .. d~o.l $~ng ......................................................................................... This eertifmale is issued to ...![t, laeor~t;...1-i~l~g:[alno~[O ........ {..olo10:~.,) ........................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector 1~01~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER ~I~AIT ~ : (THIS ~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL ~ COMPLz-TION OF THE WORK AUTHORIZED) N? :;' 1076 ,~'. Dot~ ........................... ~.....~.. ............... ~....6.0. I~erm~ssion is hore~¥,grontod to: t pUr~D~nt to ~pplicdfion doted ................................... ~....~ .............. 19.~0.., ond approved by tho B~ildi ~ InSpector}} - Ins FOI~M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E~om,ned ............ ~..~.....~....t.. ,~.~..o... App,,eot,on ~o.i.'.~.Z~ ................ 7 Approved .................... ff] ............. , lP.~L....Permff ~o. ~PPL~C~T~O~ FOR BUILDING 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 o 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 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 oil app icable laws, ordinances and regulations. ......... ......... ...... ................. ...... ..................................... (Addre~ of ~pf/licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................. 7" ...... ~"~ ~_ ~..~ ................................ : ............................................................................................. Nome of owner of premises.....c~....~'..~...,...._,.z~.c,~:,,~,.,,~.~,~. .............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate, officer) 1. Location of landon wh,ch' prop w, k w'll be done. Map N 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 .......... % .............. 3. Nature of work (check which applicable): New Building .J.~ ........ Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .....M.V../...O...~.(.2. ..................................... 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 ............. ..~....~....~f:..¢.- .............................................................................................................. 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 ................................ ................................ of Stories ................................ Depth ................................ Height ~ zNumber / .~....~ ./...c~.....~... / 8. Dimensions of entire new construction: Front ...... .'m.....~.. ............. Rear ........ ~...~.. ........... Depth ..~-~ / Height ............................ Number of Stories .......... ./ .................. / 9. Size of lot: Front ..... ./..~...~... ........... Rear ........... ./.~.g*2. ....... Depth ..... ~..~..~ .......... 10. Date of Purchase ........................................................ Name /o,f Former Owne~~./......~...~...-.~*¢~-'~" ' ' 11. Zone or use district in which premises are situated .............. ~.......~.~'~....~.....~....~.~...:~' ~~,~,/~,~ ..................................... 12. Does proposed construction viola,t§ any zoning law, ordh~an,¢~, or regulation. Name of Architect ..................................... ~ .............. Address ~~e N'O./r...~...: ........... Name of Contractor ....i.~:~c~.~....~.....C~.~.d~..I. ^ ,,- ~, ......... Address .......................................... Phone NO ..................... 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 corner lot. STATE OF NEW )~t~P~..~.,. //.~) S S COUNTY OF ~/~,~:~'.~C~)~ ' ' ............................... ~~~~. ...... being duly sworn, deposes and soys that he is the applicant (Name of individj,~l signing o_pplicgr~on) . - ~ ~'/ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized.to perform or hove 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. BOGEN · i~Otafy J~Ubfic~ State of New Yo Sworn to before me th~s ~u~ ,-~ -.,.,- rk ......... ............ o, .... ............... FOI~ NO. ! Approved .................................... , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN OERK'S OFFICE SOUTHOLD, N. Y. 19..:..,..Permit No. ~Z/O 7 G Disapproved a/c .... -- (Building Inlpector) 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 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 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 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 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 appll'cant, or name, if a c~poration) (AddreSs of ~p~'licont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buJlde, r. ............................. . ......................... Name of owner of 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 Noj,,G_,z~..~.?.?.~/;~.~ .~,.~.~/~,~././Lot~ x7 ,~ No:L .~./...~;....~.:./--~)'~'' __- Street and Number ..~'~./..:.~.. ...... ~/~:!~d.~..;~/~2./~.~..~/./~.~<;~4.~&~(~/..~/~/~4~~ / /V~6~icipaiity // / / ' ~ "' State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use andoccupancy ...... .~.~,.~-~.~,/,,~.....~.'~').~ ................................................................................. b. Intended use and occupancy ...... ~..~?.,~.... ~',c .... ;~ :.. ......................................... 3. Nature of work (check which applicable): New Building ~.,~ ......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ......~'..'~.'.~...O...~.~.'...:.....~. ............................ 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 ............................ 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 ...... ..~...f~...( ......... Rear ....... .~..~.'..../. ....... Depth ..,.q~.~..~..~.. Height ............................ Number of Stories .......... ./ .................. / 9. Size of lot: Front ..... ./...0...~.. ............ Rear ........... J~..~.. Depth ...... ./.h~. ............... 10. Date of Purchase ........................................................ Name of Former Owner . .~.~./?.~..~:,~. ...... 11. Zone or use district .n wh,ch prem.ses are s.tuated .............. ~.,~......~r.~,x.-.~.....~....-..,....~..~d...: ..................................... 12. Does proposed construction violate any zoning law, ordinange or regulation? ...... :'.~.r~ ...................................... 13. Name of Owner of premises...~.~.&~".~,~.,z'J?,~.t~'z~J<(.(,'~ia~'bCs~.,~*?./..z~'.~.~,:. Phone NQ....r ............... Name of Arch,tact .................................................... Address :...~. .......... .z,,~.'.~....' ................ Phone NO....~..: ........... Name of Contractor 1.~,,~,, ~(~ l.~ ~% 0,~ Address Phone NO. 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 come.r lot. STATE OF NEW ~OR, I~ /,,/) S S COUNTY OF .~.~-.~;~ .~,.) ' ' ............................... :z.T~,/.4~('~-~:~(~.'~./-('-.4~'. ................ being duly sworn, deposes and says that he is the applicant (Name of indivi~'g01x ~z/~-~~signing ~,pplic~on) ~ i, ,h, ......................................................................................................... ~ ~ (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 ~11 statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed ]~l~b~.~er set forth in the application filed therewith. Notary Pubhc, State of New yo k · f~o. 52~0344963, S~lf/olk CoLmty Sworn to befo me th s ~,e nm,s$ie~, Expires M~rch 3D, 19 ........... /,. .......... of ....... ......... ; ...... 7 A , ' Notory signature of applicant?