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HomeMy WebLinkAbout1088-zFO'E3$ N~O. 4 TOWi~ OF SOUTHOLD BUiLDiNG DEPARTMENT TOWN CLER/CS OFFICE SOUTHOLD, N. Y. C~RTIFICAT~- OF' OCCUPANCY No ...... Z..83.9 ...... Date .................. 0e~obez'..~9 .............., 1~0.. ' THIS CERTIFIES that the building located alS/~..No~h..Se~..Dx...,...~to%l~-hold.. Street; Map No.L.~tDZCO ....... Block No.*.t*. ............. Lot No .... .**.~, .................................................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. ..M..a...y.._.2...1. ................. 19.P.0... pursuant to which Building Permit No ....... .Z....~.0[I.~].. 'lated ................. l~y....21 .............. , 1~.0 ..... was issued, and conforms to all of the requirements of the app!ieable provisions of the law. The occupancy for which this certificate is issued is ....................................................................... ~R'~VAT~- ,ONI]}' "PAf/i~Y" 'lJWE,'Yu~ ~//~1~ ................................. This certificale is issued to ..Ad~llt..Bl~:[alrtol:l/:~,._owlle~ .............................................................. (o~vner, lessee or tenant) of the aforesaid building. Building Inspector FOI~M NO. 2 TOWN OF $OUTHO/D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (TH[SpERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK,AUTHORIZED) Permission is hereby gr(mted to: aY premises~ located gt ..... ~J~...J:8~::...~IO~h...:.l~..Dl, i~.. .............................. ................... :.....i..,....[..:tl~uthold~ ........ Ii,:~..,..,....:(LI~ICO:.mali)....:.. ,: , .,...i.... ............. pursuant to application dated ,.: ............................. ~t'".-i~ ............... 19.,~0, and approved by the Building Inspector Fee $-.~ 001 ........... FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am ned ......... 19..9...?. Approved .................................... , 19 ........ Permit No ................................. Disapproved a/c ~ ............. .......................................... (Building/nspector) App,,cat,on ........... 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 before issuance of Building Permit. d. Upon approval of this application, the Bu.ilding 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 alterations, 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, if o corporation) %o. ............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................... o.~,~ ~ ~.1~. .................................................................................................................................. Name of owner of premlses.,...~k.8,..o.,..~.~,.....T¢.%.~,~.~.O;.~.?. .......................................................................................................... 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~])~.¢.0 ........................... Lot No:.;¢~:;¢ ............ Street and Number ..~/.?.~......~,,r.o.z.C~...~e.¢...!?Z.$%~.~ ........ d.q.u.,~t~.o.~.¢ ...................................................................... Municipality 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 ........................................... 3. Nature of work (check which applicable): New Building .................... Addition...~ ............ Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ......7..0.0 ............................................... Fee ....~$...5' ............................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ C)kq..q ........... 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 ~..?J. ....................... Depth .....2r..0. ....................... Height ............................ Number of Stories .............g..n..e. ......................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth ................................ Height ............................... Number of Stori'~s ................................ 8. Dimensions of entire new construction: Front ...... ~ ................. Rear ..]).+. ....................... Depth ....1.1.+. ..................... Height ............................ Number of Stories......O.~ .................... 9. Size of lot: Front ....10.0 ................. Rear ......... ],Of). ........... Depth ..Ll'.(.)f) .................... 10. Date of Purchase .............. .l.9.[~f). ................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are s~tuated ............... A ....... f.l.zk~.~. .................................................................. 12. Does propdsed construction violate any zoning /aw, ordinance or regulation? ........................................................ 13. Name of Owner of premises ....... x~.c].-~,.~..e.-..."!,.r.!~..~!g.]~.l,~ddress .......................................... Phone NO ..................... Name of Architect .................................................... Address .......................................... Phone NO ..................... .................................................... Address .......................................... Phone NO ..................... Name of Contractor u PLOT DIAGRAM Locate clearly and distinctly all 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 corner lot. c t-',c,'T [ ft~ . J tM STATE OF NEW YORK ) S.S. COUNTY OF .... ~,;1 f,J;.~ .0.~,~:.....) Adc e Bria~onte ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ovm©r (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 applicati'on; that all statements contained in this application ore true to the best of his knowledg,~and belief; and that the. work will be performed in the manner set forth in the application filed therewith. ,~/// JUDITh{ T. BOKEN -- //~',C Sworn to before me this Notary P.l~lic, State of New York ~ _ No. 52.0344953, St~ffolk County /// // / 21. , may' m 60 ¢~,r~,~io, ~,~es ~c~ ~0, ~! /,//ff/~ ........................ clay or .................... U) ........ '~' ................... opp~(can~) Notary Public,.~(~dZ~.~...,~,~..~..~.~.:.~...~... ~ (Signature of FOR~I 1~'0, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLO, N. Y. Examined .................................... , ^pproved .................................... , 19 ........ Perrr it ..... (Buildin0 ~nspector) APPLICATION FOR BUILDING PERMIT At~plication No. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplif~ate to the Building Inspector. , :~ b. Plot plan showing location of lot and of buildings on premises, relationship to adlomlng prem(s~s or pubhc streets or areas, and giving a detailed description of layout of property must be drawn on the diagram, which is pbrt of thi~ location. c. The work covered by this application may not be commenced be.fore issuance of Building P,eFm}t, r d. Upon approval of this application, the Building Inspector will issue a Buildi.ng Permit fo t~e' ~ppliaant. 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 Certit}icate of Occupancy shall have been granted by the Building Inspector. r . APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Buil~ling Per,it pursua'~t, to the Building Zone Ordinance of the. Town of Southold, Suffolk County, New York, and other appllc,a, ble Eaws, Ordinahces or Regu arians, for the construction of buildings, additions or alterations, or for removal or dem6htion, a~ herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations., . , : :'-, ..... A. o ........ ............... , .................... ~,gnature ;~ aea~pp~t, or no~e,,(~ a corporation) (Add?ss of al?pli~:ant) State whether applicant is owner, lessee~ agent, architect, engineer, general controctgr, electrician, plun~,b~r or builder. If applicant is a corporate, signature of duly authorized officer. / (Name and title of corporate officer) / 1. Location of 4and on which proposed work will be done~ Mop No: ...}4~t~I:~0 ........ ?;..~ ............. Lot : ............ Street and Number ¢- ~ ~ .- ~ ~ Mun c pa ty . 2. State existing use and occupancy of premises and intended use and occupancy of proposed con~t[uction: a. Existing use and occupancy ..... ,~'¢?,~e~...a.o~J;~.~ ......................................... L ............................ !: .................. b. Intended use and occupancy .......... ~ ............... , ............. ~t.t~'~...aC]~t.t~iO~l. ................................... . ..................... property lines. Give street and block numbers or description according to deed, and show whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................... Addition...~ ............ Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe)'. ................... 4. Estimated Cost ...... .~30 ............................................... Fee ....~..~. ......................................... ..................................... - - -(to be paid on filing this application) 5. If dwelling, number of dwelling units ........ oae ........... Number of dwelling units bn each floor .................................. If garage, number of cars ....................................................................................... ,....: ............ ..................................... 6. If business, commercial or mixed occupancy, specify nature and extent of eec~.h type of USe ................................ 7. Dimensions of existing structures, if any: Front ........~ ............... Rear 2~ .......... ....~.,.. ...... Depth ..,..,~0 ....................... Height ............................ Number of Stories .............OhS ................................ :...),, ........ i..t..(... ................................. Dimensions of same structure with alterations or additions: Front ........... : ............. ~ ...... 'Rear ................................ Depth ................................ Height ................................ Number of Stories ............ : ........ J .......... 8. Dimensions of entire new construction: Front ...... ?t~ ................. Rear .'[~. ...................... Depth ...],.ti,. .................... Height ............................ Number of Stories._..~e .................... 9. Size of lot: Front ....t .650 ................. Rear ......... :1.00 ........... Depth J-kG.'O. ................... 10. Date of Purchase .............. l~'O ................................ Name of Former Owner ........................................................ 11. Zone or u~e district in which premises are situated ............. ,AIL....cl.~.~ ....................... .' .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........................................................ 13. Name of Owner of premises ....... A~e.],e...~t~.j,~,~O..~t/~Jdress .......................................... Phone NO ..................... Name of Architect ...................... !! ............................ Address ...................................i ...... Phone NO ..................... Name of Contractor ................... .r.~. .............................. Address ................................. t'~ ....... Phone' NO ..................... P.LOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from street names and indicate STATF OF NEW YORK ) Sl S. COUNTY OF ...~.:~],~...,.) ............................. ~ .............. ,~k;?t~h.~.f~.....][)~.].,~.~r~;O.~ .............. being duly sworn, deposes and soys thor he r~ the opplicont (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~imake and file this application; that all statements contained in this application are'true to the best of his knawle~g~ and belief; and that the work will be performed in the manner set forth in the application filed therewith. ~IUDITH T. BOKEN :./ Sworn to before me this I'totar,/ Public, State of New York i'.//~.~// ,~ , ................... day of , ,, · ~....(A~..,,~'.~f~,~..~..,:.~..-.~. C"~eet~ (Signotur# of opplica Notary Public,/"- . ,: ~t