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HomeMy WebLinkAbout1118-zFoP~W NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOL~, N. ¥. CERYIFICATE OF OCCUPANCY No....~..,~32 .......... Date ........................ )~.....9 ................. , 1962.., THIS CERTIFIES that the building located at ....~..~.....~.~..~...~..O..~..~ .................................. Street Map No. ~ ............ Block No....;lt~l;~ ........ Lot No...~{:Z~ ....... [i~t~.e]L~...~,~, .................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. ..0..~.0~.~;r. ...... .~.0..., 19.~.0.,. pursuant to which Building Permit No. ~],~-.~.... doted ............................ ~.Q...~.~O]~.~, 19...6.0., was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .......... ....... bns~e.s s...bai.l~d lng...(s.~or.e.). ............................................................................................ This certificate is issued to ..~'.~.~g...$.~hO].'~$. ...... .~.M'la.~...Og...h~l. lldJ.,llg. ................................ (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? 1118 Z Date ............ ~rOVt~;:Le....,1 .................... 19.~0~. Permission is hereby granted to: .............. ~. a.~e~.t*..~T.,.¥., ....................................... to ...~r~.. ~X~ t.i,~., l~t~j;~.~ .. ~...~...l~.~..,£~,~,,.b~li~ .. p~pv~ ~,. .................................... 7; ........ ~ ............................. ~ .................. :"'~ .............. ' ........... ................................. ct premises located at ............... :..' ......................... ~m~o~......~, ~ ......................................... ,....: ...................................... pursuant to applicaffon dated ........................... ~'"';'~"~I~"0~"~(~'-'"~0 and approved by ,the Building InSPectgr ~ .... ~',~ 1 f:.9. .... Examined ..~. ............................ , FORM NO."I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .................................... , l~ ........ Permit No ................................. Disapproved a/c ........................ y....~ ........................................................... Application No .......,.(,/ ¢~"' APPLICATION FOR BUILDING PERMIT Date ............. ;J'?~P~¢~.. 74, ~ ........................ , 1~0 ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to tl~e 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 o~ 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 Southoid, 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 comp y with a I applJcab e laws, ordinances and ragu arians. ("Signature of applicant, or name, if a cO'?poretion) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,, plumber or builder. Name of owner of prem,S~7~.* '~" ................................................................................................................................ ~ , If applicant is a corporate, s,gn~f~l~d-o c~~:O~z~ :~' (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ..................................................................................................................................................... Municipality 9. 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 ..... './..~..~,......Z ................................... Fee .,,,~.~)..,¥, ........................................................................... '~'~ *U~fo 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 67...:~..~...]..~:~... Rear ......... 9:~ .............. Depth ..... 10. Date of Purchase ........................................................ Name of Former Owner ...................................... .Z~..~.~. 11. Zone or use d strict in which premises are situated ................................................................................................... ~2. Does p~opose~ co~stmcf~oa v~oSeie ~ zo~ m~ bw, o~d~ac~ce b~ ~eG~efio~ ........................... ' ............................. Name of Architect ,(~:~2'.~t~.~Z'J..~...~,...;f~MtO:4~,Z..Address .......................................... Phone NO ..................... Name of Contractor .................................................... 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 corner lot. STATE OF NEW ~ORIK ,~/_~) S c COUNTY OF~,,)~,..~,,((~.,) ' ~' ,~ ~..¢~..~...~.'..~...4'~.~:.~.~.(.~~...being duly sworn, deposes and soys that he is the applicant c- ~/ '(Name(o] indiv~d~ol~signing application) ~ , ~ above named.~ the ............ ~~ .................................................................................................................... / (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 ~herewith. Sworn to before~e this ~ . %z.~ ~ ..~ ........day of ................ ~ .... 19:..¢~,F.,%rr,,,,e~ ~ __ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .................................... , 19 ........ Approved .................................... , 19 ........ Permit No ................................. Disapproved a/c ........................................................................................... Application No ................................. (Building Inspector) APFL,CAT,ON FoR BU,'D,NG PERM,T Date ........................................................ , ........ 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 Building Inspector will issue a Building Permit to the app!icant. 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, orln i~art 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., (Add~,ss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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 A/'/C~ ~4A ?~,'~ ?'/' !'" © > *('~" :~' ~' '' ' ' ' , Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....~./~.../~...~....~... ......... ..~....~...~ ............................. i ................................................. b. Intended use and occupancy . ~.. .... ' . ~.~:f.~.. :~:¥~....~. ................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... 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 ............................ 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 .~....~..~.Z/Z~.4~*.. Rear ........?..~.. ............. Depth~.?...5...~.~./...?~i'.../...~'/ /~' ll/"~'~r'l~/JY'~c 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are s.tuoted .............. ...'~'-'"~'"'"~:'v ..................... ~ ...... v ......... r ........... '¢' ............ 12. Does proposed construction violate any zoni.n~ law, ordinance or regulation? ........................................................ 13. Name of Owner of premises..~.~,4'~.~,~'~.)..Z'~..,~*T, Address,e~.#f~.~..~...?~..'~.~.(,....,~..M ....... Phone Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor .................................................... Address .......................................... Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly alt 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 COUNTY OF ............... ~ ........ ) ' ' ,. .-. ....... ~~...~..... d~¢~..~ ................... : ................ being KName of individual sigr~g application) duly sworn, deposes and says that he is the applicant 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 application filed therewith. Sworn to before me this ........................ day of ........................................ 19 ............ Notary Public, . ......................................................... County (Signature of applicant) FOltM NO. 1 TO~ OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Approved .................................... , 19 ........ Permit No ................................. ................... ................................. ........................ ....... ~ ~ , ',* (Buil~n~ Ins ......~ **<:,~..~APP. LICAT. iON~ FOR BUILDING PERMIT - . *: ................. ....... , o. This application must be comp etely~ filled in by typewriter '~d dbb'~RT6~in duplicate to the Building ]nspector. b. Plot plan showing location of lot and of or areas, and giving a detailed description of layout c. The work covered by this ap d. Upon approval of this appl permit shall be kept on the premis e. No building shall be occupie~ shall have been granted by the Buih on lication may not be cam :orion, the Bu.ilding s ava.ilable for inspectic or used in whole or in lng Inspector. APPLICATION IS HEREBY MAD Building Zone Ordinance of the To~ Regulations, for the construction of The applic2nt agrees to car ply with State whether applicant is owner, les: to the Buildin( of Southold, uildings, additions all applicable laws Name of owner of premises .................. emises, relationship to adjoining premises or public streets drown on the diagram which is part of this location. issuance of Building Permit. issue a Building it to the applicant. Such ~out the progress of work. purpose whatever untJ a Certificate of Occupancy ~e issuance of a Bull Permi York, and other ~r for removal or )lition. [ regulations. pursuant to Ordinances ~rein descril: if a Address of ~pplicant) agent, architect, en general contractor, el, :trician, plumber or builder. i ........... z :~','; :'~ ' ~';~; ~/'"~'¢;,"/~' ~"i;~ ~ ............................. ~' ............................................. 1. L t~on of land on which ro osed work will be done Ma No, oca' ' p p . .p_~o~:~_..:,~,:~,~.~..~?...:~., ....... 6~ ................. ,~,~C~:'F'":~t' : .................... Street and Number ................................................................. ~....~/ ........................ L.; .......... ~ .............................. 2. State existing use end occupancy of premises and intended use end occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................. Intended use and occupancy ................................................................................................................................. ~-,,%,% x.,. · %~.~r-~-.. Locate clearly and distinctly al/ buildings, wh~ther exi~ property lines. Give street and block numbers or cJescriptj,& whether interior or corner lot. '1 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .............. ~,~... Repair ............... z~... Removal .................... Demohhon .......,~ .......... Other Work (Descnbe) 4. Estimated Cost ....'~.../~..O, 9. . Fee ./,.Q. ....................................................... (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 / (4 ' Depth Height ............................ Number of Stories ..................... ~..~..u..(./. l)r A/'C- -~ ~'o/'~ £~ / 9. Size of lot: Front ....~...'~.:'.~,~,..~...~.... Rear ......... ?.,'~..'. .......... Depth ..../...~..¢./,,../,~../.. ...... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...............i .~....~i....../.~..: .............................................. 12. Does proposed construction violate any zoning law, ordinance or reg~gtion? ................ ~..0. .............................. 13. Name of Owner of premL~r~s.Z.~.'~..~....:~,.,Addresst~_,~r,~'l~ ~ ..... ~~ .......... Phone NO Name of Architect .,......~]~.......~C',.~..~.....%,~: ............. Address .......................................... Phone NO Name of Contractor ..~..v..~.~....~.~(~ .......... Address ............... .~.~ ........................ Phone NO ..................... PLOT DIAGRAM ting or proposed, and indicate all set-back dimensions from according to deed, and show street names and indicate STATE OF NE'~,,YgR~I4F & ) S S COUNTY OF ~..) ' ' (Name of "~r~ividual signing app~cat.!on'%J above named. He is the ......................... ~.Z.....~~..: ................................................................ (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 manne~,~t forth in the application filed therewith. Sworn to before me this .~ day of ....