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HomeMy WebLinkAbout1566-zFOI~M NO. 4 TOWN OF' SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY 2~ 1457 Oet. obe= 23 62 No ............................. Dote ........................................................ , 19 ........ THIS CERTIFIES that the building located at ~..,O..~..n...~.?.,i...?......A..~.,?.:.:.....8..o..~.~...h..o.,~.c.~. ............ Street Mop Mo ....................... Block No ....................... Lot No ....................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated Sept. er~e~ 26 19 61 pursuant to which Building Permit No. g$ ~L566 doted Se~o~,ember 26 19.....6..1., was issued, and conforms to all of the requirements of the applicable provisions of the lew. The occupancy for which this certificate is issued is ........ PRIVATE OLdE FAMILY DWeLLiNG" The certificate is issued to Hez'A~zl Keller, o~ter (owner, lessee or tenant) of the aforesaid building. 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? 1566 Z September 26 Date 19 ........ Permission is here~'o~.aRt~,.' & SOnS ~ne ~/C Herman ICeller~ Build anddi ti. om.. on.. ~n"'ex± stln'g" d~'llTn~ ................. at premises located at ................................................................................................... ' .......................... Southoid pursuent to applicotion dated .................................... 9. , and,' opprbged by the Building Inspector 5- O0 Fee $ ........................ ......... BuiJding Inspector'\'\ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exeml ned ....... ~'7...; ................... , ~, ........ Approved ........................................ ]9 ........ Permit No.......~'--? ....................... Disapproved a/c .._~ ........................................................... (Building Inspector)~ App,ication No. (o APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plen showing location of lot and of buildings on premises, relationship to adioining premises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is pert 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 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 wherever until a Certificate of Occupency shall hove 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 lows, ordinances and regulations. ......... (Signature of applicant, or name, if a corporation) ...... ..z. ................... (Address of applicant) ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................... ............ ................................. Name of owner of premises u~'~_z_~' ~2~.~/ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on Lw_hich. Rrop. osed work will be done. Map No: ............................................ Lot No: .................... Street and Number ....~.,Kfl~.f.~.'r.K~-..~J. ......................... .~.....~.....'~..~..'~..~.~. ........................................ : ..... Municipality 2. State existing use and occupancy of p~emises and intended use.and occupancy of proposed construction: a. Existing useandoccupancy ......... (...?..~...e~.~-~..~......~.~r.~.j~':~ ....................................................... b. Intended use and ~ccupancy~.~..M.~.~..~..~.~.~f`~..%.w~z~.~..~(.~_~...`~. 3. Nature of work (check which applicable): New Building .................... Addition ....... ...~... ....... Alteration .....J~... .......... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ....... ./.~.....~?..~')..~...~.-:..°.......'/Z'..r..--:.. ............... 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 ..../.~....~-z../---~.~~. ....... Depth ...~.../..~'..~....~ ....... Height ...~./...-/...~...~/. ....... Number of Stories ........ ..?........'~......~.--~A~....~ .................................................. Dimensions of same structure with alterations or additions: Front ....~......-~'...~...~....~/. ......... Rear .....~....~...._fx....~,...~..~. ........ Depth ...... .7.~...'.'~..~....x/. ...... Height .....~...../..~.~....x/...... Number of Stories ....~.....~....~..'~g~'~'~,/~ 8. Dimensions of entire new construction: Front.....~...~]./-..~.:./. ..... Rear ...~-..'~...~..~-..'.'~ ...... Depth .....7..~...:.--/...~...'~' ....... Height .....~..../..~..g~.'..Z ..... Number of Stories ........ ~. ............... 9. Size of lot: Front .../.../....g~..../.-m.. ......... Rear ./../...~....,f'~...~.... Depth .¥'.:~..,~.r~:.".~,~.... /~;-,s-Z ~ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ............ ~4r,~,r..-~'<,,~-~ ............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ~:. ............................... 13. Name of Owner of premises..~..~.e'~'~..../.~-4~...Address . ./..~.<P.........~.....Phone NO ..................... Name of Architect~....,P~'. f,.~t~.,.'.~,~.~~..Address ............................................ Phone NO ..................... Name of Contractor~~..~..c~'.......~.%Address .~..~~...,'K~.~'~¢~,.~'.Ph°ne NO//X/4~..~..-- .~..~...~.? 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,cORK, ) S S. COUNTY OF ....... ~ ~F.q.~ ........ ) ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ......................... ~..:. .......................................................... · ' (Contractor, agent?'corlborote 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 appl cation; that a 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 n the application filed therewith· i~i]i ~ ~i! .d.].aii~ ~] ~~ ~~!~i]' (signature °f appllcant) '~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... b.~. n;~'r'.'?...... ~.~.. ~?...... 19. ,iq.(.. Approved ........................................ 19 ........ Permit No ......................... Disapproved a/c ............. :~ ........................: ............................................... .......................... ~.~./ ~_z,,~.................................~x --(Building Inspector)~ Application No..../.......~....(,.'2. ...... 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 adioJning 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 available for inspection throughout the progress of the work. e. No building shall be occupied or used in ,~hole 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 Southotd, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions ~r alteratlons, 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 a corporation) .................... State whether applicant is owner, lessee, agent, architect, engineer, ge,n, eral contractor, electrician, plumber or builder. Name of owner of premises .................. ~..~.,.~...'V,--¢i¢,¢..~.......~....~.~..~.~.~...-"~,~....~.... ............................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which .ozopos,e/~work will be done. Map No: ............................................ Lot No: .................... Street and Number ...... ~~._~.,..~.:: ..................... ~...'rr..~.....~.~z .................................... Municipality State existing use and occupancy of pr,cruises and intended use and occupancy of proposed construction: OCCU anc ~'~'~'~'~-~'~--Cx~/ (~ ' ~ ~ a. Existing use and p y .................................................................. ~..~ ....................................... b. Intended use and occupancy ~.~.~..~.. ~...Z~..~..~...~-~,.~......~. ~,,. 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ....~ ......... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ........... '.~.....~..~...4~ .......... '..'~....'..-? ............ Fee ............................. ,~ ........................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling unlts ................................ 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 ...~.¥:.-....Z~.. .......... Height .....~...¥.:~...~...~../. ...... Number of Stories Dimensions of same structure with alterations or additions: Front ....~....'-~'.......~ ............ Rear ..~..~.......~. .............. Depth 7~,~2 4 ,~,~/,,/~ H Nh ~,he, of Stories ....... ~......?....~~, .............................. Height ..................................... 8. Dimensions of entire new construction: Front......~...~...-Z...~. ....... Rear ....~....~..:z:..~. ...... Depth ....~..~..-Z....~.? ......... Height ..... ~...../.~..~...~/. ..... Number of Stories ...... ~.. ................ .......................... .... 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 ....................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .............. ~ ........................... 13. Name of Owner of premises..~'.~...~.Addres~'~..-/...~...~...~..~...Phone NO ..................... Name of Architect,~.,~.~.~4?.:~.~~, .Address ............................................ Phone NO ..................... Name of Contractor.~t~=~r'~.~....Address .................... Phone PLOT DIAGRAM Locate clearly and distinctly ali 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 YORK, ) S S. COUNTY OF .....&.~F.~O.~.t.¢ .......... ) ........ ~.~..~ ........................... being duly sworn, deposes and says that he is the applicant (Name of individual slgning ~~.¢:.....~...~/,.~.. above named. He is the ........................................................... .x...~ .............................................................. (Contractor, agen~/cor'porate 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 applicat on; thor al statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the m.ann~ set forth in the application filed therewith. Sworn to before me this O~,N NOTAI~y pI, J[LiC' ~ate of New c~/°~ ~-' of ,~4Z/~,/,o., 1~J,z-~os~s0 (Signature of applicant) ........................ ...... i.