HomeMy WebLinkAbout1571-zFORM NO, 4
TOWN OF SOUTttOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
OEI~TIFIP. ATE OF OCOUPANOY
No. ~,. 2~-~0 ..... Date ............. ~r~e -28 ....... , 19.6~.
THIS CERTIPIES that the building located at ~/S..01ct..l]o~'~h .~oacl ...... Street
Map No. ~ .... Block No.X:~ ......... Lot No..~... ~ol~tb.o]..rll. }~,~, .......
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ........... 0a.~; ·. 2 .... 19. ~ pursuant to which Building Permit No. ~.~.
dated ............. 0et.,..2..., 1967,., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is P~*iva.l~e · ane .2a~ai-ly- ~l~e~L~.i~lg .......................................
The certificate is issued to .. Ma~'ie..We~,t~on ........ Gu'ne~' .........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ..
FOI~M NO. 2
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? 1571, Z
Dote ..................~l(~.~ob,e:~.....,~ ...............
Permission is hereby granted to:
.kC-~,ie.....W e.~ ¢~n .................................................
................. Sou.tho.l~ ............................................
to .. Build...n~w..~vne.. £.~.~ 1.~.. d. we.ll.i, ng ....................................................................................
at premises Iocoted at ..~/~8.....0,*Ld...No,~'.t}:;~..}:~.o~,d .............................................................................
.................................................... S.o~J.t he ld,.....}.~, ~. ..........................................................................
pursuant to application dated ............................... 0C~.Qb.e,:~.....~, ......... 19.6,]..., and cpproved by the
Building Inspector
F.ee $.10,..00 ...........
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. Z ~.4GG Dote O~,tc)be~ 23 1962
T~IS CERTIFIES that the building located at .,.~.~l~..~.~...~}~Q~.~ ........... ~treet
Map No ....................... Block No ........ ~.~ ........ Lot No ...... ~. ............................................................
conformB substantially to the Application for Building ~ermit heretofore filed in this office dated
.................................................................. , 19_ . p~rs~an~ ~o which BuHdin~
de~ed ........ ~c~e~..2 ........................ , ]~...~,~, wes issued, end con(orms
of the applicable provisions of the law. The occupancy for which this certificate is issued is ........
The certificate is issued to )'~;to E~ ~on,
foyer, lessee or tenant)
of the aforesa.id building.
· 'B ii lin ' ins 'Jctor '" / ..........
!
S-9
SCHD
SUFFOLK COUNTY DEPARTMENT OF HEALTH
Date JUN 2 8 1967
Bldg. Permit No.
TO WHOM IT MAY CONCERN:
The sewage disposal facilities for a structure
'- (Give dZe~ location) -
located
have been inspected by this department and found to be satisfactory.
Distriot Engineer
District
TOWN OF SOUTHOLD
BUILDII,~G DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ........... ~.,.....~....... 19..~'../.
Approved ............ ..~..:......~...... 19....~...(Pe rmit No .......... . ..~..../'..~..~
Disapproved a/c ......... ~.........'~=~' ...... ~ ...................................
(Build~ I~nspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Build}ng
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 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 v/hole or in p 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.
............. .................................
(Signature of applicant, or name, if a corporation)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.......................................................... Q,,~z~. ............................................................................................................................
Name of owner of premises ............. Y.'~.~t~q,~,c'...'~.,...;..';g~.~,~)tg ...................................................................................................
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 ................ ~Zl.f;~..~:L(~'t..)2o;~-~.~...Jy,~zzf:'~zo~? .............................................................................
Municipality
2. State existing use and occupancy of pPemises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ............... ;~¢~3:'J&..~¢&~C~. ...............................................................................................
b. Intended use and occupancy ........... ~t.~'~)~.~.~[).'l~;...~'.v[;~.L)'.:(2~;;~. ..............................................................................
3. Nature of work (check which applicable): New Building ........ ~ ......... Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost .......... !!~.~.~..0..0...0. ................................... Fee ..........................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ........3, ...................... 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 some structure with alterations or additions: Front ................................ Rear ................................
Depth .............................. Height .............................. Number of Stories ................................
8. Dimensions of entire new construction: Front ........ 7.0.!. ............. Rear ..... 7.0..!. ................ Depth .......~(~,! ..............
Height ............................ Number of Stories ...... o~e...~.i~o~.
9. Size of lot: Front ..... ~.~.~,..l .............. Rear ..... ~.~.,~,.! .......Depth ..~...~O.~.....-....'~]$ 170~
10. Date of Purchase ........ ..~..e.~.~.~....]...c).~.]... ....................... Name of Former Owner ..~.,...]~.~...~P.O..~ ............................
11. Zone or use district in which premises are situated ................................................................................................
12. Does proposed construction violate any zoning Iow, ordinance or regulation? .... ~o ...........................................
13. Name of Owner of premises..}c~a~ifk,~J~f~o.~....Address .~o~J~o]~ ....................... Phone NC~0....~.,,.~],.9..
Name of Architect .............................. X ....................... Address ............................................ Phone NO .....................
Name of Contractor ....... $.,...¥~.,...J~.~,~.~.~flZ'. ........... Address ...I'[o.],~,.a~£]L%a ................ Phone NO .....................
PLOT DIAGRAM
Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block numbers or description according to deed
whether interior or corner lot.
end show street names and indicate
STATE OF NEW ~R~ ~ ) S S
COUNTY OF ..~.)
...................... ~..~.~...~ .......................... being du'y sworn, deposes and says that he is the applicant
(Na~e~of individual signing application)
above nomed.~e-- 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 ore true to the best of his knowledge and belief;
and that the work wJ[I be performed Jn the manner set forth in the application flied therewith.
Sworn to before~me this ~ ~IT~ z. ~0~
~ / ~) ~ ~ ~[~ PablIc, State of New York
.............. ~.~ do~of .......... ~~, ..... 19~,~.~, s~fto~ E~u,~,,(S,gnoture of apphcont)
otary ......
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
E×om ned ...... ..........
Approved ....... ~, .~....'., ,... ,, .~... ....... 19,,.,,~.~.../. Pe rmit No .............................
Disapproved o/c ...~Z~,,~.~,~.~. .....................
Application No....~..~..~..~.../.. .........
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 [ocation.
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 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 Lows, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
(Signature of applicant, or nome, if o corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises .............. ~v.[.~27..~.~...~,,...~/~.~ ..................................................................................................
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 ................. .0.~L~..~.9.~..t;~...~p.~f~.~....~.9.~,.~o.~,.~ ...........................................................................
Municipality
2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ................~.?~.~...~-kn~ ..............................................................................................
b. Intended use and occupancy ............ .D~7.:~.~.0...Cl.~;.O.~]-J,~ .............................................................................
3. Nature of work (check which applicable): New Building ........ ~ ......... Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................
4. Estimated Cost .......... ~;LS,~£)0~t ................................... Fee ..........................................................................................
(to be paid on fi]lng this application)
5. If dwelling, number of dwe]llng units ........'1, ...................... 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 ................................................... z .........................................................
Dimensions of same structure with alterations or additions: Front ................................ Rear
Depth .............................. Height .............................. Number of Stories ................................
8, Dimensions of entire new construction: Front ........ .'~.O.I. ............. Rear ..... ~.0.~. ................ Depth .......,~.(-?.? ..............
Height ............................ Number of Stories ......
9, Size of lot: Front ..... 3,~!,~. ............. Rear ......~,~[~.~.~.],~.! ....... Depth ..~:;,?,...~,,],0.!...~...~;~
10. Date of Purchase ......... ~.O.~);b.*..~L~.~6Z ....................... Name of Former Owner ..0..~..,\~'.~....~;..O..O..~ ...........................
11. Zone or use district in which premises are situated ................................................................................................
12. Does proposed construction violate any zoning Iow, ordinance or regulation? ..... ~,J.¢~ ..........................................
13. Nome of Owner of premises..~.~..~,,~,~4~t].~O~...Address ..'.',~..i~.O3L~ ...................... Phone
Name of Architect .............................. -:~r,. ...................... Address ............................................ Phone NO .....................
Name of Contractor ....... G.~..,;;,,,,.,;:~9~.,'.~¢. .......... Address .....*,$o,l,'t~:J.V.~3,~ ............... Phone NO .....................
PLOT DIAGRAM
[_ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set~bock 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.
COUNTY OF ~ ....... ) '
................ .............................. being duly sworn, deposes and says that he is the applicant
" (N%~e of individual signing application)
above named~e 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
th~s application; that ail 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 flied therewith.
......... ~... ~ (Signature of applicant)