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HomeMy WebLinkAbout1572-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...,~g.$~/A~t~tt..J~.e,~.,...~g.C~lJ~:}.t~].~, ........ Street Map No....~.*~. ............ Block No...~.~ .............Lot No .................. ,~, ........................................... conforms substantially to the Application ~for Building Permit heretofore filed in this office dated ............. ..~..~.~..~...~.l,~.~.~...~...g. ....................... , 19..~,~. pursuant to which Building Permit No. ~..~.. dated ..~g..~..O..~J;~.'~,...:~ ............................ , 19.~,I..., 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 .......... ............. ~..Z.~ .~.'~.. g~.~...~. ~t.~. ~ ..~.~.~.~.~ .................................................................................. This certificate is issued to ..... ~..~f~i~'~J~.~...~i{~i~'. ........................................................ (owner, lessee or tenant) of the a.foresaid building. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHO/D, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 1572 Z Date ................... 0e~oj)el~.....~. ............... 19_.6.1 Permission is hereby granted to: .......... · outhol~ .................................................. to ..... But l~..an., add& t~Lon..oa..an..~x~.sti~..~wel.lSm~ .................................................... at premises located at ..~/~.....]~o.i.s.?.ea.H.....AYe ............................................................................... .......................................................... 8eu.~.bo.l.~ ................................................................................... pursuant to application dated ............................. 0e.~(>bO~....~. ........... 19.~1.., and approved by the Building Inspector Fee $.~0a ............. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN BALL SOUTHOLD, NEW YORK 765 - 1802 1197! APPLICATION FOR CERTIFICATE OF OCCUPANCY NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUILDING ...... VACANT LAND ........ o, .............. HOUSE NO. STREET HAMLET Owner or Ownerm of Property ........ ~ou~ty Tax ~ap No.,000 Seetlo. Subdivisio, ....................... Filed Map ........ Lot .......... ~ ~ o~-o~ ) ............ Health Dept. Approval .................. Underwriters ~pproval .............. Planning Board Approval ................ Request for Temporary Certificate ....... Final Certificate ~. ............. Fee Submitted: $ ..... . ........ rev. I0/ 14/88 TOWN OF $OUTHOLD P~tOPll!RTY RECOIID CARD OWNER ' '"~'"' STREET VILLAGE DISTRICT SUB. LOT FOYER E -' ACREAGE ,.~ OWNER N .... ~ W ,~. ~ ~PEOF BUILDING .... (,H.' .~'~-~¢.,: ' ' ._~..,~ ..... ~ '; ?,,~.~..:.~ z 'C~' LAND IMP. TOTAL DATE AGE NEW Farm Tillable 1 Tillable 2 NORMAL Acre ~3?ILDING CONDITION BELOW Value Per Acre ABOVE Value FRONTAGE ON ROAD BULKHEAD DOCK Total Tdiable 3 Woodland Swampland Brushland House Plot FRONTAGE ON WATER Extension ExtensionExtension,,__ Breezeway Garage Foundation Basement Fire Place : ~ ~ ! Heat Porch , Roof Type Patio Driveway Interior Finish , '~;~, * ~ Porch :Rooms 1st Floor ' Ro~ms 2nd Floor , [ Dormer FIRST TOWNE REALTY 53155 MAIN RD. SOUTHOLD, NY 11971 PAY TOTHE ORDER OF Southhoid, NY 11971 ~ FOR 17010 DOLLARS ~ O I-.I-t- t40LO FOR. M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .........~:.....~ ........ , 19...~f.. Approved ............ ,.~.....~..;'.....~...~......., 19...~.../..Permit No ..... ~./.~..~..,~.~. ....... Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT Date.. :J~_..',~Z) .................................. 19..~/ .......... 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 adioining 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 application. 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 pa rt for any purpose whatever unti~ 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) ....................... ..................................... (Address of ap~'licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .....~..~.,..~'.~ ................................................................................................ If applicant is a corporate, signature of duly authorized officer. ............ (Name and title oF corporate of icer) 1. Location of land on which~proposed work. will be done. Map No: ............................................ Lot No: .................... Street and Number ....: .~.~i.~~...~¢,,~ ...................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. [xisting 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 ........../.~--'-~r.~. .................................. Fee ..~.. ..................................................................................... (to be paid on filing this application) S. 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 ...~ ........................................... Z~ ...................................................... Dimensions of same structure wffh alterations or additions: Front ....... ~.~ ................... Rear ................................ Depth ............................ Height ................................ Number of Stories ....~ ................................. 8. Dimensions of entire new construction: Front ................................ Rear ............................ Depth ............................ Height ............................ Number of Stories .................................. ~. ~,~ o~,o~: ~o~ ........ -~,zC~'~ ......... ~ ...I~:. ............. ~ ...~..~..: ....................... Date of Purchase ..Z~..~ ....................................... Name of Former Owner .~..~~ .............. 10. H 1 1. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construct on vipa~e any zonng aw, ordnanceor reguaton~ ~... 13. Name of ~ner of premises .~~~..Address ..~~..~<~ .......... Phone No~4.~?.~.~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~~..~.~..~ess ..... 4~...~¢~.. Phone N~.~. PLOT DIAG~M 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 descriptio~ accord~ to deed, and show street names and indicate whether interior or corner lot. COUN~F ..~ ~.~...} -' · ....... ................. he obove no~~...5.....~ ........................................................................................... (Co~ctor, ofiont~ corporoto officer, etc.) of soid ~z~ pe~r~ ~ h~erformed tho s~id work ~nd to m~ke ond file this ~~cotio~ ~re~e to the best of his knowled~e ond belief; and t~~h in the applicon filed thorowith. Sworn to bef~ this m ~ ~ ... JUDITH T. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... ~'~':........~ ....... , 19Z~...~.. Approved .......... ~...~ ........ ...~. ~..., 19...~.../.'.Permit No. ~/~/~ Disapproved a/c ........ ~ ...... ~ .............. Application No ...... .../.?z]-..~...~ APPLICATgON 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 application. 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 pa rt 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) ........................... ............................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ../~....~.~..~ ...................................................................................................... If applicant is o corporate, signature of duly authorized officer. (Name ~nd title of corporate officer) 1. Location of land on which proposed work will be done. Map 1'~o: ............................................ Lot No: .................... Street and Number .. ~...: .................. ~. P Y 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ...~ .................................................... . ................ b. Intended use and occupancy .../..~ ......................................................................................... 3. NaCure of work (check which applicable): New Building .................. Addition .....~. .......... Alteration ................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ...J.~t/:.~ ........................................ 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 .~..~'.....~T. ............... Depth . .~.c~'.. ....................... Height ............................ Number of Stories ....................................... :"~'"'v .................................................. Dimens~ons of same structure with alterations or add tons: Front ...~'.~,~.....-~.. ................. Rear ................................ Depth ............................ Height ................................ Number of Stories ./ ..................................... 8. Dimensions of entire new construction: Front ................................ Rear Depth Height ............................ Number of Stories ............ ~ ..................... 9. Stze of lot: Front .Z~¢~.~.. ................. Rear ../.~.,~... ............ Depth 10. Date of Purchase ....~..~.~..~-~.~J;' ~ ......................................../Name of Former Owner .~..~.~....~ 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate 9ny Ton ng aw, ord nanceor regu at onP .~ 13. Name of Owner of premises ~'.~~....Address ..~'~.~..' ......... ~ .......................... Phone No~,~,.,.:.~..~..~...~.. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..-~f.~..~.Ir...~..,~(~,rss ...z~~'....~.,.-f ..... Phone No.~..~..~.'.z.~...~..C PLOT DIAGRA.M 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 ac~f~,?jJing to deed, and show street names and nd cate whether interior or corner lot. STATE OFNEWnYO~,I~,,,,~) S S ....... ~r ~ ' ..... ~ COUNTY 0 t~-.qZX~,~. ~&.~... ~ ..... ~ ~e of individual siqnin~ above named. He is the ...... ~~ ........................... ~ .................................................................................. (Contract~agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have ~rmed the said work and to make and file this application; that all statements contained in this application are tru~o the best of his knowledge and belief; and that the work will be performed in the manner set forth i~he app~io~filed therewith. Sworn to before me this ~ ~ X.. ~ ....................................................... Notary Public, ~F~G~..~....~.(~...~5~f~,,,, ss~0, Expires March ~i~re, of applicant)