HomeMy WebLinkAbout1583-zFOB~M NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFF~CE
SOUTfiOLD, NJ. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIF:S that the building located at ~a~..~,~'e,tltte,..,M~,~,~L!i~,Lt~ .............. Street
Map No ...... .~..~...~. .......... Block No..?..?.?.. ............. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.~Ct:O~e:I: 3..3, ' .. , 19..6..~.. pursuant to which Building Permit No.~....~..8..3....
dated ..0et:o~e~...~.3......:: ................... , 19...63., 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 ..........
This certificate is issued to I/e~'~o~1
(owner, lessee or tenant)
of the aforesaid building.
......... Building I~'spector ~
FORM 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.o 1583 Z
Date ....................... ~ob~'"'"]L~'i. ...... 196]....
Permission is hereby granted to:
.... ¥~J'~o~ '.Gu.' t~ t,.---ub .......................................
......... · .az,~.. Ave ...................................................
............ lJa.~t i.tuek ...............................................
to. ~h~i~d.. an.. &ddi~.o~.. ~n..~n..-e~i. ~t .i~g..-d~®.l .ting ........................................................
at premises located at ....PS~.k...A~'~ ......................................................................................................
................................................... ~e J; t/l't ~ek .......................................................................................
pursuant to application dated ......................... 04~t;~F.......~ ............. 196~..., and approved by the
Building Inspector
Fee $..~O0 ............
FORM NO. l
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined (.)' 'z, ,A,~ /~ 19..(.~.,I
Approved ........................................ , 19. J./....Permit No .................................
Disapproved
a/c
...................... ~'""Y'"'.'z ....... ~'":" ................... '~ ...........................
(Building Inspector)
Application No. / ~'~ ~
Date ........................................................ , 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 p remises, relationship to odioining premises or punic 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 o~ the Town of Southold, Suffolk County, New York, and other a~pJic..a. Ne' Laws, Ordinances or
Regular,ohs, for the construct,on of bu~ld,ngs, add,tlons or alterat~ons,"h½~f~r remova~r herein descr,bed.
The apphcant agrees to comply wffh all apphcable laws, ordinances and regulations.
(Address of applicant)
State whC~h~) ~p~"[~cant ,s owner, lessee, agent, arch,tec~, ~e~ng,nee , general contractor, electr,c,an, plumber or bu,lder.
Name of owner of premises .....................................................................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
l;) jk ('( ( /3*.- ~J L: ~qdL
1. Location of land on which proposed work will be done. Map No: ............................................Lot No: ....................
Street and Number ....................................................................................................................................................... '
State existing use and occupancy of premises and.~ntended usf~ a~d~o~cup~ncv
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) ........................
(to be paid on filing this application)
5. Jf dwelling, number of dwelling units ....... .0...~..~ ............... 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: rront.....4].~j,....; .......... Rear ...... ~..~- .............. Depth ..............................
Height ........ i..~j~ ............... Number of Stories ........... I....~. ..........................................................................................
Dimensions of same structure with alterations or additions: Front .....~..i~.....~...~..! ......... Rear
Depth .......... 7-'~ ............Height ......... t'~ .................. Number of Stories ........................................
8. Dimensions of entire new construction: Front .......... I'"? ................Rear .........../..,'? ............. Depth .
Height ............................Number of Stories ............ I .....................
9. Size of lot: F/o~t ................................ Rear ......... 7.~ ............ Depth ............ ~..~Q,.,F,...-, .......
10. Date of Purchase ........................................................Name of Former Owner ....ZttJ[~.J,l~Re~J,:,~ ...........................
i l. Zone or use district in wn cn premises are
12. Does proposed construction violate any zoning law, ora nonce or regulation? ......................................................
13. Name of Owner of premises ........................................ Address ...................................... ..~...?Phone No .....................
No.me of Contractor .................................................... Address ............................................ Phone No .....................
/~. ,~OE b~.~K(~S~riPLOT DiAGRA~R~c~
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate qll set-back dimensions from
property lines. Give street and block numbers or descript!On according to deed, and show street names and indicate
v)hether interior or corner Jot.
N~rS
~t
oq
STATE OF NEW yC~IG. ~,~, ),c c
COUNTY OF .... ....
(Nome o~ individual signing application) .
o ove ,omed.. *e ........... .....................................................................................................................
(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 therewi~.
Swam to before me this , BOE[~ ~ /
~.~. ~. ?'~ ,day of .............. ~e24~;~:~.:.,~J~ik'~/s, Jolk
--Publ '"" ~,~ ~i/ ~. u ' ~amh 30. 1~ .
Notary lC, ']~:.,~..,d .~,.~~~ ,g , . res ..... ~ ............ (Slgnatu' .......................... re of ~pphcant): .....................................
lq'OP~l~I NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Disapproved a/c ................... ;~:.,-~.~.Z.~.~,~ ........ ~-
Application No. / -~-~- z~
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be ~ompletely 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 al~ applicable laws, ordinances and regulations.
............. .............................. L..;i
(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.
......... ..~D...k~..~.~..,, .....................................................................................................................................................................
Name of owner of premises ........... ~) ~?~.. ]~' x~'~....~
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Lactation of land on which proposed work will be done. Map No: ............... . ............................. Lot No: ....................
Street end N~er .............................................. ~ ......... ~,~..~ ~
~unicip~lJty
State e~tJng u~e and occupancy of premises ond i~tended u~e e~d occupancy o~ propose~ construction:
a. Existing use and occupancy ~qO~C F~,~ ~ , F~ tL ,
b. Intended use and ~cupancy ........ ~ .......................................................... % ...........................................................
3. Nature of work (check which applicable): New Building .................. Addition ...... ~ ...... Alteration ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................
4. Estimated Cost .........~....~.j..O....o....o. ................................. Fee ..........................................................................................
(to be paid on filing this application)
.............................. Number of dwelling units on each floor ............................
5. If dwelling, number of dwelling units C'r~--c~---~-
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: rront.....w...,::,.~ ..........Rear .......................... Depth ..............................
Height ....... !..,~. ............... Number of Stories ........ !....~. ..............................................................................
Dimensions of same structure with alterations or additions: Front .,.~..._~.'.~..~ ......... Rear ~f- ~ ¢
Depth ......... '..~...~. ............. Height ......... I.,'~ ................... Number of Stories ........................................
8. Dimensions of entire new construction: Front ......... (...~ .................. Rear ......... !.~ .............. Depth ....... I....~. ...............
Height ....... L.~. ............... Number of Stories .......... 1 .......................
9. Size of lot: Front ....... ~L.2~ ................. Rear ...... .~...?m. .............. Depth .......... ~,...o..c.?....F....~. ..........
10. Date of Purchase ........ l..~....~....'..7. ............................... Name of Former Owner ...~..~.~.:...'~..~¢~.L~/.l!s,....,C-r.q.L.:~.~.~,...~¥.
1t. Zone or use district in which premises are s tuated ............. ~....~.6.',.S-..t..~...~..~.~..~..~.. ...................................................
]2. Does proposed construction violate a:ny zoning law, ordinance or regulation? ............. ..~...(?, .................................
13. Name of Owner of premises ....~.~.V,:.~.,..~.T..~..u..Ct ......... Address .P./L.~.~./'~IL~.~..-~%.L¥.¢..c.~... Phone No. /~-...~.:.~.~'.~..~
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor .t~* ~.~.. J~.'.~..~[~....~..u~..~..~.l ......... Address ~.R,t~.r~.t.~....~..,O ...... i/~Zk~.V.¢¢ 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.
N ,-f s
I-'
P
STATE OF NEW ¥~¢RI,¢.¢..¢~ . ) S S
above homed. He is the .......... ~..~ ......................................................................................................................
(Controctor, o~enh corporate officer, otc.)
of soid owner or owners~ ~nd is duly outhorized to perform or hove performed the soid work ~nd to moke ~nd file
this opplicotioni thor oll stotements contained in this application ore true to the best of his knowledoe ~nd
ond that the work will be performed in the manner set {orth in the opplicotion filod therewith.
Sworn to befor9 me this ~ JUDITH T. BO~E~
--Fl'~t~ry Public, State of New York
......... r ............... ~ ...... ') ............ ~....~..-.q-.~..~.~arcn ~u, ~. r I In, Yl
~ ,, ~/ ~ ~// ~~.. ]~g~ ...................... ~.~.~.~, ................................................
~otary ~u~ lc, .~.~.,.~.W~Ed~y (Signature o~ ~pplicant)