Loading...
HomeMy WebLinkAbout1475-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFF~CE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY No. S 1765 Date Novem~:;er 4 1~..3. ..... THIS CERTIFIES that the building located at .~.~.~..~g.].~...~.Y..~..*.~.....~...q?4.q.~..O..c~..~. .................. Street Map NoMo. J~.o...~i~l.. Block No ........ .*.~ ........... Lot No....~.~....~ ........................................................ conforms substantially to the Application for Building Permit heretofore filed in this office doted · Z 1475 ................................. ..J'..~..1...y......~..O. ................ , 19~..~ .... pursuant to which Building Permit ,'~o ................. dated ....................... ..~..~...~..~.....]:.0.. ............... , 19....~.?/., was issued, and conforms to ali of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ PRIVA~ ONE FANCILY ~DWELLING The certificate is issued to Benn:le 8zczetka, owner (owner, lessee or tena1~t) of the aforesaid building. Building Inspector 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 lzt75 z Dote ......................... ~.~t. ....... 10 ........... ~9...61 Permission is hereby granted to: Benn~e..~Ize~tka ........................................................ ........... '2~'-~,..Pl".O~l~e~.~...~',/'e ...................... ................... · C.:l,:l.,t'tto~ · · ~ ,, J... ................................ to bu~t~ ' '~ew ' 'one" l'~'~y ' · d~t~lJz~ ...................................................................................... at premises located at ....~O~..6.1...&..6,~.....~z~./..]~d .................................................................... ...................................... T~ek...~® ........................... ~te~ .................................................. pursuant to application dated .......................... ',T~I].'~"'"].O ................... 19.6.~.., and approved by the Building Inspector Fee $'"~Oi:00 ......... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI'IOLD, N. Y. Examinea ...... ~.I .......... ~ ................... ~ ............................ ............................................................... .................. ................................. 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 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 whole 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 af 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, ord inances a~tions.,?.~..~ /j~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, ger~eral contractor, electrician, plumber or builder. Name of owner of premises ...................... .~...~.~'...'~.....~.~.~..:..~'~.~-~.~..~../..O/.~.. .................................................... 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 ...~...~..~J2..,~.O..Z~...'..~..~C..-. ............... ~...~.2~..../....~..(-:~..~....~. ........................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use end occupancy .............. ~......'~.....~ ................................................................................................ b. Intended use and occupancy ............ ~..~..../.~.,~..~..~ ........................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition ..... ~.....Alteration .................... (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 ...... ..~..~..,7. .......... / , Height ......... ./.~,~..i ......... Number of Stories .... ~.z~,.~ .......................................................................................... Dimensions of same structure with alterations or additions: Front ........ (¢'...~-.../. .............. Rear ..... ..~...7..~ ................. Depth ....... ...~...~..(. ............. Height ............ ./..~. J. ....... Number of Stories ..... (~.....~2..~. ........... 8. Dimensions of entire new construction: Front ......... /..~..~. ....... ~.' Rear ....... ~..~,../. ............ Depth .....~'~,~,..~. ............ Height ......./..~../ .............. Number of Stories ......... ...~...~.....~< ..... 9, Size of lot: Front ....... .~...~....~.../. ........ Rear ....../...~....~....~.. ....... Depth ....,.~./.,.~.. ......... 10. Date of Purchase .~.~Z.~/.../..~.L, ....... .7...?.~5.~...7. ........ Name of Former Owner .,~.¢~.../.¢,..~.....~(.~.../.G~;Z..~..(;;~,,..~.. ]1. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction vi,~te any zoning law, ordinance or regulation? ..... ./...~.~.. ..................................... 13. Name of Owner of premises..L~.~'.6~.:..'~..C~..~.,~.r.O,~.....Address ./~..z~,.(..~'.(~..~. ............. Phone NO/'~'.~.~...~..x~6 Name of Architect ................. ~...."T~T......; ............................ Address .............. % .......................... Phone NO ..................... Name of Contractor ............ ;...-7~...: ................................ 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 acdording to deed, and show street names and indicate whether interior or corner lot. COUNTY OF~d.~ ./. ) ' ........ ~:~.~.~...~.~.~..~.~ ....................... bruno duly sworn, deposes ond s~ys thor he m th~ opphc~nt //~ame of i~ividual signing application) above name~ d. He is the .......................................................................................................................................................... (Contractor, agent, corporate officer, etc.) ~owner e~s, and is duly authorized to perform or have performed the said work and to make and file this application; that ail st~ments contained in this application are true to the best of his knowledge and belief; and that the work wil be ~e~formed in the manner s~l~;~appiication filed therewith. Sworn t~e me th~s' 'k I , ~ ~JO~RY~UB~lC' grl'A]'E Ol: NF:~}'N, 2-4259000 Y(H<?.. '"' FORM[ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×omined ............ ..~.../.~ ...... 19..~.../.. ^pproved ........... 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 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 drown 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 oppllcant. 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuonoe 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. Thb applicant agrees to comply with all applicable laws, ordinances and regulations. .......... ~?natureof~~''' "~;t ............. ; .................. ( 'g pp' ~ n me,' acorpoation) ..... ~.... ~:~ .-.. ~.~.: ~;~-~ .~. ~.~ ~..,. ~ z,, ~:,~. ,.. ~:~.~:~ (Ad~fess of applicant) / (~/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ........... ~:.~.t~ ................................................................................................. 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 ....~/,;Z4¢:(:~. ~........(,~-;m~ ....... ,.....~ ~/~,.'Z~r:~.~,~ .................................................................. Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ..................................................................................................................................... Intended use'and occupancy ........... ~.~.~,~..~..~...~. ...... 3. Nature of work (check which applicable): New Building ....... ~ ........ Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... Cost ............ 4.> ~.,¢..~ .................................... Fee .......................................................................................... 4. Estimated ' ~ ~" (to be pa~d on f/ling this application) 5. If d~,e[ling, number of dwelling units ......... (-..'s~n...~ ........... Number of dwelling units on each floor ............................ If garage, number of cars......~....,~m¢~-,~?~.*.,~ .jw~ .............................................................................................. 6. If business, commercial or mixed occu~Sancy,M ~,~ .,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 .......... ./..~..'i~ ......... Number of Stories ...... ./. .................... 9, Size of lot: Front ...../...c?..~. .............. Rear .../.ri.C? .................. Depth .....,Z.,~.b. ........ n .... /...t......?. 10, Date of Purchase ...................... ..................... Name of Former Owner .... .~¢4~-~:..~..~;,~..~.*~ ................... 11. Zone or use district in which premises are situated....;:/~.~;...~..,..L/t,: ............................................... .,~.... ................... 12, Does proposed construction violate any zoning law, ordinance or regulation? .......... ./.../~..o. ................................... 13. Name of Owner of premises4~,.e'~... ~.., .... Address~,~.:'?...~'.;~,x~'/r~4,.~.~,~. Phone. ~ NO,/?.~.,....~...z~,./.(.~? Name of Architect ........................................................ Address ............................................ Phone NO ..................... of Contractor....>~ .~.'~.~......~. ............. Address .,.~,~.'~'~4~-...,,J~,,~'~' " ~,Phone,~.~/, ~ NO. ,~.~.L..~..:'~/. Name PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, end 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. ~..~:.~,.~,..~. i~,~...:~..z~... ............................... being duly sworn, deposes and says that he is the applicant ............... i'l~am~ ~ i~i~:~ig~ing apl~lication) above named. He is the ........(.~.~.~.>~gg~. ............................................................................................................................. (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 flied therewith. Sworn to before me this JUDITH T BOKE~ ~' ~'~'~ . . ~ ~. :. , _ .~ ~l~rv Pu~l]c,~tate of New yorKSianature of applicant) ........ /~...~ ..... day ~ ........: ............ ~ l y....~...~ Sulrolk County ~ Notaw ~ublic, ..~~...~.~~..~ou~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam ined ................. ~/'l, ......... 19 ........ ~/~--~/Z /O / No. Approved ............... ~.~ ......... 19.~:....Permit ..~Z .~..~...~..~. Disapproved a/c ........... ................. (Building Inspector) 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 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 whole or in part for any purpose whatever until a Certlficafe of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc.e 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, o,r for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ........ 4 d.,~ ~,~.. ~.~,~ ....................................... (Signature of ap~ic~t, 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 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 ........ ~. fC:~.-....~c~...cck..~'~.. ................ ~.~,¢.~.4-"~,.,~.;~'.~.~,,: ........................................................... Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: o. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy .......... :..,/~.df,:~z,w~..,~.~.~ ....... ~',~,~...'~.:::.:-:.~"- - .............................................................. 3. Nature of work (check which applicable): New Building ...... ../~¢~..........Addition .................... Alteration .................... Repair .................... Removal .................... Demolition ......... ~.....z~Other Work (Describe) .................... 4. Estimated Cost ........... ~..~...~'..~..Q. .................................. Fee ...,/V. .................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling umts .........C..a'-;:~.... ............... Number of dwelling units on each floor ............................ If garage, number of cars......:/,'Z-....z~?.....~..!~;-~ ................................................................................................... 6. If business, commercial or mixed o~'cupancy, specify nature and extent of each type of use.....r,~.:..~.~ ............... 7. Dimensions of existing structures, Jf 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 ....... ~..r~..~ ........ Depth ......c'~.....'/.. ............ Height ......... ./.(~..:. .......... Number of Stories ....... ,{ .................. 9. Size of lot: Front ......,/.O..O. ............ Rear ........ /..~..~. ............ Depth ......... Z..~.~2. ......... 10. Date of Purchase ................. ..~...~...~:...?. ........................ Name of Former Owner _...~,~'~...,~/~,~-rz.t~¢~... 6,' ~' 11. Zone or use district in which premises are situated ...... ~ ................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? o,z'/',~. .................... 13. Name of Owner of premises.:'~.~.,,~f/~,~.~:.~....Address-- :~;~$..?~..T...~.-rk.~.~?.~/JV~f.~,,f~,.~hone NO. Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor...~ ...... .~. ................ Address ...,,~/bZ~/-~..L'~'~.~.~,~hone NO...~..~....~.:.~.~[ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sehback 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 ,~DRJ(/ /~z~' ~) S S CO NT , ~~.-~.~..G~....: .................... being duly sworn, deposes end says that he is the applicant (Name of indJviduaF/~,~;mg applic~ation) above named. He Js the ........... ~~ ......................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and Js duly authorized to perform or have performed the said work and to make and file this apphcation; that ail statements contained Jn this application are true to the best of his knowledge and belief; and that the work will be performed Jn the manner set forth in the application filed therewith. ~ Sworn to before me this ~ ' ~-- ~ ' /~ 4~ nf ~-;, 19 ~ ,.3~ T, ~0~ (Sgnature of app cant) ........... .... - ,'"'; ...... .