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HomeMy WebLinkAbout1476-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...Z. 3494. · · Date ....... May. .... 2.7., ........., 19.69. THIS CERTIFIES that the building located at . Bu~g~.a..l~lace ........... Street Map No. l~con~.c... Block No ........... Lot No. 104, ~,05 ,&3,06. Peconlc,. N,.¥, ~.rtoz'e8 ' conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... July ..... ].1,.., 19.61. pursuant to which Building Permit No..1476 dated ....... July ..... 11.o..., 19.6~., 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 ,.. ~rtvate. one. family..dwell/ng, with. addition ................... The certificate is issued to ... W~lliam .A.. Mullto ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... House % 140 Burtls Place 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 PULL COMPLETION OF THE WORK AUTHORIZED) N? ~76 Z Permission is hereby granted to: 99.~ 66t~ Ave ................ ~ ~.~...~.~.e.,.....~,.~, ................. to...~.~...~..~.~.~...~..~,~...~.~.~.~...~.~ ...................................................... pursuant to application dated ........................................ .~...~. .................. 19...6.~., and approved by the Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT T~N CLERK'S OFFICE SOUTHOLD, N. Y. Exam.ned' ' I ~ [ .....~,~./-.........t ................. 19....:... Approved ................... '?. ................... 19 ........ Permit No. Disapproved a/c ......... ~ ................................................. -~*,~ ............ (Bui~ing I nspeciJor) Application No. / z.~ "J (-.o ~, '/(//~. (j APPLICATION FOR BUILDING PERMIT Dote ............................................................ 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 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 co~ered 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 Laws, Ordinances or Regulations, for the construction of buildings, additions or o Iterations, or for removal or demolition, os herein described. The applicant agrees t° c°mpIy with all applicable laws' °rd'~r~es and regulati°ns' ~-x~. O~ · ...¢.. ........ ..................... (Signature of applicant, or name, if a corporation) ............ ..................................... (Address of applicant) State whetl~er al~plicant is d~er, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................. ........ A": ...... ............................................................... 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. t~l'~oo.t~.j...~ ........................... Lot No: .................... Street and Number ..,/..X~O......~....b'....~....-~..(...~........~...~.~ .............................................................................................. Municipality State existing use and occu~ncy of ~emiAe~ ~ t~de ~U I-, '"1 ~ ~ ~ ~C~pr°p°sed construction: a. Existing use and occupancy ................................................................ ( ........................... v ....................................... b. Intended use and ~up, nc, ............... ........... ~.). ................................ '. ............... ~Z..~.~...'. ................ ~O¢,to~', 3. Nature of work (check which applicable): New Building .................... Addition ..... ~ ......... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ...... .../~..~..g.....~../....~.. ............................. 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 ............ ..'~......~... ..... 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 ....... L..G, ............... Rear ....... ./...G. ................ Depth ..../...G. ................... Height ............................ Number of Stories ..... ~ ........ 9. Size of lot: Front ........ .c~...O.. ........... Rear ..... .c~...0. ................ Depth ../~./.../..~....O. ..... 10. Date of Purchase / ~' 5' (~ Name of Former Owner ../~...4 I L ~_~ .~j' situated '~J'~ 11. Zone or use district in which premises are ...~Z~ ........................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~..~ ................................. 13. Name of Owner of premises....C~....~.......~.lJ.~.~.L.0....Address ............................................ Phone NO ..................... Name of Architect ................................ .S! ..................... Address ............................................ Phone NO ..................... Name of Contractor .................................................... 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 according to deed, and show street names and indicate whether interior or corner lot. STATE Of NEV~,~/'(~J?~,K,~ ) S S COUNTY OF ~r-'~.t ....... ) ' .................... ~4J....~.A~..~ ................................. being duly sworn, deposes and says that he is the applicant (Name of [~vidual signing application) ~ .~ above named. He is the ....... ; ........... ~.:.-....~~ ................ : .......................... : ........................................ (Contractor, agent, corporate officer, etcJ of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file th s applicat on; that all statements contained in this application are tfue to the ~st of h~ knowledge and belief; and that the work will be performed in the ~nner set fo~h in the application filed ~erewi~h~ Sworn to before me this ~ ~ ,,. JUOl~ T ~re ~A~, ~.~ ~ · ~ ~.~ / / ~, ~f Y/~ ~ ~p.J~. Y~ (S,gnature of app cant) .......................... ~ ...... ,'"l"f""~'-l~ .... ~~U~olk ~un~ - ~oto~ ~UD ic,~.~.~..;..~...~..c~ ........ ~.-~'"~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .................................. 19 ........ Approved ........................................ 19 ........ Perm t No ............................... Disapproved a/c ....... ~....~. ..] ~.~7.; :z.~ ......... C'~ (Building Inspeclor) Application No. / /~j ~/ (~ APPLICATION FOR BUILDING P£RMIT Date ~ (~[ ................................... f ....................... 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su~)mitted 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 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 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. Theappiicantagreestocomplywithallapplicablelaws, ordini~k~es and re§ulatio~(~^ ..... (Signature of applicant, or name, if a corporation) ............ ......... ................................... ,-- (Address of applicant) ~oR~£T State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~A,/'I \ [ I A'x h~ A ' If applicant is a corporate, signature of duly authorized officer. ro o e ork i e ne Ma No 1. Location of land on wh'ch p p s d w w II b do . p : ............................................ Lot No: .................... · Street and Number ....................................................................................................................................................... Municipality 2. State existing use and occupancy of pr. emises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and ccupancy ............................................................................ 3. Nature of work (check which applicable): New Building .................... Addition ...... ~ ......... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ....... ~f~t..~..O.....~./.F:%~ ............................. Fee ..... .~.~..' ............................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling umts ...........C.~ .......... 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 same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ j...ro .............. Rear ........ /..~ ............... Depth ....Z..f~ .................. Height ............................ Number of Stories ...... ~ ....... 9. Size of lot: Front ......... !~..~'~ .......... Rear ....... :~..0. .............. Depth ..[.~/.'../..../.,~..O.... 10. Date of Purchase ...........~..~..~.C, ............................... Name of Former Owner ..../..~/..~..kL,.~_'...~/. ............................. 11. Zone or use district in which premises are situated...i./~,.*.i....~?.~z-z~IC..~ .................................................................. 12. Does proposed construction violate bny zoning law~ ordinance or regulation? ........ ./..~..'i/~. ................................ 13. Name of Owner of premises.....~.)..! ...... ..~.....U...L..l:../...O...Address ............................................ Phone NO ..................... Name of Architect ................................. ".~ .................... Address ............................................ Phone NO ..................... Name of Contractor .............................. .~..'. .................. 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 according to deed, and show street names and indicate whether interior or corner lot. I~/'~ '[ ~5 ~/,~,O~b, STATE OF NEW,,Y~OJ~J~,/',)/~, ) S S OF__ ............ , ,' ' ..................... ~..~'~.....~.~Z~ ................................ being duly sworn, deposes and says that he is the applicant (Name of' i~dividual signi~ application) ,., ~ ~ above named. He is the ..................................... : .................................. ~ .................................................................................. (Contractor, agent, corporate officer, etc.) of soid owner or owners, and is duly authorized to perform or have performed the sald work and to make and file this application that all statements contained in this application are tr~ue to the best of hi~know[edge and belief; and that the work will be performed in the manner s~o~(~rt]h ~[~he a~p[ication filed t~rewi[h.~ Sworn to bef~Ti t~,f ~, [~ ~' r fa ....................... ........ cz ZZ , ...... '~ ~1~ '~ ~~ ~.Count"