Loading...
HomeMy WebLinkAbout1478-zFOF~M 1~'0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLI~, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...~.8...~i1~1.~h..RO~l,..~..~'lc~ial~..~Go~reet M~a~p~....~.~..~.~.....~..?..~lock No...,,~:CX~ ......... Lot No ..................... ~.eeot'~O ............................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................................... ~.~3~' ....... 9.-., 19..6.1. pursuant to which Building Permit No...~..1.1f.~ dated ............................... ~..~]~......~,,~..., 19..~L., 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 .......... ........... Pr.i.v.a.~.e. ::one... fa~t~l¥...d:~el ling. .............................................................. :...: ................ This certificate is issued to ..... Geo~e..~e~.na~Z~ ............... 0~ne,~ ................................................ (owner, lessee or tenant) of the .aiforesaid building. H.D. approvall Dec, 28 1961 - R, Villa 'Building Inspector ~ FORi~ NO. :~ 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? 1478' Z Permission is hereby granted to: Oheto Or ~.o.w~k~..... ~.C......G~. g.e...~.e.~'~' ............. ............ ~.u.t. cho.~. .............................................. at premises located at ..~./..~. ...... .~]l~1,.~'LI..I..]l~k.J~.~......~l~,ll~..~..,~l~ .......................... .............................................................. ~.e~.otfl, c ................................................................................. pursuant to application dated ............................... ~T~' .......... ~ ........... 19.~., and approved by the Building Inspector Fee $..~.0...~...0~... ........... Building Inspector/ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHO[.D', N. Y. Exam nea ......... t~/._......I ......................... Approved ......................... ~ .............. 19 ........ Permit No......~...../...?..'.Z...~.. .... Disapproved a/c ................... ~~~"i'i~- Application No. /L/? ~ 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 drown on the diagram which is part of this Iocatibn. c. The work cov, 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 p art for any purpose whatever until a Certificate of Occupancy shall have been granted by the Buildifig 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) ............... .................. (Addre~ of applicant) l State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem.ses ....... .~.~ ......... ~-, ....... ............ ........................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... ~ ~unicipality State existing use and occupancy of pr,emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ';~ ......... ;.; ..................................................................................................... Intende,~ u .... ,~ o~u~,,n~,,. ........ ~..~.~..~..n:..~..~.(J.~.....~...z~...Y...~..:..~.-¢...:./~..~..~.~:?."; :~..:..~..:~...~.'r~ ...... : ......... property lit)es. Give street and block numbers or descr whether interior or co~er 3. Nature of work (check which applicable): New Building...~ ............ Addition .................... Alteration .................... Repair ....... : .......... ..~/emoval .................... Demolition ................. ..~ther Work (Describe) .................... 4. Estimated Cost .......... ./..~','~.....~ .......... , ........................... Fee ............. /.. .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... ~-,~,¢. ........Number of dwelling units on each floor ......... ~ ...... If gargge, 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 ................................ Dept.h .............................. Height .............................. Number of Stories ................................ 8. Dimbnsions of entire new construction: Front ....... ..'~'-.-..g. ........... Rear ......... '~....~. .......... Depth , .-~'.-...~.. .................. Height ...../.....Ir/.....: .......... Number of Stories ....... ~ ...... 9. Size of lot: Front ..... J...~...¢~ ............ Rear ...... L...,,~..?~. .......... Depth ....... 10. Date of Purchase ...~.....:::%;..~/,.,..~,..~..v..~..O .............. Name of Former Owner ..~.______?..~.;....~:¢-~-......,,. , 11. Zone or use district'/in which premises are situated....4V~,~.. ....... ..'~........~.;;.,~¥~ ,~.?.v .................... 12. Doe~ proposed construction violate any zoning law, ordinance or regulation ............ ./~.....' .................................. ' /-/i /3,,, t-/ ........'.~. ~' ....................... ~v-¢.,, Phone NO ..................... 13. Name of Owner of premises.;.~..,..~.~*~,.w'~4¢,~.~.....Address--' Name of Architect ........................................................ Address ..... ..k~....~./..?..:Y..~....Phone NO. Name of Contractor. C..~ .J.~....(~-'.~'.~-,-.,?~.-~..~: .............. Address ...~~ ............ Phone NO. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from ~tion according to deed, and show street names and indicate STATE OF;NEW,,,YO~,~Jf ) S S COU NTY~-OF ...~-~m~...~/~. ~. :.~..¥. ~,. ) ' ...... .~ , ~'.'" . . ' ...... :,,.,;. ........ :..,..: .................... . (Name of ~nd~vldual mgnJng opp/~,at~on) above named. He 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 app cgtion; that al 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 applir~otion filed therew, i,th. Sworn to b~fote me this r---,, n /r~ (~ ~ ~ /'r) ()_ ................ doy f .......... ...... Notary Public, ~,y-,c/~,r~..,,,.~..; .... ;....~r~'~ [xl~ ~,m~ ~0~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... .L..'..:'. ;..~.. ~.... ,..... ....... 19 ........ Approved ....................... :.: .............. 19 ........ Permit No. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled Jn 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 coYered 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 k, ept 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. APPL'ICATION IS HEREBY MADE to the Building Department for the issuanoe 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 opplioable laws, ordinances and regulations. ........................ (Signature of applicant, or name, if a corporation) ................ .................. (Addr~s} of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .: ............... .............................................................................................................. Name of owner of premises ........ :,~...r~..~...?~.. ....... ~~ ....................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work_will be done. Map No: :. ...................... : ................... Lot No: .................... Street and Number ..... ~ ! .... ~ ................ ~ ........................... (/~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: , ,./, ~.--. ..~-~'- , ~. Existing use on~ occupancy ........ ;~;:~.~ ......... : .......................................................................................................... b. Intondod use ond occuponcy .................. i ............................................................ t .................. 3. Nature of work (check which,appllca'ble): New Building.....~. ............. Addition .................... Alteration .................... Repdir ................. .~,)Removal .................... Demolition ................. ~Other Work (Describe) .................... 4. Estimated Cost ......... /....~.......~..~..~..:..~...~.. .................... Fee ............. ./....°...i..~ ........................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...........~.~ ........ Number of dwelling units on each fJoor.......~.~ ....... If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each h,pe 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 enti[e new construction: Front ....... .~.~...O. ............ Rear ........ ..~.....~.. .......... Depth ...~?.....~7. .................. Height I ~/ ............................ NumJ~er of Stories ............................ 9. Size: of lot: Front .~ ........................ Rear ............................ Depth ............................. 10. Date: of Purchase ...~...~.../.../.~..(,....O... Name of Former Owner ...b~.....~...~..'.~..~..-..-~ · . gl ...... . . . ] 1. Zone or use d~str~ct m which premises are s~tuated....:.:..'~.~ ..................... ~..;.;'....'T.'..-?....T.."~...~.'.~...'r. .................... 12. Docs proposed construction viplate,.any zoning law, ordinonl~e'~~gr regulat~n? ............ ..~...~i]~.~.' ............................ 13. Name of Owner of premises ........................................ Address .....hX~"'"~'~'"'4'"";,""Ph°ne NO ..................... Name of Architect ......... £ ~,~ /r- ~U.~ ~_?": ........................... ; .............. Address ........................... ~(~t~, g ,~ ~ ~.....~..~'......Phone NO ..................... N O. ~.."~.. ~Z ~.?...~.. ~-, Name of Contractor.~....~];.'....~....~. ............... Address ...~..'~..:.~ ............ Phone 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:NEW ¥,J;~/l~-(};([. ) S S COUNTY OF ......~...~L~ ............. ) ' .... · ~.i.~..C.~ ....... ~ ...... '--.~..~..~..~..0.~,~...~*~.~.., .............................. being duly sworn, deposes .and says that he is the applicant ~~ i~i~plication) above nam~d. He is the ............................. ~. ...... ~.....~ .............................................................................................. ' ~~or, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this a)p icat on; that all statements contained in this application are true to the best of his knowledge and belief; and that the work wi I be performed Jn the manner set forth in the app ication f ed therew th. Sworn to bef~e me this ~'x ~ "' ' ' ~ ~ ~' ~ ~