Loading...
HomeMy WebLinkAbout1719-zFOI~ 1~O. 4 TOWN OF SOUTHOLD :BUILDING D~'-PAi~TM£NT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. "[HIS CERTIFIES that the building located at . ]~oad...~&~;ers Roaff ....... Street s ~_u ~oeO~No. XXX,X ...... ~,ot ~ro...2~3~ ..... C.utehogue,. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. ~1~1~;~.~...~,, 19.~.~. pursuant to which Building Permit No....~.~.~..~?, dated ........ A~r~. 9.~.. , 19. ~., wa~ 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 .... l~ivate oue ..£amiJZy.. dvel~i, ug ....................................... 'Chis certificate is issued to ~]RO~..~.~ .JB~..(gii .......... 0~'i~Y ........................ (owner, lessee or tenant) of the aforesaid building. H.D. approval Sept 12~ 1962 by P. Ma~kowski ~Ol~ ~0. B 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) 1719 Z Date .........................~A]:lr~jL....~7 ......... 1 9..~, Permission is hereby granted to: l/,~o~...~O~,s...~/.~ .-l~e~o~..~-~,~s .............. to -..~,I~. ~ev..m~e-..~--~-l-y...dvet. t~ .............................................................................. at prem,$es located at ...... Y,~ -~'-~-- -.lq~I~IS~A. Po:~tl --P~o~ .................................................. ............. '. ................................. :~1~ o~rl%te~te r~.. Ro~d ......................................................................... ................................................................ ~tt.~ma~ae ..................................................................... pursuant'to apphcation dated .................................... ~,t~.~]L.....~ ..... 19.. 6~, and approved by the Build,rig ilnspector Fee $..]~r O0 .......... Building Inspector BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location / - - (n,~mber~& street) .... (~icipal'~y) Subdivis ion ~~ ~/~ Map No. N~e of O~er(s) Admitted by: (owner-tenant) Accompanied by: Key available Suffolk Co. Tax No. Source of request ~/~ .~. f-~/ ~m-_ Date DWELLING: Type of construction Foundation Total rooms, 1st. F1 Bathroom(s). Porch, type Breezeway. Type Heat Fireplace(s) Domestic hotwater Other #stories Cellar Crawl space 2nd. F1 3rd. F1 Toilet room(s) Deck, type Garage Warm Air No. Exits Type heater Patio, type Utility room Hotwater Airconditioning ACCESSORY STRUCTURES: Garage, type const. Swimming pool Other Storage, type const. Guest, type const. VIOLATIONS: Housing Code, Chapter 52 Location Description Art. Sec. Remarks: Inspected by: Date of Insp. Time start end FORM N~ 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .........Cx:c~.'~,..."~ ..."t...., 19..~....L' Approved ....................... ~..: .............. , 19...L'....Permit No...~../.....(...~....I ....... Disapproved a/c ...... i~;./,.~~-.....- .................................................................. ............ ........................ .............................. Application No....!...~.../..,!(. .......... APPLICATION FOR BUILDING PERMIT 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 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. , .......... or ......... 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: ................... ..-.4 ................. ~..^Lot No: ...,~,~;~ ........ Street and Number ...~.i~ ........ ~Municipality~'"~'" ........ ~ ........................ 2. State existing use and occupancy of premises and intended use~and ~c~ancy of proposed construction: 3. Nature of work (check which applicable): New Building V/ Addition .................. Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ............. ..Z,..~./.....~,~ ............................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling un ts ....................... ~/ Number of dwelling units on each f oar ~'.~.~.../.....~..g...~... If garage, number of cars 6. If business, commercial or mixed occupancy, specify natureand extent of each type of use ................................ " " z2'" ............. 7. Dimensions of existing structures, if any: Front ...ZA.....~ .......... 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 ~'~. ' ?/~ '~ ~/ Star es ...... ./.~..~.. ................. Height ............................ Number of 9. Size of lot: Front ............. ~, ................. Rear ....... /~/ Depth ........ .?...~...~. ....................... 10. Date of Purchase ............................ ~/ ~..Z..~'./.W.Z ...................... Name of Former Owner ...~'~..~.....)9.(-c' .......... Lx,,~../C ...................... ] 1. Zone or use district in which premises are situated .................. ~... ....... 12. Does proposed construction violate any zoning law, ordinance or regu ation? ........... Xjcx.~ ............. 13. Name of Owner of premises ..~.<~./~¢;~....~,..,~l.~.s......Address ....~.C9.~...~c...~..f,1/~dX~l/..~.~di~hone No.,/.~...~(~..F/.' ..... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....~..¢~.?.~.¢...../~.a/../c.~ ................... 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 NEW YORK, ) COUNTY OF ............................ ) S.S. _ _ .............................. · ~.~ ......... ~ ......................... being duly sworn deposes and says that he s the applicant (Nome of individCJol signing application) ~,~ ~, 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 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 m(~' s~th in the application filed therewith. Sworn to before me this ~ Public, State of New ....................... Y /'~ ~J ( 'g ature of applicant) ..............