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HomeMy WebLinkAbout1721-zFORItiI NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .1~ ./.~. ..... ~,...~.~.(~.~..~...~.t(..~...~..~..~....~..~. .... Street Mop No..~ ........... Block No .......... ~g;~... Lot No...;Jl~;~.....~.e...~.'q...,~.g.~.:B,t..s....~..,.~. ............ conforms substantially to the Application for Budding Permit heretofore filed in this office dated ........................................ ]~.'i;t~l~l,~.~ ..... ~k~.., 19(:t~... pursuant to which Building Permit No. ~.~-. .... dated .................... A.I~I~.~......~.Q ......... , 19.~.~..., 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 ....... ........ P.~;l,.v.~l~e...~e..J~emi!F...dw.ellln~ ...................................................................................... The certificate is issued to .~.~t'.~'~..~....~ ......................... J~r~ .............................................. (owner, lessee or tenant) of the aforesaid building. ( FOI~M NO. 2 TOWiq 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? 1721 Z Date ................../illg~t, · · ,~0 ....... 196~... Permission is hereby granted to. ...... ~.t,~t~ N.,.*~,, .................................. to ... 3~tld.. ne,,~..cme.. ~amll.3r.. ~I~e;1.~l.~ ............................................................................ at premises located at . .]:llir!~.....~O~t~/.~...~/'l~...ll~::[ 'II"~Cv~t~[ ....................................................... ............................................ 0~. i~n.t..lPet~at~...lf..Y. ~ ................................................................. · ..(&,~e~s..~pp~,~vecl..lay.t?~cl.....~t~pea.l-~.) ........................................................................... pursuant to application doted .............................. ,,l~'Z'i'~' 2~ '&"i~I~19"~o2, and approved by the Budding Inspector Fee g sp I TOWN OF SOUTHOLI) ~ . /6/ ---' No ..... L..). ........ /. ....... Approved 19 ........ Permit No. :...~..../...Z..,,-~,..L ...... Disapproved a/c ................................................ ~ ......................................... APPLIGATION FOR BUILDING PERMIT Date ........ Auguetl...).r/~b ...................... , 19..6R.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submittecl in duplicate to the Buildin~ Inspector. b. Plot plan showing location of lot and of buildings on p remis~s, relationship to adjoining premises or public str~te ~ areas, and giving a detailed description of layout of properly must be drawn on the diagram which is p~rt of this ol~licu- tion. 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 S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuar~ to the Bu ding Zone Ordinance of the Town of Southold Suffolk County, New York, and other applicable Laws, Ordinances or Regulations for the construction of bu dings additions, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances a~~ ~~.~...r~t..~f.) · · ........ ............... : ............... ................. (Ir;Lent ..P. oint, ~ .. L, I. .................. .~ ............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............... T.d~.ta..l;~..li.tz~ ............................................................. .............................................. Jf 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 .... r.~.~.at, e.~:oad...-/.$..aal~..l~,oecl~..D~,te~t,.,.~L~t~.--.~ae~,.~xt~..~e:~ ............................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ................................................................................................................................ b. Intended use and occupancy ......... P.~.~Lvat, e..one. Eem~.~.y..de~l;;klag .................................................................. ~-3. Nature of work (check which applicable): New Building, ...... 1~ .......... Addition .................. Alteration .................. Repair .................. Remova! .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost .............................................................. Fee ...................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...~)ne..~sm~L],~...,... 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.~vith alterations or additions: Front ................................ Rear ................................ Depth ................................ Height ................................ Number of Stories ................................ 8. Dimensions of erSt!re new construction: Front ......... "~i~.i~..i..'. ....... J~e~ar .............................. Depth .............................. Height .............................. Number of Stories 9. Size of lot: Front ...;.-[3.5!'..~'.: ....... il.. R~0r ....],35.~. ...................... Depth ..),5~ ............. ; ........ 10. ; Dote of Purchase .......... .'lg~,/..~li, Djl~e~;..) .................... Name of Former Owner ... llo..ll:l~rlllJZ'~.Z~.t~l~l. ............... ' 11. Zone or use district in which premises are situated. .... A. · .. ~s .tz~-~t~Csl. ~. Age'&cultural ...................................... 12. Does proposed construction Violate any zoning la~, ordinance or regulation? ....... JAo .................................................. 13. Name of Owner of premises .,~I~,II..][,~..K;I,I~ .......... Address ~.;t..qll~..~..o.~.p.~...~^~ .... Phone No.................~.0z'* 2-06 8 Name of Architect ...... c,~em.~.ea~.~,.~i ............... Address ~.a,~;..~d~!fl~;I, lr~..~y..e.~. N lDhone No. ~.A.:...c~0 Name of Contractor ....0~'~e.t,..&e.~.[],e(~..~. ....... Address ................................................ Phone No .................. o~ t~t~ PLOT DIAGRAM Locate clearly and distinctly a!l 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 ..~.t~'.9~, ........... ) S.S. / ............. ~-t~J.~ ......... e~ ......................................................... being duly sworn, deposes and says that he is the applicant (Name of individual 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 manner set forth in the application filed therewith. Sworn to before me this ........................ day of ............................................ , 19 ........ Notary Public ............................................................ County (Signature of applicant) FOII.~ NO. I TOWN OF SOUTHOLD BUILI~ING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. y.r ~ 9.." Examined ......· .'~T. · · ..-?[~¢~ .~.. · 1 ....... , 19 ........ ' (~ojj~ ,~ ~ r it ,.~.../~'~"1 Approved...~'~: ..................... , 19 ~czPem No ............................... ,sopprov. a,c ................... ............... .................... ............................................ (Buildin~ Application ......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink anti. $~nitted 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 t~ediagram which is part'of this application. c. The work covered by this application may not be commenced before issdence of Buildln. g Permi~ ,. d. Upon approval of this application, the Building Inspector will issue c Building Permit to she aPPlicant. Such permit shall be kept on the premises available for inspection throughout t_he progress of the work. e! No building shall be ~ccupied-..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 bf buildings, additions or a Iterations, or for removal or demolition, as herein described. The applicant agrees to complY/ With all applicable laws, ordinances and regulations. (S!gnature of applicant, or name, if a corporation) .......... D .:Lent,, ........................................................ (Address of applicant) State whether epplicont is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premiSes ........ F,d.~D...H....Rf~.zlg ............................................................................................................. If applicant is a Corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ........ ~ .............. ~ ...... LotNo: ~ .......... Street and Number .]~.T~...I~o.O.o.W~...~/.~..J~I./~.~...(~J. en~..I~.OJ. XI~.~.:.~ .......................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... .~.&~,~3~...[84'~1, ...... ~ ............................................................................................ b. tnterided use and occupancy ..... J)~e..~.lL~L1,[~'...~we.l].]rt~ ............................................................................. . 3. Nature of work (check which applicable): New Building ~ Addition Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ....~.0.~.(~.0...~./,,1~ .............................. Fee ]0o ...................................... (to be paid on filing this application) .............................. Number of dWelling units on each floor ............................ 5. If dwelling, number of dwelling units one If garage, number of cars ..... .~...~.1~(' ........................................................................................ .~.., ............................ 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 ............ .~.~. ............... Rear' . ......... ~9. .............Depth .... .~.~. .................. Height ............................Number of Stories ....... 1~-. ..................... 9. Size of lot: Front ...]-~'. ..................... Rear ..... ~.,~' ................ Depth ........ I~'.Q ........................ 10. Date of Purchase ........................................................Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ......... ~.I, IL"...I~I,~.~.~ .................... ~ ................................................ 12. Does proposed constructiOn violate any zoning law, ordinance or regulation? ......... ~.O ........................................ 13. Name of Owner of premises ..]~,,~,,.T~. .................. Address ............................................ Phone No ..................... Name of Architect ......................... ~ ............................ Address ............................................ Phone No ..................... Name of Contractor ............ [o~,[.~g ..................... 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. YD, P,K. ) ,~e ^ 0 COUNTY OF .......... ) S.S. ....................... · ~l.W~..~,,.~ )J;'~...~g ~ . be rig db y s~arn, .deposes and Says that he is the applicant (Nome of individual signing application) above named. He is the ....... QW~aZ'. ...................................................................................................................................... (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 cation that all statements contained in t~is application are true to the best of his knowledge and belief; and that the work will be performed in the ~ fl~ in the-appl!cotion filed therewith. Sworn to before me J'his .................... co.. ............................. TOWN OF SOUTHOLD BUILDING I~PARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, N. Y. ~xomined ........................................ , 19 ........ Approved ........................................ , 19 ........ Permit No .............................. DisQpproved a/c ............................................................................................ Application No ............................. (Building Inspector) APPLICATION FOR.~UII~I~ PERMIT Date ........ ~,t/&1~e.t~..~1 ......................... , 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 drown on the diagram which is part of thi.~ applica- tion. 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 applicont. 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/V~DE 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and~regulations. / ....... ................................. \l ...................... ..................................... (Address of applicant) Stote whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....................... ~,~J.9~.~,...~!~ .................................................................................................. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ...................... Street and Number ...................................................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ................................................................................................................................ b. Intended use and occupancy ......... g~.e...~.l...~..~?.. 3. Nature of work (check which applicable): New Building .................... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other 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 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 .............................. Rear .............................. Depth .............................. Height .............................. Number of Stories .............................. 9. Size of lot: Front .............................. Rear ................................. Depth .............................. 10. Date of Purchase .......................................................... Name of Former Owner . ! ]. Zone or use district in which premises are situated. 12. Does proposed construction violate any zoning law, ordinance or regulation? .............................. ; ............................... ]3. Name of Owner of ~remises ...................................... 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. STATE OF NEW YORK, ) COUNTY OF ............................ ) S.S. ................................................................................................ being duly sworn, deposes and says that he is the applicant (Name of individual 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 sta.tements 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 gpplicgtian filed therewith. Sworn to before me this ........................ day of ............................................ , 19 ........ ~ Notary Public ............................................................ County (Signature of applicant) ?