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HomeMy WebLinkAbout2055-zFO~M NO.~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE~ OF OCC:UPANCY No...Z..21~5 ........... Date ..................... A:~./,&...~ ................ , 19.65.. THIS CERTIFIES that the building located at G:caacl. A.v. er~.ue..&..t~/o.Qd~.l/.~'../)r.~.e$~titu~k~ Map No .......... .XXX ...... Block No ......~ ......... Lot No ......... ~ .................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................... ~TI/1~...1.~/.~...3,9.6~l ........ , 19 ........ pursuant to which Building Permit No..2...0.~.5.~ .... doted ................. J'U),~."I{~""A'96'3 ........ , 19 ......... was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .......................................................... one,. · ~am,~.~. y.. ~,et .1..%n¢~. ......................................................... The certificate is issued to ........... Allan..~.,.D~cker~on .............................................................. (owner, ~essee or tenant) of the aforesaid building. Building Insp~'tor FOl~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS I~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2055 Z ~ate ........................... ~U~"'""I~ ............ 19'6~" Permission is hereby granted to: · .A.l. la~..~)teke~;en. ........................................ ........ ~a~.-&..~o~et-i~£-..~ ............ : .......... ............. .~la-~t.~k .............................................. to 2u. tld.., a.n. · ~dd.i %i.o~ · .~*. an. · ~;.$ ~.l~it~-*~e t.$t~1tI ......................................................... at premises located at ..W/~....G~en~:..t~e,.~.~*/S..~od~ti-f~.-B~ .......................................... ................................................ lial;ti.ttt~k~ ..... l~,.~-, .......................................................................... pursuant to application dated .......... ~ .................. ~'~c~"'"~'~' ............... 1963...., and approved by the Building Inspector Fee $..~.~.O0..~*.~.h~ FORM~ NO. ! Application No. ~,...~...~,..~..: ........ (Building/i'nspectbr) APPLICATION FOR BUILDING PERMIT Date ..........]~).~t~Y~.....~..~. .................... , 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 approyal of this application, the Building Inspectbr will issue a Building Permit to the applicant. Such permit shall be kept on the premise~ 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 Certi~ficate of Occupancy shall ha~e been gr.anted by the Building Inspector. APPLICATION :IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building .Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable kows~ 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 anc~gulations. ~. (Signature of/applicant, or name, if a corporation) , State whether applicant is own~essee,k,_k~,.__..j~.~.k~. 'agent' architect,., Engineer,., ,general contractor, electrician, plumber or bu der. If applicant is a corporate, signature o,f,duly authorized officer. (Name and title of corporate officer) 1. Location of land on whiclj proposed work will be done. Map No: .................... Lot blo: ............ Streetand Number ..~:J..g0...~...?..~...~'....~.~ ~..O...~. ~ ..~..~....~....c:..~L(-~. ~£.. ~.~.)~'~ f..~.~ C~J ~ -- Municipality '~ ............................... ~ ...... 2. State existing use and o~upancy of premis~j--~d i fi[ended use and occupancy of proposed construction: e. Existing use and occupancy ....................... ~ ....... .~.)~ ....................................................................................... b. Intended use and occupancy ...................... ..xZ.~, ...~...~.~.,~,..~.,.,C~... ........................................ 3. Nature of work (check which applicable): New Building.. ................. Addition ..~............... Alteration ............. Repair .................... Removali .................... Demolition ................. ~ Other Work (Describe) ........................ / 4. Estimated Cost ..................... ~,O..?.~ ............................ Fee ......... ,,~..~. ..................................................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling unJJs .~.~.~.~..~.....~..~...~u~'rr~er of dwelling units on each floor ....................... If gbrage, number of cars ........... ..~..~)ffL~J~......Uk~,~IT....~...~....~....A~..,~.'.) ............................................................ 6. If business, commercial or mixed%occupancy, specify natu~ and extent of each type of use ...~ ............. 7. Dimensio~of~,l ~1~ T~xisting structures, if any: Front ........ / ...~...O.[_ ........... Rear ..... ,~...O. .............. Depth .....~ .............. Height..t,~..t~..~.~,. Number of Stories ...... '~ "~" "YJ~'"~' ........................... '~ ................................... 'i ............... Dir0'ensi~s i~f: .~.0.s°m'~'-s~;~ctu re wi t h (~Za~,Llotn s....~ '~°r ~ditions~ FrontNumber of Stories ......... ....[...~.' ~..~~, ,"~ ~,,~Rear ......~.~.~.~. Depth ....... .............. Height ....... ..~.~ ...... ...... 8. Dimensions of entire new construction: Front....~....~.fC .............. /l~ear ...... :.k.~'..~.....,.J..... ~l~epth ...... ..~...1. .......... Height .................. Number of Stories (.~.~ S~...~4.. '[~O~O.M-t~ .......... ~ I ....... i'~:"i"-"~'"'~, \ ,"~ 9. Size of lot: Front ............. ~...~........~..~. Rear .......... t.~....~. .......... Depth ........ ~.....~..O......:.. 10. Date of Purchase ................... .......... Name of Former Owner ....... [.~..[.~..~...~.......~/L~.~..~.... 11. Zone or use district in which premises are situated ............................................................................................ 12. Does proposed construction vi~ate any .zO~ng t[aw, ordinance o~regul, ation? ...... 13. Na~ne bf Owner of premises ...!~.~/~,'~...~.:...~,~..~dress ...... ..~. ~'J~....~..t.i~'.[~... 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 fr property li. nes. Give street and block numbers or description according to deed, and show street names and indic, whether inYerior or corner lot. ~,/_' STATE OF NEVv~OR~r ~)~, ) COUNT.* (Name of ' divid o' above named. He is the ........................... (Contractor, agent, corporate officer, etc.) of said owlner or owners, and is duly authorized to perform or have performed the said work and to make and th s applic.otion; that all statements contained in this application ore true to the best of his knowledge and and that the work will be performed in the manner set forth in the apF :arian filed therewith. Sworn to ~efore me this ~oto,'V Pub ic, .~~.~ ......... ~ (Siflnoture of opplicont) TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE .~j SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No..~.~'..r;: .................. APPLICATION FOR BUILDING PER/vIIT Date ......... .................... , ....... 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 bui.ldings 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 port of this application. c. The work covered by this application may got 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 o 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 Lows, Ordinances or Regulations, for the construction af buildings, additions or alterations, or for removal or demolition, as herein described. Theopplicant ogreestocomplywith allopplicobte Iows, ordinonce~tio~s. ~ (Signature of~ applicant, or name, if a corporation) ...... ....... ....... ........ (Address of applicant) I State whether applicant is ownC011essee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ........................... i'""i' ................... .......................................................................................................... IF applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 'l~"eoation of land on whic~ propo/9~, d work will be done. Map No: ............................................ Lot No: .................... Municipality ' ' 2 State existing use and o~cupancy of premised i~tended use and occupancy of proposed construction: a. Existing use and occupancy ...................... ~. ....... ~ .......................................................................... e an ~c~ , b. Intend d use and occur cy ...................... '~ ................ .~ ............................................................................... 3. Nature of work (check which applicable): New Building .................. Addition ..~......... ..... Alteration Repair .................... RemovalI .................... Demolition ................. .~-Other Work (Describe) ........................ 4. Ester'noted Cost ........................ ~ .................................. Fee ......... (to be paid on fillng this application) ' 5. If dwelling, number of dwelling s '.~:..~.. dwel ng units on each floor If garage, number 6. If business, commercial or i specify natureond extent of each type of use ................ t ........... 7. Dimensior/~,of eixisting structures, if any: Front ........ ..~..'0'i .......... Rear ..... ..~..~..O..i ............ Depth .......~....~.....4~ Heiiht ....~,i.~,....~.~... Number of Stories.i ~. cb [ .,~ .~.' , Dimensions o/f some s~ucture with "lteratJon~"~i' ~'~t'i~i~'~'s'"~';~'r~ .......... .~..' ................. ~'e'~';''''''~ ................ ............................ ...... - \ A _ J 9. SizeI of lot: Front ............. ~ .............Rear .......... ~,..~...? ........... Depth ....... .~...~....O.. ....... , ........... ~ 10. Dat~ of Purchase .................. .I..~...~...~.......L.~. ~.~. ........... Name of Former Owner ...... ~..Crk~......('~:L~..~(~. .... 11. Zonle or use district in which premises are situated ............................................................................................. 12. Does proposed construction vi~ilate ony,zCm~jng t[aw, ordinance o~;, regu/atiqn? ......................................... .~ ..... Name of Owner of premises L'~A.V, (~'....~'~i~'ddress(-~"/~L~ ~4~ ~A~ Phone No .~." Name of Architect ................................. :'. ................... Address .................... ./..t'. ................... Phone No. Na~e of Contractor .................................................... Address ............................................ Phone No. i PLOT DIAGRA.M [.ocat~ clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions property lines. Give street and block numbers or descriplion according to deed, and show street names and indi whether interior or corner lot. STATE OF NE'v~'~'OR~, 0~. ) COUNTY OF~ ...,,,)..q,.q.~'.~..) S.S. I~11, ,~ 1'~ ~ ................................................................................................. being duly sworn, deposes ond s~ys that ~e is the opp[icc ~ (,~Name. of individual signing application) above na~ed. He is the .................................................................................................................................................... ' (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make and this appHdation; that all statements contained in this application are true to the best of his knowledge and bel and that t,he work will be performed in the manner set forth in the apiarian filed therewith. Swam to 5afore me this.., f~ .......... '.',1 9 ~~ .... .......... , ....... do~..:~; ........ ~ ,:.~.~ ~.....~. Notary Pub ~~ ~~ ~4~f]~]~r~ (Signatur~'~' app cant) '"11 ....