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HomeMy WebLinkAbout2092-zFOI~i~I NO. 4 TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. IZ£RTIF'IIZAT£ OF' IZIIZIZUF'ANIZ¥ No. Z. ~6.X. .... Date ................ October · · L~+., 19.66. THiS CERTIFIES that the building located at ~/l{' T~I"J~' ~{~,yi~' ............ Street · x~rxx ..... Lot No. 1'~.6 ..... ~m~tl~ol~l'i '~t¥~: ..... conforms substantially to the Applicatl, on for Building Permit heretof, o~'e filed in this office dated ............. .~ .... [lil~ 1~.6~. pursuant to which Building Permit No. ~ 'I~' dated ............... ~1110.'0 .... [1+1~. '~2~' was issued, and conforms to all of the require- ments .of the applieable provisions of the law. The .occupancy for which thls certificate is issued is 'P~t.'~.~.~' 'Or~O' ~am:t~7' ~lw,'~l'~r~g ........................................... The certificate is issued to .. ~l.l~-~a. ~eh~2rl~ ......... ,0~t~ ..... ~ .................. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health App,,oval ....... {~4,R'~; ............................ Building Inspector '~ FOt~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS F~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2092 Z Date .......................... J~.~le ....... .1~ .......... 19..6..~. Permission is hereby granted to: · "~s'""Ets~e"~ha~e .................................... ............. ~e~.~y...L~e ........................................... ..................... S~u.~h~t~ ......................................... to ...Bu~,ld...an..add£t io~..on,.smdexi$~n~..awe],l~ ...................................................... at premises located at ...L~...l~*.~,..t6,~..-J~a.~h ,e~..Ove~..~,P...~.O.~.~ .............................. .......................................................... Terry'w,*~e ~"'"'Sou~ho]:d .................................................... pursuant to application dated .................................. '~'J~L~"'"'[~' .......... 19..63., and approved by the BuiJding Inspector Building Inspector FOt~M NO. 1 TOWN O.F SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOI.D, 1'4. Yo Approved ........................................ , 19...7....Permit No ................................. Application No. '~ ('~) ~' ~ Disapproved a/c ..................... [....~ ................ -.~ ........... ....... ......................... ('B~'i'l ect;~'} .............................. 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 [at 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 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 po rt for any purpose whatever until a Certificete of Occupancy shall have been gr.anted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Pernqit 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) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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: ...... ./....O...,~..~.~y .................. Lot No: ./.'.~.~.~.../...~_.. Street and Number .....-h..~..~Zc..~.~.~..~.4~X....c.~/k~..~,.~.~. ........ ~¢¢.-~(~.~.....~.,....~./. .......................................... ~ 'Municipality ; ~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: l ,B · ._ . a. Existing use and occupancy .~ ..~...~.~.,-~¢~. f.~.~.~Z..~ ........................... b, Intended use and occupancy .......... ~.~.',..~,~.'%.K~.(..,,~,J~k~',.~.,.~.~. ...................................... 3. Nature of work (check which applicable): New Building .................. Addition ..... ~.~ ..... Alteration ............. Rep?ir .................... ~rnoval .................... Demolition .................... Other Work (Describe) ........................ 4. Esti~nated Cost ....... .~..,~..O.....C~.. ....................................... 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. Dim~ensions of existing structures, if any: Front ....... j.~ .............. Rear ........ I..~ ............. Depth ...~1,~. ............... Hei~lht ........ ./...%:~.. ............. Number of Stories ......................................................................................................... Dimensions of same structure with alterations or additions: Front .....~.~g. ................... Rear ...,~g,...~,. ................. Depth ....... .~....~.. ............. Height .......... ~. ................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ......... l..~ .................. Rear ...... .~..~ ................ Depth ...~....~. ............... Height ...... ~ ................... Number of Stories .................................. 9. Siz~ of lot: Front ....... I..O.O ................ Rear ./..~...~..r...~..~'~' ..... Depth ...~L.~..Si....?,/'.,-~..-z...~.o..a 10. Dat~ of Purchase~..0~.....~,...O...~.....l....~..(o..I ........... Name of Former Owne....~. 11. Zorie or use district in which premises are situated .......................................................................................... .~. 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................. 13. Name of Owner of premises~.~..~.~.~z~--,~..AddressZ'-~j.~..~a~a~iShone Name of Architect ...................................................... Address ............................................ Phone No ................. Name of Contractor .................................................... Address ............................................ Phone No ................. PLOT DIAGRAM I_ocatb clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr~ property Ifnes. Give street and block numbers or description according to deed, and show street names and indic~ whether interior or corner lot. STATE OF NEW Vo~RK, , -- ) - - COUNTY ~OF ~ ~'~' ................. ~....~.....~ ....................... being duly sworn, deposes and says that he is the applicc (,Name of individual signing application) above-na~ed.,6-te is the ........ ~ ....................................................................................................................... i (Contractor, agent, corporate officer, etc.) of said owher or owners, and is duly authorized to perform or have performed the said work and to make and 1 th~s' o,pplication; that all statements contained, in,~hisu~, apolication. . are true to the best of his knowledge and bell and that the work will be performed ~n the,,man~csg~ ~f~ m the application filed therewith. /~day of ............. ~ ., 19...~ ~, . ~ / / ..................... Z ', ............. ..................... FOP~M NO. i Examined ...................................... , 19 ........ TOWN OF SOUTHOLD BUiLDiNG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................. Approved ...................... ;:.~~t ]~o ................................. Disapproved a/c ............................................................................................ (Buildin~ Inspector) APPLICATION FOR BUILDING PERM~._...~. / ~ [ (~ Date ........................................................ , ] 9 ................ 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 Ioca¢ion 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 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 Southo]d, 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) ~f' (Address of applicant) ' ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......... ~.:M?..~z~.~,.....~.~.~,~r..~ ......................................................................... 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 (~ ~ Municipality ~ 2. State existing use and occupancy of premises and in~ended use and occupancy of proposed construction: a. Existing use and occupancy ........ . .~...~ .~.'..-~.. ~ .~Z. ~.¢v......~.~~~ ..................................................... b. Intended useandoccupancy ..... .~...~:z~..~..(~t~......~.....-R~:..~...~.~.Zi..'. ................................................... 3. Nature of work (check which applicable): New Building .................. Addition ....L,~.. .......... Alteration ............. Rep:air .................... R~qoval .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ........... ~..O.....O. ................. ..................... Fee ..................................................................................... (to be paid on filing this application) ,5. If dwelling, number of dwelling units .............................. Number of dwelling units on each floor ........................ ~f g~rage 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 ....... .~.....--~.. ............. Deplth .... ¢2,.~ ............... Height ......... c~ .................... Number of Stories ........................................ 8. Dim"ensions of entire new construction: Front ..........!..9 .................. Rear ......... ~...0. .............. Depth ....... .Q....~... ......... Hei~J~t ........ ~ .................. Number of Stories .................................. ~ ~ff-,.~-, / ~ -- ,/¥'~zF,zy/ 9. Size of lot: Front ....... 'k .(~.. .................. Rear ../..0...-R.,...0..~:~ ..... Depth ._..~...~..~..:..~..~...z......~...q. R2'V'/ 10. Date of Purchase ..~ ~-~...~.b.r....J.....~. ............ Neme of Former OwnerX(~.~...'.ZJ'~:.....~.. . 11. Zone or use district in wh~h premises are s~tuqted ............................................................................................. 12. Does proposed construction violate any zoning law ordinance or regulation? ............... ................................. 13. Name of Owner of pr,emises . ,~m,.~fZ-~Address . (~hone N Narhe of Architect ...;- .................................................. Address ............................................ Phone No. ' Na~e of Cont?actbt ..~ .................................................. Address ........................... ; ................ Phone No. ! DiAGRA ~,; PLOT ,M Locate clearly' and disti'nctly all buil~ngs, whether e>~isting or propgsed, and in~licate all set-back dimensions property lines. Give street ahd block numbers or descriptign according to deed, and show street names and indi~ whether in~erior 6r corner lot, STAT'E O~ NEW Y~ORJ(~, ~,~ ) ~ ~ ,' COU NTY~.~,_ ~'b'.OF '~~') b ~ , ...............~....~,,..~..,~.,, ; .......................~.~ .......... being duly sworn, deposes and says that he is the applic( (~,a~e of individual signing application) above named~He is ~he ........ ~~ ...................... (Contractor, agent, corporate officer, etc.) of said owher or owners, and is duly authorized to perform or have performed the said work and to mbke and this application; that all statements contained in t~is application are true to the best of his knowledge and bell and thflt the work will be performed in ~ ~]~K~r~h .~n the application filed therewith. Sworn to b~.efo[e me this ~ J~o 52-0344~63, .............. ~.:z ..... aayof ................... ~ ....... ~ y..~ ~ ~. ' ~ . · j ............ ........................ Notory Public, ,.~,.~.,.,~~~ (Signqture of opplic~nt)