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HomeMy WebLinkAbout2097-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY Date Nove~ez' 4 19 63 THIS CERTIFIES that the building located at ...~U~[e~..~, ~...~,.~,,~.~:][ .............. Street Map No ...... ~ ............ Block No .......e.~ ........... Lot No ........e~ ........................................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .............................. .~...~..~..e...2..O. ................... , 1~.~ ..... pursuant to which Building Permit No. .......... ~ ..2097 .... doted .................... ~.U..~...~.....2.~: ................... , 19.G..3....., was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate ,is .issued is ........ .......................... ~r~.~:B~., .~.U~¢);~. .................................................... The certificate is issued to Ge/~lev~e~e Nat~g].elg, o~e~ (owner, lessee or teh;a,r~t) ' of the aforesaid building. Building Inspector' FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS ~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 2097 Z Dote ............... Z~II~.....~, ....................... 19~... Permission is hereby granted to: Gen~ev~--~a~,~ te~ ........................................ .............. Na~/~le~..~r .......................................... ........................ t,~a~i.~u~tf~ ...,..N, .~.,~ .................. ................ (sho~e~...reor~s.. ert..~k.-.he~.ls~.) .............................................................................. at premises located at *..*E/~9...*.Na. tlg.l, eo..F.a, ..................................................................................... ................................................. ~a.ttt.tuok~......I~.o.~., ......................................................................... pursuant to application dated ................................ '~'*tt~e."'*20 ............ 19~.~..., and approved by the Building Inspector Fee $. ·...~.,v9~ ..~ '- ¢ttk TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ^pproved ........................................ , ]9 ........ Permit No ................................ Application No. ~.~.~. ............. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This app[ication 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 iss?e o Building Permit to the a:pplicant. 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 g~anted 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, ordinajgces and regulati6ns. (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. ome of owner of premises ....................................................................................................................... If applicant is o 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: .................... 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 ..~.....~..-~.~ ........ .... 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 gproge, 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 / .....~...~.. ............Number of Stories ........ Height Dimensions of same structure with alterations or additions: Front ................................ Rear Depth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front ......... ~..~.. ................. Rear ....... ~.. .................. Depth ..I..O. ................ ........~ ''~...~.~.: ....... Number of Stories ....... ./. ......................... Heibht 9. Size of lot: Front ................................ Rear ............................ Depth ........................................ 10. Date of Purchase ........................................................Name of Former Owner 1]. Zor~e or use district in which premises are situated ....... /.Y 12. Do~s proposed construction violate an, y zoning law, ordinance or regulation?, 13. Name of Owner af premises ..... Add ess .~'~.~.~.~./~'..> ...... Phone Name Architect ..... ~ .................................... Address ............................................ Phone No. Name of Contractor ,..¢:=..ZTZ...../...~...~.....~:f~.. ...................... Address .'/..z/_~.4r~..¢.C ............. Phone No. PLOT DIAGRAM kocatJe clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property lines. Give street and block numbers or description according to deed, and show street names and indic whether interior or corner lot. STATE O[k NEW }~ORK,,~ ) ~ ~ '~C' /.~ .............. ~~ ........ [..~ ................................. boinO duly ~or~ose~ond s~ys that he is the ~pplic ' (Name of individual ~igCng application) abow~ named. 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 appliCation; that all statements contained in this application are true to the best of his knowledge and be[ and that ~he work will be performed in the manner set forth in the application filed therewith. Sworn to before me ~i~n~ .... ~ ~ ~ . k~ ~ ~., /~ti~gin Sutf~o~ .... M ................................. ~ .... FO~ N0. ~ ,~ TOWN OF SOUTHOLD BUILDING DEPAI~TMENT TOWN CLERK'S OFFICE. SOUTHOLD, N. Y. Examined ........ ~.~.. ( ........ , 19..~.4~.. Approved ........~ .......... t.h ............ , 19...C'....Permit No.~..C)...:~....~ ....... Disapproved a/c ................................................................................. ~ ....................... 2.~ ............ ................. ............................................ ~ ~(~ildin~ Iffspector) APPLICATION FOR BUILDING PERMIT Application No. ~)..~...'~. ............ 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 adioining 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 e 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 part 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 applic~able laws, ordinancf,~l,?d~7~:'~'':'~''~'''~:~''~'''~''TM~'~'regulati°ns' · (Signature of appl~rpo~gtion) ................ .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .....~....~. ~ .~..~C:.'L._ ........................................................................................................................................................................ blame of owner of premises ...... j..~.~I~.~.L~... ~ ........... ~ ~' .................................................................................. If applicant is a corporate, signature of duly authorized officer· (Name and tide of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number .......... i.}'Z'~?~-:~,~..~'.....~ ........................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................. b. ,ntended use and occupancy 3. Nature of work (check which applicable): New Building .................. Addition ...~;~ ........... Alteration Repair .............. ~. Removal .................... Demolition .................... Other Work (Describe) ........................ ] (to be paid on filing this application) 5. If d,welling, number of dwelling units .............................. Number of dwelling units on each floor If g~rage, number of cars ........................................ 6. If 5usiness, 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 ..... DJr0ensions of same structure with alterations or additions: Front ................................ Rear Depth ............................ Height ................................ Number of Stories ........................................ 8. Dirr)ensions of entire new construction: Front......./~,..: ................ Rear ..... ./.~.[. ................ Depth ..L..°....~. Height ......... ~..~/~... ....... Number of Stories ....... / 9. Size of lot: Front ................................ Rear ............................ Depth ........................................ 10. Dat~ of Purchase ........................................................ Nome of Former Owner ]2. Do~s proposed construction violate any zoning law, ordinance or regulation? ....~. Name of Architect ...... ~ ....... .~ ......................... ...................... Phone No. Name of Contractor ...C,..2~......~..~ ...................... Address i iii~)~i~ ................ Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr~ property I nes. Give street and block numbers or description according to deed, and show street names and indic~ whether n}erior or corner lot. ~. .......... 2.---4Z_ZZ ........... .... "---"----'---- / STATE OF NEW )~OR/l~,, ~ ) S S COUNTY}OF ...~ ....... ) ' ' .............. ~~.....~..~ ................................. being f (Na~ of individbal ~ing application) above named. He is the ou y sworn~ aepog'~ond says that 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 ~ this applieation; that oil statements contained in this application are true to the best of his knowledge and bell and that the work will be performed in the manner set forth in the application filed therewith. Sworn to I~efore me tI~BARA A. C/)~N ......... r~..,..m..... 'aay'Br~..~,5g69~.~....,.~ ......., Notary Public~. corr/m,ss,on'~q~-' "Z~. ~,,. ....~ .. -,,. "~'/ County~ ........... i~'i'~';'~'~J';'e'"~'f"'~'~ii'c'~'~;i'"'""'"' - ' .............