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HomeMy WebLinkAbout2139-zFORi~ i~O. 4 TOWI~ OF SOUTHOLD BUILDING ~EPARTMENT 'I'OWI~ CLERK'S OFFICE SOUTHOLD. N. OE~TIFIOAT£ OF OOOIJI:ANOY THIS CERTIFIES that the building located at .~4.-..~4t21.1..~l'~.ek. ~]X':t.v.e ..... Street Map No.. XXX ....... Block No ...... ~,]~... Lot No. ~ ...... ~Ollt;~lO3,Ct~...~.~/'~ ........ conforms substantially to the Applicati, on for Building Permit heretofore filed in this office dated .......... A%IgllS~...2 .... 1963. pursu'ant to which Building Permit No .... 2~9Z dated .......... A.~g%L~%...2 .... 19~.~.., was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The .occupancy ~or which this certificate is issued is . ~.~'$,.V.~;.e..~%~. I'.a~l,].y. ~l%telling .......................................... The certificate is issued t,o . .A IISI[ax'. F. lak ..... 0~IleI'. ................................ (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ...~/..~-.9../..6~...Ai~d~e~ .............. o , Building Inspector FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ©N THI: PRI:MI$£$ UNTIL FULL COMPLFTION OF THE WORI(AUTHORIZED) N? 2139 Z Date .......... Permission is hereby granted to: ~s~'"~a~c ......................................................... '69"~'~¥~:"~'~ ................................................ ....... ~'Z~ ....................................................... to 't~'iifZ'd" ~ii~ki/"~5~ii~"';f ~'iitZ~" 'c'F#& 1Zf'z;iiii ..................................................................................... at premises located ut ... ~7~ '""t~'II"C'i~ii~Ii" ~i":i~if ....................................................................... .............................................. !t'~i~'i;'ii'a':lii'~"i'"it';'~: ............................................................................... pursuant to application dated .............................. ~ ....... ~. .......... 19~..-, and ~proved~b¥ the Building Inspector Fee $....~'Q~.O0 ........ FOP~Ff NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... n .~.. .... ~ ........, 19 ........ Approved ........................................ , 19 ........ Permit No ................................. Disapproved a/c ............... (Building InSpector) Application No..~...~.:.~.....o~ ......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o, 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 tot 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 port 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 sholJ 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 ar a~terations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ........ ......................... , (Signature of applicant, or name, if a corporation) (/:~dress of applicc~nt) // 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 pro, posed work will be done. Map No: ......................................... :.. Lot No: .................... Street and Number .. ~_~.~..~.~.~...~.~: .~.....A~..,~ 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 occupa cy ..................................................................................... 3. Nature of work (check which applicable): New Building .................................... ~ Addition Alteration .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Esti ated Cost ........................ .~...,¢'-:..~ ..................... Fee ...................................................................................... (to be paid on filing this application) 5. If d~elling, number of dwelling units ...........: ....... ~ .......... Number of dwelling units on each floor ........................ If garage, number of cars ....... .,ff. ............................................................................................................................... 6. If business, commercial or mixed occupancy, spe~ ~,~,~.and extenj~lltype of use ....~.C~...'../..:: ..... 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 ........ ~7 ..................... Rear ............................ Depth ........................ Height ..... ....... /~/.' ............... Number of Stat'es .......~ ....... , .................. ~ ~ ~' .~r .<~' ~ ,S"" · t~' ' 9. S ze of lot: Front .......................... Rear ................... Death . ,. ' ..... × :. ,,.,, , ............. r ............... , 10. ua~e az vurcnase~./..~./C.. ............ ~ .... Nom~ of Eormer Owner ....., 11. Zone ro use district in which premises afc situated /~'! 12. D°e~ pr°posed construction ~iolate~ny ;~onj. n~ aw, ordinance or r~aJzlati~n? ..Z~..C~....~, ..... .... /-.: ~4',~-,;, ~,,¢-~,~z .)¥r,-~ z.~. ........ '~'~,",~.~.~ 13. t'~ame or uwner or premis~t',~..~.,~...:.'ff ...... ..,,>Z~...~.'~.!....Address .................................... i~. ..... Phone No ~" ~, ~-~v ~,~,,~'~ :~-~, ~ /' Name of Arch tect/Z~.~ ~ ~C~ Address~..~' _ ' ' ~,~^ M^ ..........~ ~~~'L ........................................................................ ~".'"" ~ ~"~"~ '~ ......... Nome of Contractor .~.~..~..,'.~~ ...... Address ~~..~'..~..~ Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property fines. Give street and block numbers or description according to deed, and shbw street names and indic~ whether in~erior or corner lot. NE~/~Y(~PcK,~,//(~ ) ~ ~ STATE OF ...................................... ..~..:..c~.. ............................... .~ .............. being duly sworn, deposes and says that he is the (Name of individual s~ng application). above named. He is the ~(~-~¢~ '- (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to ~erform or have performed the said work and to make and this application; that all statements contained in t~is application are true to the best of his knowledge and beli and that the work will Be performed in the manner set forth in th~li~ filed therewith. Sworn to b~fore me this .......................... ' .......... '~ .......... ~2 .... ~.:~., ......... ......... .................... FOR REVFRSAL of the house design, these plans are reprinted (in reverse) on the back of each page. To facditate use of the reverse plan, take the main d~mensions from the front of each sheet 'l LIVIN~ 1&'-4~ ~PY'~']5/.~C~, ~,mi.loa,sbe~b~lmnmdlo,he ~u[,A ..... build f,om ,he~d ........ H .......... in,~d *. . · m RUDOLPH A. MATERN A.I.A. /) ~__. I i- , ,,I -,j RUDOLPH A. MATERN A. I.A. -/) -- · · ! designoj z~ ~J.'~number TI .L ,I II ,I I I I IDRAWN APPROVE BY J -'1 r_l z4'~z4'At~ c~c )RAWN BY BY RUDOLPH A. MATERN A.I.A. REGISTERED ARCHITECT Idesign number ~442- SILL detail aluminum double hung windows in, frame wall ~1 F&EPLACF_ ~;[CTIO~ DETAILS b EbF___TAI L$ DRAWN BY APPROVED BY RUDOLPH A. MATERN A.i.a. design number q JAMB RUDOLPH A. MATERN A. i, A. ?v,.,~o.,.,,o,.~,..,=.u,u~,.,~ ~ IV[ £,~/Fy/L )/