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HomeMy WebLinkAbout2167-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..~..~(~t~J ............ Date .......................... ~J~.ellllJ~,,~.....~J..., 19..~'. THIS CERTIFIES that the building located at ...~.~..]~II~..~T~ ...................................... Street G. !. Tuthil! Map No ....................... Block No ........... ~ ...... Lot No. '"]']'t .......... [~tl~el.t......lJ-.~, .................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................................... Ati&u~t....21[...., 19.63... pursuant to which Building Permit No. ~.~...~. dated ..................................... All~.~.....2.~, 19..6,~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ............. ]~Z i~ ~t.t e...olde.. ~.~l :[Y.... dl~e.1 ~ ............................ . ....... The certificate is issued to ....~f~.2~n..&..~'~lecta.....Taeh~elal~e~ ................. I:)~lle~.s. ............... (owner, lessee or tenc~t) of the aforesaid building. FOP,~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 2167 Z Dote .............. ~IS~ ............2~. ........... 19..6~. Permission is hereby granted to: I~,rtt. n.-~b ..1~'.~ e~a......T~c~I~ .......................... · ...Br~y.....~ve ....................................................... to ...... ]~ .~ .i. -t~1 · .-an...ad-~ .i.~ .$c,n.. ~rt-..a,,~ ..~ ~ ~n~ ·. d~e.~.n~ .......................... .(. ...................... at premises located at ..... 10~,,..~.~t.....~..O~...G,.I.~.~;Lll ...................................................... ................................................ :~/~.. 13r~...Av~ ......... ~u~.eZ ........................................................ pursuant to application dated .................................. A~..kl~.~....~.....19~,~..., and approved by the Building Inspector Fee $..5, ~)0 ............. Building Inspector TOWN OF SOUTHOLD BUILDING DI~PA~TME~,I'I~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om,ned ...... ........ , Approved ........................................ , ]9 ........ ~ormit ~o ................................. Disapproved a/c ............... ~ ................ ~TZ ........ ~/ ~ ~' ~ ........... ~= ........ .................. ................................ Application No. ~)- I ~-~ ~ 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 shewing 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 bedrawn on thediogram 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 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 applicable laws, ordin~.~s~d'reggJ~o~s. ,~ /~ (Signature of applicant, or nome, 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. ~ocotion of bnd on which proposed work will be do~e. Map No: ......... ' ................................... ~ot No: ...~..,~ .......... Street and Number ...~...:~ ...................................................................................................... (/ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ~. '.Z . ..~...~ ................... b. Intended use and occupancy ...... ~:....'f~4....'T....~.~.. .......................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated t, ost ............. t .............................................. t'ee .,..~... ................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units .............................. Number of dwelling units on each floor ......................... If gcirage, 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 ....... ~5..'7(~ ........... Rear ........ .~...'~. ........... Depth ....o~....o..'....-:......~...~ Heightw. ........................... Number of Stories ..... / ................................................................................................... D ens ans of some str cture w th a terat ons or o d t ons: Front ....... 'Z.Z,..f. ........... Rear ....... ......... Depth ........ ..'~....~ ......... Heightx ................................ Number of Stories 8. Dimensions of entir~ new construction: F:ront ............. ~ ................ Rear ............................ Depth ........................ Height ....... Lts...~ ............ Number of Star es...../. ........................... 9. Size of lot: Front "5-'O / Rear ~<'~D ~ Depth 10. Date of Purchase ..~. ...... /.~...47~.. .................... Nome of Former Owner .. 11,/ Zone or use district in which premises are situated .............................................................................................. 12. Does proposed construceion violate any z. oning Igw,. ordir~ance or regulation...~ .................................... 13. Na~e of Owner of premi~ses~..~../..."~...~..~...~ ............ ~..~...~. Phone No?~/.....~..~Z..~/., Name of Architect~.~..~~Address .~.~.~...~o/~..°~....~.T.~ Name of Contractor ..~'Q~ ...................... Address .~¢~....~ ........... Phone No.~........~. PLOT DIAGRAM Locate 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. \ \ i STAI'E OE NEW ~R,K~ COUNTY'~OF ~..e:C/.I S.S. ........ ~.~.'..~ ......... ~ ...............be'n~ duly sworm deposes ond s~ys thot he is the (Name of individual signing application) above 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 bel and ~hat the work wdl be performed m the mannggt~f~l[~f~? the appl cat on f led therew th. /) ~ : ~ ~/~ ~ J ........ ~.w.. .......~.~ .................... ~ ............................... FOI~I~f NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ....... ....... , Approved ........................................ , 19 ........ Permit No. D,sapproved o/c ............... ............. ................... ............................................... (Buffdino Inspector) 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 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 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building ~nspector. APPLICATION [S 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 applicf~ble Laws, Ordinances or Regulations, for the construction of buildings, additions or a Iteratio,,n/% o/~?for rem_o,~l o~demolitio~, as herein described. The applicant agrees to comply with all applicable laws, ordin (Sign~:ture of applicont~ 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: ......... c~ ~ ) Lot No. Street and Number .......... ,/ ............................... '~j'~'i~i~ii~ ............................................................................. 2. State existing use and occupancy~ premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. ntenaea use aha occupancy .~. .............. :~m .................................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition ........1~... ....... Alteration .................. Repair .................... Removal .................... Demolition ....... ,¢ ........... Other Work (Describe) ........................ I 4. Estimated Cost ........./...(~ ...................................... Fee ..~2...: ............................................................................... I .... (to be paid on filing this application) 5. If dwelling, numbe~ of dwelling..4units .............................. 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 ..... Dap'th ......~.....'~., ............... Height ................................ Number of Stories ....... ./. ............................... 8. Dimensions of entire new construction: Front ........ .%:~7....,.~- .............. Rear ...... ~ .................. Depth Height ............................ Number of Stories ......l .......................... 9. Size of [at: Front ~,~'-0 ~ ~-'~ / /q~) ....(//~' .......................... Rear ....; ....................... Depth ........................................ 10. Dote of Purchase~......'~...-....../..~...'~......?. .........Name of Former Owner J" ~'J ' '~ 111" Zoqe or use district in which premises are situated. 12. Does proposed construction violate any zoning Iow,, ordina0ce or regulation? .~.. re i ~2/~'4x'~/'~ ! ~ No~L~ 13. Name of Owner oep m se~ ...................... ~ ...... ~ .......... ,, ...... . ..... Phone Name of Architect .'..~..~..~AddressO/~..(..~..~one No.~ Name of Contractor ..... ..~..~ ....................... Address~ ....................... PLOT DIAGRA,M kocatj~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fn property lines. Give street and block numbers or description according to deed, and show street names and whether interior or corner lot. STATE OF, NEW~OR, K/ , ~ ) COUNTY OF ........ ~/~..~~z~ ......................... b ' g duly sworn, deposes and says that he is the applico (Name of individual signing application) above named. He is the ........... ~~ ..................................................................................................................... (Contractor, agent, corporate officer, etc.) of said oCner or owners, and is duly authorized to perform or have performed the said work and to make and this applic'ation; that all statements contained,inr, t~L~ppffcation are true to the best of his know/edge and bet and that the work will be performed in the mo~t Ce~e~6 in the application filed therewith Sworn to 5efore me thi; u0,,,~s;,;[; '~¢~(¢r~sS~a~'¢~ ~¢~$~ / r~ ' ~ ~ ~ / ~ ~ J ........ ~/.~r.~cr.....~.~c.~r.r.r~r.~.x%~ .................................