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HomeMy WebLinkAbout2169-zFORUM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ~./~ C~eD, tra], Ave ..................................................................... Street Capt Kidd ~state~ *', Map No. Block No. Lot No. 1%6~ ~.a. ttituek conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................................... ,A..,~:~.t........~.?, 19...~.~ pursuant to which Building Permit No. ................ Z2Z69 dated ............................ .A..I~..~'~..S.~.....~.?....., 19...6..~..., was issued, and conforms to ali of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ~.~v.~te one family, dwellin~ The certificate is issued to ~)..a..".~.~ ;~4s...t. ates In~ Owner (owner, lessee or tenant) of the aforesaid building. H.D. approval October 1963 by R.Villa ...................... ....... ..... Building Inspector / TOWN O~ 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) N? 2169, Z Dote ................. i.....~.~lg~S~......~9 ........... 1963." Permission is hereby granted to: Russell A1s~..C~ ...... .... 13..S~et,..D~ ............. ~ .......................... .......... ffm~.th.T~n...:...I~,. ~., ................................. to. ~B~lid.. neg..one.. ~'~tt~r.. 4twe!ltr~: ................................................................................... at premises located at ....l~t..~..~.r...-.~p~..K.~.d~-.~at~ ........................................................ .......................................... Can-tr. ~t...D~.l-vet ....... F4a.~l.tu~k ........................................................ pursuant to application dated ........................... ~Al~.tA~t ....... ~.~ .......... 1963... and opproged by the Building Inspector Fee ~1. O...OO ............ FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ...... Permit No ................................. Application No...~;./....~....~ ........... Disapproved a/c .~.~:.;:~..~...:~ ...................... (Building In'tar) APPLICATION FOR BUILDING PERMIT 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 buildings on premises, relationship to adioining premises or public streets or areas, and giving a detailed description of layout of property must bedrown on thediagram 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 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 app :lCant, ....................... or name ":':'Tit a ............ corporation): ............ ............................. ............. : .......... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. /, . ..................................................................................... ' if applic, c~n,t is a corporate, signature of duly authorized officer. (Name and}'itle of corporate officer) 1. Location of land on which proposed work will be done. Mop No: ~ '~ ~ ..... "'~ Street and Number ~' '/~ ' ' / ~/~'~ Municipality 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 ~;f~/¢;~2z7(~ 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 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 Depth ............................ Height ................................ Numbe? of Stories ........................................ 8. Dimensions of entire new construction: Front ........ ' ....... ~ ........... Rear ......... .~.f.~ ............. Depth ....I?./ Height .......... [.?.'. ............. Number of Stories ................ ~ ................. 9. Size of lot: Front .............. ]. ................ Rear .......... .C.~..O.. .......... Depth . I 10. Date of Purchase ........................................................ Name of Former Owner 11. Zone or use district in which premises are situated. 12. Does proposed construction violate,~_ __ c, ,~_,.z_. /any zoning law, ordinance or×~,_ ,~,,~ ~..~;,~/regulatio,nP ........ 13. Name of Owner of premises ....~.¢~....~.....<-Z~,.(./.z../..~.?../.~.:~.Address ....... f'.'..~.~-.~(../.¢:...~.'..~%../C.~./~... ...... Phone No. Name of Arch,tect ....o,.,m~. ................. ¢.,., ........... . ........ Add ess ....¢,.z#.:z.-..:/~....~.. .............. Phone No. Name of Contractor ..../..z..4.~?.;../../........~..?./..~..~.:....~.:..........Addross ....../.?..:...b/~..'c~/.../C...~'..'k'~'.~'...<.../...' ..~... Phone 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. STATE OP NEW~J~,. ~ / ) ,.~ COUNTY~.~ ~.~ ) ' 0~..,). ~'~' , ............. ~:~~ ......................... being du,y sworn, deposes and says that he is the applic, (Name of individual si~qing ,applicati?) above named. He is the ...~~~* ~ .............................................................................................................. (Contractor, agent, corporate officer, etc.) of said ow,her or owners, and is duly authorized to perform or have performed the said work and to make and 1 this application; that all statements contain¢~d in)~Kf~ ~p¢~tion are true to the best of his knowledge and bell and that the work willi be performed~ thec~'~4~f~a~,~},~e~Z~t~,.., ~ "'"';?.'" ~ application filed therewith. ............ o, Notary Pu?',~~." 4-~¢e of applicant) FOP~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ ~ lc; ........ Permit No ................................. Disapproved a/c ...,.,.~...,.~.~....~.. ......................... (Building Inspector) Application N o, ,c~,~,, ./., .(,-~,. l ?. ........... APPLICATION FOR BUILDING PERMIT Date ........... .~.../....; ~. ............................... , 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 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 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, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) / State whether applicant Js owner, [~ssee, agent, architect, engineer, general contractor, electrician, pbmber or bui]der. m,eo ow,.,o',,emes ........ ........ :.:..:.::..::. ......... .......................................................... If appliqcnt is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done, Map No: ......... ~/.~ .........../'//¢¢/) ~-~..~.-,~.~ Lot No: .................... / % Municipality 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 ......................~-.~/~,~:i¢..~.~ ............................. 3. Nature of work (check which applicable): New Building ...... ..~..'. ...... Addition .................. Alteration .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Fstimoted Cost ............................................................. ee ..................................................................................... (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. Dimensions of existing structures, if any: Front .......................... Rear .......................... Depth .......................... Height ............................ Number of Stories ......................................................................................................... DiMensions of same sh'ucture with alterations or additions: Front ................................ Rear ............................ DelJth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front .............. ~..(~ ............ Rear .......... :~: ............ Depth ......... ~..~.. ....... Height .......... /...'?. ............ Number of Stories .................. I ............... I 9. Size of lot: Front ............. .~...O. ............. Rear .......... ..~..~..i ........ Depth ............ I....%....O. ................. 10. Date of Purchase ........................................................ Name of Former Owner .................................................... I1. Zone or use district in which premises are situated ............................................................................................. 12. Does proposed construction violate on~y zoning law, ordinance or regulation? ................................................ 13. Na~ne of Owner of premises ~I)~ Name of Architect ..~.)..c.'.//..~.r~.%l~,....~......~.~z:'/. ......... Address ...... .~..~ .~..f'/.~.. ..... Phone No. Name of Contractor ...~..~.~.5.~.~../.~'......././.././~.T.~......~..~'.: ......... Address ../...~..~-~...~..~.~...z..~ ~...../~... ....... Phone No. PLOT DIAGRAM Locate 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 indic whether interior or corner lot. / l.o% STATE OF NEW. Y~RI.¢4',/~..// ) S S COUNTY,OF,~.) ' ' ....................... ~~ .................. being duly sworn, deposes and says that he is the applic~ (Name of individ~ls~gn ng~' ' flication) above named. He is the ......... "~'"":"~.~~ .................................................................................................... ,~.' (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorizefrl~tf~ Rerlf,grlr~ or have per~ormed the said work and to make and · this application; that ail statements cont¢in~d~.duc,tl~i~,,apl~l'kca~,ibn are true to the best of his knowledge and beli and that the work will be performed in theCr~P,~f~¢?f~t~&J~e'~pplication filed therewith. Sworn to bef~me this / ............... ' ........... :'"ii "L' ....................... . ....... .... ..........................................