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HomeMy WebLinkAbout2220-zFOR~i i'~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~ N. Y. CERTIFICATE OF OCCUPANCY No..Z..2~L~ ............ Date ................................ ~,19.~'.~....2..2......, 1~)..6.~... THIS CERTIFIES that the building located at ~;~.~t~...jJ~ac~,,..-.~.~e~.~..~.~.~..J~l~:l,.~ Street Map No ........~ .........Block No .............. ~... Lot No ...................... ~ ......................................... conforms substantially to the ,~,pplicafion for Building Permit heretofore filed in this office dated ~'eb~u~¥ 17, ~.961~ 2296~ ................................... ¢~C.j:O~e~.....l. Si....., 19.~.. pursuant to which Building Permit No ..... 22.2Dg dated ....Jt~i~..~l~..~,b~¥~ .................... , 19 ......... was issued, and conforms to oil of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ............................................. On~.. ~,~J~ 1.~... s.ummez.. ~e~J. ~n~e ................................................... The certificate is issued to .......~J~.;ke..J~tl:~,..g.C~PJKg.~...~,~.~.~...q,],. ..................................................... (owner, tessee or tenont) of the aforesaid building. Building Inspector( FOI~M NO. 2 TOWN OF $OUTHOLD 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.o 222o, Building Inspector Fee $....~,,,.00. .......... Permission is hereby granted to: · , ZoJm.. ~aue~ .....A/C ,'. ~e~.~e ..[Ce~e~. .................. ........... 6reen~o~ ............................................... to ........ B1Atl~t..azL add£t;:Lo~..o~a., an,.~x.i~t;i.ng..,d~et, ting~ ....................... : .......... : ............. at premises located at ...~.~.....J~&~..]~O~ ........................................................................................ ............. : ........................... .Ea.~...Ma~. ien.t......N'~.. ]E~ ........ ~ ................................................................... pursuant to application dated .................. ; ........ (~tobe.~......~j~ .......... '196~...., and approved by the FOKM~ NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exom,ned ........ Approved .................................... , 19 ........ Permit No ................................. Disapproved a/c ......... (Building InspeCtor) 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 adjoining premises or pui~lic streets or areas, and giving a detailed description of layout of prope.rty must be drawn on the diagram which is part of this location. c. The work covered by this application may not be commenced b~fore issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit shall be kept on the premises available for inspe.ction throughout the progress of the work. e. No building shall be occupied or used in whole, or in part for any purpose whatever until o 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. C,/ (Signature of applicant, or name, if a corporation) (Addre~ss of applicaf[t) ~/' ~ 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 duty authorized officer. ..................... ................... 1. Location of land on wh ch prop~os'ed work w be done. Map No'. ................. ~L~t N~):..~ Street and Number '.?....~..~ ~.: .....~...~..~.~.i~iiiiiii....'.ill .... i .......................... i Municipality 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 ............ ~..r,~:,c~r..~.~,<~f~z~(.......~~¢~._~.. ................................... 3. Nature of work (check which applicable): New Building .................... Addition.::.J~....Alteration"'....' ......... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ............. ~..ZL.~.C~ ............................... Fee ....................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......................... Number of dwelling units on each floor ............................... If gorage, 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 ................................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ......................... Height ............................ Number of Stories ................................ 9. Sizeof lot: Front ../..~....--,~....~... ..... Rear ........ 10. Date of Purchase ..~.../....~...z./..~.. ................... Name of Former Owner ...... ~...~..z¢7 .... / 11. Zone or use district in which premises are situated .................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ..................................................... 13. Name of Owner of prernises/~.~. .__~Address .~.~.~.~...~.~¢~...~ ..... Phone NO .................. Name of Architect .................................................... Address .......................................... Phone NO .................. Name of Contractor .................................................... Address .......................................... Phone NO .................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block numbers or description according to deed, and show street names and indica whether interior or corner lot. //~..~.' ,~,-¢,<¢r..¢-~(...~ ............................. being duly sworn, deposes and says that he is the applica ............. ~' individual"sig'~i'r~'g al~l~lication) above named. 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 f this application; that all statements contained in this application are true to the best of his knowledge and beliJ and that the. work will be performed in the manne~)~tTfq~(t~ kin the application filed therewith. Sworn to before th.s ~ _~,,,,~,,~;~,o~ '~x~ ~s'~rc~, ~0, ~~ ~ ~ · ~ ............ ¢'T .............. ........ . ........... . . applicant) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTJV~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y~ Disapproved a/c ~~.. i ......... -- APPLICATION FOR BUILDING PERMIT App,,cat,on 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 adjoining premises or public streets or areas, and giving a detailed description of Iayout of property must be drawn on the diagram which is part of this applica'don. 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 a Iterations, 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) 66~f9 Forrest Ave~ Brooklyn (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. OwNer · s Msrze este] if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Loc~tion of land on which proposed work will be done. Map No: ...~%~g~ .......................... Lot No: ..?.L.7.,%.' ........... Street and Number ..~./.S_.MA.i,g..]~.o.a.d.~ ....... ~a.$.%...?ja,.~J,.Qg.%..~,..~(., ................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...d.w.ell i;0.~ ....... . ...... b. Intended use and occupancy same with an addition 3. Nature of work (check which applicable): New Building .................. Addition ...... ;¢¢~¢,~.. Alte, ration Rep~air .................... Removal .................... Demolition ................... : Other Work '(Describe) ................. : (to be paid on filing this application, S. If dwelling, number of dwelling units .............................. mumDer or 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 ............................ 'o .......................... 30 7. Dimensions of existing structures, if any: Front..2. ..................... Rear 20 Depth .......................... Heibht ............................ 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 ........ ~ ............... ' ....... Rear ..... ~...c) .................. Depth .......9. ................ Height ............................ Number of Stories.....iO.D.q ..................... 10. Dote of Purchase ........................................................ Name of Former Owner .................................................... "~" d±st ] 1. Zode or use district in which premises are situated ............ ~ ............................................................................... ]2, Do~s proposed construction violate any zoning law, ordinance or regulation? ..... ~.o. ........................................ 13. Name of Owner of premises .l.v~i;~.;~,.~..~.~,~.~f.i.~. .......... Address ............................................ Phone No ................. Name of Architect ...................................................... Address ............................................ Phone No ................. Name of Contractor .............................................. ~eder~l I{or. le Imp. vt Address .'l~:~b Hem~steac~; ........... :....: ............ ~P Phone No ................. PLOT DIAGRA,M 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 OF NEW YORK, ) COUNTY OF ~.,.~!.Zc~.]~k ........... ) e e~t¢ ' deposes and says that he is the opplio (Name of individual signing application) above harped. He is the ............. .o..~..z2...q.z? ........................................................................................................................... (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 app ~ation; that all statements contained irt this application are true to the best of his knowledge and bel fhe work will be performe~ vn[,~l~, ~¢f~l~e~0rfprth in the application filed therewith. and that Sworn to before me this b'., 52-,~4983 Suffolk County . Notary Public, ,~'~...,.~.~........~. ~ou~t~. ,~ ~ (Signature of applicant, FOEI~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .... ?~"*"~' t > ' 19....~.~ Approved ......................... k .......... , 19 ........ Permit No..~..~......~......~.'.%.?.. Disapproved a/c Application No ................................. (Building Inspector) 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 adjoining premises or punic streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location. 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 comp y with al app icab e laws, ordinances and regu arians. .... ....... ....................... ~/(Signoture of applicant, or name, if a corporation) ........ (Address of app~cant) ~' ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, Nome of owner of premises.....~.../~...~...?/. ................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) /u-c,~v~--¢~*-~ ~- 1. Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number .~..~.~.....~....~......~.c.....,..~..?.~..~...z~... .......................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ...,,rx-~..~.~'~...~$..~h...~... r..~41 ........................................................ b. Intended use and occuponey ....... ~ ~... ..................................................... 3. Nature of work (check which applicable): New Building .................... Addition.....~;~7... .......... Alteration ................. Rep0ir .................... 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 ................................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ........................ Height ............................ Number of Stories ............... ~ ................ 9. S ,elof,o,: Rear ...... ..... Date of Purchase ~z~.~ ' z(.~ .~../? .~......Name of Former Owner 0. 11. Zone 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 ..... /~.~dress ~..~..~....~..~.....~:c--~e NO.~,~..~.~.~.L Name of Architect_,~_...,~.........~ ............ ......,~ ......... Address ..................... Phone NO .................. Name of Contractor~.~.~' Z~-~_ ~ ~C~..~...,,,,~.~ ........ Addres ~//~-~.1,~:?~~'~'~'~'"~'i"--~....~./..7 ..... Phone NO.~.,~'~....7.~.~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block numbers or description according to deed, and show street names and indica whether inferior or corner lot. STATF OF NEW, Y.~R~/. ~/2) S S COUNTY OF .~~ ' ' ...................--- ~'C~.~-'. ..........~ ..........................g duly sworn, '~ be n deposes and says thai' he is the applica (N&f'ne of individual signing application) above named. 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 f~ this application; that all statements contained in this application are true to the best of his knowledge and beli~ and that the work will be performed in the mannerist forth in the application filed therewith. Sworn to before me this a~l~[io3f14~3, Su[foIk COu ltv ~ ~ I , on Expires March 30, 19~$ ~ ............