HomeMy WebLinkAbout2779-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. Z.2932 .... Date ............ ~ovember. · .t0., 19 67.
THIS CERTIFIES that the building located at -M~_d~r~e,~l- ~ -&. East~'ood. Dt~treet
Map No. Eas%WOOd BM~k No. IX ......... Lot No...18t. . .Ctttchogue,. };.,¥, ......
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ......... JV.l~e---1... , 19.6~. pursuant to which Building Permit No..-27-7~9 .Z
dated .......... ,l',o.r~e ... 2. .... ,19-6~-, was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is Pr~..v~te. one. {'ar~ll.~ .dw~l.l~ng ........................................
The certificate is issued to . .Alldre. C~.b~lsk~ ............ 0wne,~ ...................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ...~.oy,. ~.~ .~-9.~.7... ~Y..1~.,..V.~.~.~..
Building :Inspector \
FOl~ NO. ~
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)
N.o 2779 Z Date .............................. ~.....~. ............, 196~...
Permission is hereby granted to:
·DoT:La,..~ee~e..&..So~....A/O..~e..Cybu~
............. Cutebo~tm ............................................
to ...;i~tld...ne~.~tm...f. aa~l.y..~ett.~.n~ ...................................................................................
of premises located at ...L~t...],~.--.$eet~er~..~9.-...Eaet~o~..E~t~te~ ...................................
.......................................... ~Ld~aood..Rd..&..F.a~t,~eo~..l~d .............. Cg, t, oho~.u® .........................
pursuant to application dated ................................ ,~1A1~ ....... ~ .......... 19.~.., and approved by the
Building Inspector
Fee $.~.fl. I~O ...........
S-9
SCHD
SUFFOLK COUNTY DEPARTMENT OF HEALTH
Da~e
Bldg. Permit No.
967
TO WHOM IT MAY CONCERN:
The sewage disposal facilities for a structure located
· (Give deed lo~ation) ~
have been inspected by this department and found to be satisfactory.
Distric ~ Engineer
District Engineer
~ ~ FOI~M NO. I
Approved ........................................ , 19 ........ Permit No .............................
·
D~sapproved a/c .......................................................
........................
' (Building
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, building code and regulations.
............ ...................
(Signatu~ 9,f applicant, or name, if a corporation)
.............. ............................
(Ad,ss 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 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.' ...... ;~;T-./,...~..-¥.7......~..~...¥.~.. Lot No.: .../...?... ..............
Street and Number ......................... ..,~, .................... ~ .......... r, ........
Municipoffity
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
o. Existing use and occupancy ......................................... : .........................................................................................
b. Intended use and occupancy .......................... ~ .........................................................................
3. Natt~re of work (check which applicable): New Buildin. g ~ Addition Alteration
Rep<~ir .................. Removal .................. Demolition .................. Other Work (Descrlbe)
4. Estimated Cost ............... ~. ~ ..~...O....O. ............................ Fee
-- (to be paid on filing this application)
5. If dwelling, number of dwelling units ...... /....i ................ 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
Dim~ensions] of existing structures, if any: Front ............................ Rear ................................ Depth ,
7.
Height ........................ Number of Stories .............................................................................................................
Dimensions~ of same structure with o.lterations or additions: Front .................................... Rear ........................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front ........ ..~....~. .................... Rear .....~...~. ................ Depth ..... ..~
Hei ht ....,/..~.~. .......... Number of Stories ...........
9. Size of lot: Front ../...~'..~.. ................ Rear ........... /..0..~.. ................ Depth .././..~...(~....'(..~'.../. ......
10. Dot~ of Purchase .....x~¢~-.......~..~./.~..~...~... ............... Nar ,rmer Owner ...~ ................
11. Zon,~ or use district in which premises are situated
12 Doe~ proposed construction violate any zoning law etd nance or regu at onP '
13. Nonce of Owner of premises .~ ......... Address ~..~~....?~.....~,~one No...~..;..~..:~
Name of Architect ...................................................... Address ............................................ Phone No ................
NaTo of Contractor ....... ~ ~,~.....~..~ddress ~.~.......~.. ........ ~:~.... Phone No./-.~.2~....62..~..~!/.
J PLOT DIAGRAM
Locot~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr
property lihes. Give street and block number or description according to deed, and show street names
whether inferior or corner lot.
/6-0 i
....
STATE OFi NEW YORK,
COUNTY 'OF ................................ ~ ....
.................................................... beino duly sworn, deposes and soys that he is the applic
(Nome4~f individual signing application)
above na~ed. 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 applic~ation; that all statements conta:ined in this application are true to the best of his knowledge and belief;
that the wgrk will be performed in the manner set forth in the application filed therewith.
Sworn to before me this ~
......... of ........................ ,
x, ..... .K.. ...........
'v ~bl~l.~....~.:..~~ ............. C~li~ ^. ~cl~r nature of applicant)
Natal, Pu~l~o;, ~, /7 ' ' ~OTAR¥ PUBLID, State r.~ '-
i
~erm ,Expires
NO. 1
TOWN OF SOUTHOLD
EUIL. DING DEPA~.TMENT
~ ~\ ~ TOWN CLERK'S OFFICE
:~/ '--'*SOUTHOLD, N. Y.
Examined
..... ~7/ ............. ~'~ ........... , 19 ...... ~.,
Approved ........................................ , 19 ........ Permit No .................................
D~sapproved a/c ..... ~,,..: ............. ~ ...... ~ ........... .~ ......................
...................................................................... · .......... ,.,:: ...........................
1
................................. .........................
Application No .............................
APPLICATIOI~ FOR BUiLDiNG P[RM~T
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 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.
i" ur, an~licantr(S~,ature of app icant, or name, if a corporation)
.... ..............................................
~ (Address of app cant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber, or'builder.
Name of owner of premises ..............................................................................
~f-b~?licont 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: ............................................Lot No: ./.~... ...........
Street and Number ........ .~~ ....... ~....:.~ .................... ~'..~.~..~...q/q~Zw.. ~....~.: ..................
Municipality (/
2. State existing use and occupancy of premises and intended use and occupancy oF proposed construction:
a. Existing use and occupancy
b. lnlended use and occupancy ..... .~.~~ ..................................................................................................
3. Natare of work (check which applicable): New Building ................ Addition .................. Alteration ..............
Repair .......... ~,.... Removal .................... DemoJition .................... Other Work (Describe) ........................
4. Est i ? at ed Cos~Y.:~..~. ~..~..~. .................................... Fee ......................................................................................
j (to be paid on filing this application)
5. If d~welling, number of dwelling units ......Z. .................... Number of dwelling units on each floor ...~......:...~.zrr.~:._
If g!rage, number of cars ........... ..~... .......................................................................................................................
6. If l~usiness, 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 ............. . ...............
Dep,th ............................ Height ................................ Number of Stories ........................................
8. Dim!ensions of entire new construction: Front ...... ..~.-...~.. ................. Rear ...:~....&?. ................. Depth ...~.~...~.. ............
Height ..j.,,,k'..~ ................. Number of Stories ........ ~ .......................
9. Size of lot: Front ../....~..~.. ................... Rear ..... /..~..~.~ ............. Depth ..//.~.....'.~o._.../...~../'. .........
10. Date of Purchase .~))':~a':~,....I/.. ........ ~..~...6.~' .............. Name of Former Owner ..~.,~..~
11. Zoqe or use district in which premises are situated......~..-~.. ...............................................................
' 12. Doe,sJ proposed construction violate any zoning Iow, ordinance or regulation? ........ ~ .................................
13. Nar~e of Owner of premises(~,..~.....Address~.vm..~..~/ ,.. Phone No../~..~.~..~..z.~':
Nar~e of Architect ...................................................... Address ............................................ Phone No ................
Name of Contractor .......... Address~C,,&..r'~ ............ Phone No./~..~'..,~...~.~
PLOT DIAGRAM
kocat~ 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 show street names and indic
whether in~terior or corner lot. /,5-~9 ~
STATE O~: NEW YORK, ) ~ ,
COUNTY~OF ............................ ) ~'~'
.... ~0,~,/.....~' ................................ being duly sworn, deposes and says that he is the applic
( (Name 9f individual signing application)
above narhed. He is the ............................ ~,r~ ...............................................................................
(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 b~
and that Yhe work will be performed in the manner set forth in the application filed therewith.
Sworn to (?afore me this
...... , ........ ; ......... o.y o. .
Notary P,ublJc,~..~,~-,.~,,.-,./..~.~°.~l~;u~,~-'~' //'""i~'ignature of ~l;l~fi&'~i ......................