HomeMy WebLinkAbout3161-zI~ORM ~0. $
TOWN OF SOUTHOLD
'~UILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
GI:"RTIFItlATE: I:IF EII:IEILIPANEIY
No....~. ~606' i" Date ........... 'Novemb'e:~' · '1 ..... ' 19'66
THIS CERTIFIES that the building located at . .l~l~B.~i~lt. ~1~,~ ........... Street
~ap~r.y...W.a.t..o~.s. Block No........ ......... Lot No.. '~3 .... Softflair,. I~,¥., ........
conforms substantially to the Apphcatron for Building Permit heretolore filed in this office
dated ~ ' pu.rsuant to which Building Permit No ~J.(>~. Z
............... ....
dated ............ lttly'"lg'" fiOB~':' was issued, and conforms to all of the require-
ments of the applicable provisio ~s ({f the law The occupancy f. or which this certificate is
issued is .. l~;[V~r~. OrlO' .family ?t~to~t-~in'§ .........................................
The certificate is issued ~o . ',I 'I{~;[(~b'Ol"' ...... lessee or tenant)'
of the afore.said building.
?
.Suffolk County Department o~' H~alth
'Appr,oval
FORM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILD~NG PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FUEL
COMPLETION OF THE WORK AUTHORIZED)
N?
Permission is hereby granted to:
~e~..~.~ak~....A/C....~e~.z~...K.~.lebe.~...i.....
............ ~th fr~L'"~ ................................... ~ .......
................. · ~q~et~gue .........................................
to ..... ~t~ ' ' ~e~ "o~e' · 'fmu'Z~v...cftc ~:1" ~ ,- ·
, ~ ~. ~:~.~ ..................................................
et premises located at .......~rf~.....~ ....... ~-~L~"[~"C~f~ .................................................... ;...~ ...... ~..
.................................... r~'e ~ ~ ~' "~2~.~'~ ............ ~cu-~'c~t~.~..-~.~ ..............................................
pursuant to application dated ................. ¢T~4.~......~ ..... , 19../o~, and approved by the
Building Inspector
Fee $'""~0 ..............
Dui ding Ins~;;;:'t';~]'"""~' ...........
S-9
SCHD
SUFFOLK COUNTY DEPARTMENT
Date
Bldg.
OF HEALTH
Permit No.
TO WHOM IT MAY
at
CONCERN:
The sewage disposal facilities for a structure located
(Give deed locatio~
have been inspected by this department and found to be satisfactory.
District Engineer
FOE~ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
×am,ne .........
~[~t~'
~o~ ............. '.: ...... ..... ~o .... ~.,...~.,...~
Application No...~..Z ~../ .........
APPLICATION FOR BUILDING PERMIT
Dote /~'
...... ................................
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 BuiJding ~nspector will issue o 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
Bbilding Zone Ordinance of the Town of Southo]d, 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.
~"'"i'~;"~'~';~;"i'~nt'"';';;'~'~me, ,'--~"~';"~';~o';'; ........
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber ar builder.
Nome of owner of premises ........................................................................
Jf applicant is a corporate, ' ' ' ·
]. kocation of Iond on which proposed ..~ ....... ........................
s~o~ o~ ~m~*~ ..~..(.~:.~.~..(.....~/.~..C.~ ............................................................................................
Municip,olit~
2. Store oxistin0 uso ond occuponcy of premises ond intended use ond occupancy o~ proposed censtruction:
o. [xistin~ uso and occuponcy .................... ............~. ............................................................................................
b. Intended use ond occupancy .................................................................~ ........................................
Rep(
Es[Jr
5. Ifd
6, If
NatUre of work (check which applicable): New Building .................. Addition .................. Alteration
ir .................. Removal .................. Demolition .................. Other Work (Describe)
toted
Cost
...... ~].,/.,~.~.~.~,,.o....¥. .......................... Fee (to be paid on filing this application)
veiling, number of dwelling units ...... ~ ........... Number of dwelling units on each floor .....~7'~_
~rage, number of cars ................. ..~-.. J
usiness, commercial or mixed occupancy, specify nature and extent of each type of use
7. Dim:ensions of existing structures, if any: Front ............................ Rear ................................ Depth
Heiiht ........................ Number of Stories
Dim~ensions of same structure with alterations or additions: Front .................................... Rear
Dep!h ................................ Height ............................ Number of Stories
.......... ~ ...................... Rear ........ ..~...~ .......... Depth
8. Di,~ensions of~./~ new construction: Front -:2-/ ...................... '~' .......
Height ....... ~...:~CZ.. Number of Stories 4~ , ~ /
x Z(. ~ / . Depth ....... ~...~ ...................
9. Sizei of lot: Front ...... /,....~... ........... Rear .................................
~0. Dar of Purchase .............................. /....~....~..~'.. ........... Name of Former Owner ...........
11. Zon'e or use district in which premises are situated
12_. Doe proposed construction violate any zoning law, ordinance or regulation? ....... ~.....~.~....~.~..
13. No, e of Owner of prem,ses ...~...~ ........ ~ .................. Address. ~.~/~.e
.~.,....~,, .~.,~....,~..~..t Phone' ,~,, . ,ft./i e~/~A No.
No, of /?"'/'" Phone
.,'~....~.~... "~ ~'~"%:~;'~ ...................... No
Na,,ae of Contractor ....... ..~.....'?~...~...."~....~...~. ......... Address ...~.?~..¢..¢.~..~:F~'..~..~.... Phone ..............
j PLOT DIAGRAM
Locot~ clearly and dlstinctly all buildings, whether existing or proposed, and indicate all set-back dimensions f~
property lines. Give street and block numbe.~; ;or description ,~cgrding~ro deed, and show street names and indic
whether in[erior or corner lot. f',/'C ~ ~ a ~. ?'- ~'/a c
STATE OI NEW YORK,
COUNTY
being
deposes and sa th.at he is the applic
above named, is the
I gent, carper 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 appliqation; that all statements cont,alned in this application are true to the best of his knowledge and belief;
that the wlbrk will be performed in the manner set forth in the application filed therewith.
Sworn to I~e~ore me this ,~-) ., ~ ~ ,
Notary P;LHc, ..~'~~~~.~ County":~ (Signdture of applicant)
FO~M NO. 1
TOWN OF SOUTHOLD
I~UILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
........................................ 19 ........ Permit No .............................
App,cat,on No. / g /
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
. A ,. ..........
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 td 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.
· ~, ~(Sigr~ure of applicant, or name~'~'~rporetion)
(Address of' applic6rC(t) ) ............
State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder.
Nome of owner o{ premises .....................................................................................
If applicant is a corporate, signature of duly authorized officer.
.................. :::::::::::::::::::::::::::::::::::::::::: ...................
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 ......... ~....~.-r:. ....................................................
3. Natu~.e of work (check which applicable): New Building .................. Addition .................. Alteration
Repaff .................. ~emoval .................. Demolition .................. Other Work (Describe) .......................................
/~ o/o
4. Est~m ~ted Cost ............... ~ ............................... Fee ...............................
(to be paid on filing this application)
5. If dw;lling, number of dwelling units ....~ ......... Number of dwelling units on each floor ...... ~ .......
If ga~ age, number of cars .......................... '. ................................................................................................................
6. If bu?iness, commercial or mixed occupancy, specify nature and extent of each type of use ..........................
7. Dimehsions of existing structures, if any: Front ............................ Rear ................................ Depth ....................
I-leig~t ........................ Number of Stories ...............................................................................................................
Dimensions of same structure with alterations or additions: Front ....................................Rear ..........................
De tl~ ................................ Height ............................ Number~of Stories ................................
Pe~ ~ ~' ~ -
8. Dim sions of entire new construction: Front .......... ..~.....'~.. ................. Rear .....?....'~.. ............... Depth ......... ..~..........¢~..
Heigl~t ,../. ,~..~. Number of Stories .............. ~. ......................................... t~ .......................................
9. Size ~f lot: Front ...... /...~ ..........Rear ......... /'.,..?...:~ .............. Depth ........... ~ ............ .~....~
10. Dateiof Purchase ................................. ~..~..' ................ Nome of Former Owner .................................. /. ..........
11. Zon¢or use district in which premises are situated ..................................................................................................
12. Does proposed construction violate any zoning Iow, ordinance or r, egcd¢ion? ............. ~ .................................
. 6~-o,~,~ ~J lC/, ~¢~ ,~- e ,~, ,~o, I
13. Nam; of Owner of premises ........................................ Address .~........~..'..¢....¢.<..~ ............ Phone No ..... r. ...........
Nam~ of Architect J.?/~ ~J~'~r /,~_,¢¢ Z~,,~A~J~'ress /~,'~¢/-~'e~'( Phone No
r ...................... :; ............................... ~;'Fe'~:;;'~ .........................................
of Contractor ..... Phone
Nom~
PLOT DIAGRAM
Locoteiclearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro
properly lit es. Give stree, t.ond block number or description according to deed, and show street names and indica
whether iht, rior or corner'~t~. o~.~"/~) "~'
STATE OF [NEW YORK, ~ ~ c ~ / ~
............. ~.._~.~.~ ...... ~~ ................................. be/no duiv swom~doposes ond s~s that h% is tho oppl~co
' (!No, of individu¢l sig~g application) ·
, . ,
.boy.. m.d. ............................................................................ ............................ ..........
~ (C~ntract~ agent, corporate off~r, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work anti'to make and f
this application; that all statements contained in this application are true to the best of his knowledge and belief;
that the will be ~erformed in the manner set forth in the application filed therewith.
l?.Io,
............. ~. ........... , ........
Notary Public, County~',~ (Signature of applicant)