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HomeMy WebLinkAbout4106-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. $..~.6_ .~. _...'. Date ............. .~.~.~....~.l ....... , 19. THIS CERTIFIES that the building located at . 'l~q;' '~'~' -P~a- Street ~a~ No. ~ia i~ .......... ~ot ~o~.~,~ ~r.~ ~si~d ~,~, co~orms ~bst~ti~y to the Application ~or B~g Pemit here~fore filed in ~ office dated ........ 0e~ .... 2~.. -, 19 ~. p~su~t to which Buil~g Petit No. ~.~.~_ ._ d~ted .......... ~ .... ..~9.., 19 .~, was issued, ~d confoms to ~1 of the ments of ~e applicable pro~sio~ of ~e law. ~e occup~cy for wM~ t~ cert~cate The ce~ificate is issu~ to . -~rS- ~. Edward. Sr ...... ~a~ ................ (owner, lessee or ten,t) of the Moresad b~ding. Su~lk Cowry Dep~tment of He~th Approv~ -Pen6~ng ........................... ........ i- m ......... ~l~g i~pector ~ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENt' TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4106 Z Permission is hereby granted to: l~O~t...Lgad~ J~k~to~.. J.~... A/~..a~mai.. ........ Fish~..Ialan~ ................... .................. pursuant to application dated ....................... 0e.~.....~,~ .............. i....., 19.~., and approved by the Building Inspector. ~0~$ App~oVo~ by ~d of App®a:[~ ~ee *..Lq.?,.O.9 .......... Budding Inspector Examined ...........................~ ......... 19 ........ TOWN OF SOUTHGLD BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................. Approved ........................................ , 19 ........ Permit No ................................. Disapproved a/c ............... ,cz ............... ~.,.,...~ .................................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date 7~- INSTRUCTIONS a. This application must be completely filled in by typewriter or in i~k 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 o detailed description of layout of property must be draw~ on the diagram which is part of this application. c. The work covered by this application may not be commenced befor~e issuance of Building Permit. d. Upon approval of this application, the Building Inspector will isscje 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 anypurpose whatever until a Certificate of Occupancy shall have been granted by the Building InspectOr. APPLICATION IS HEREBY MADE to the Building Department for the issua/~c~of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New ~ork//a/d ,,~her ap,~l,j~b/e L,~ws, Ordinances or Regulations, for the construclion of buildings, additions or alterations, or ~:~Z/r~,,m~/~l, or ~mT'7:it/on//~s herein described. The applicant agrees to comply with oil applicable lows, ordinances ond~o~ . ( 'g i pp 'c ~ or r~me, ,if o corporation) ........... ...... ........... State whether applicant is ownef, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1, Locat on of land on whichchchch~°P9sed--../._'7~/_//~/..J/w°rk will Ipe don~. ~r~p13-Nq: . ~.f.?e ~ Lot NO: ~:~1:1~.~ Street and Number ...... ~Tf~,~/, ,~-?,,~,,,,~..,~,,/.~./.'.~.b?6../..D. ',.~..~..~..~..b..~ ....................................................... Municipality 2. State existing use and occupancy of premises and~intended use ~nd occupgi~cy of pro~osb~d construction' a, Existing use and occupancy ........ '' ~'~J-~../.'.~.f:'~.~..~.L, ....... /~.D,...~.....: ............. '..:..: ................. ' ........................... b. Intended use and occupancy ...... ~". ..... t. .............................. z ....................................................... TOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. --- ~pprovea ....................................... , 19 ........ Permit No ........................ ... APPLICATION FOR BUILDING P)ERMIT INSTRUCTIONS i a. This application must be completely filled in by typewriter or in ihk 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 issqe o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughou~ the progress of the work. e. No building shall be occupied or used in whole or in pa rt for any pu(pose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the~s Building Zone Ordinance of the Town of Southold, Suffolk County, New Regulations, for the construction of buildings, additions or alterations, The opplicont agrees to comply with oll oppl[coble lows, ~ce of a Permit pursuant to the Laws, Ordinances or as herein described. if o corporation) i (Address of applicant) (~_~.~(~) ~.S.t..~t..~..w~t~.~h.;./.r?.~.~.p~:cI~.~t~.~.~.~..~.'/.'~s~..~.t~...~hite~t, engineer, gene[al co~tr.~.it.~i, el. eil.r, iiian, plumber or builder. Name of owner of premises ~./.'/..~.~..~ ~ .[~/~'rTrJ/.~J ~~ ~ ~ ....................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Locat on of land on which pr,oposed work will, be do~ne. ~ ...~.~Z~.~_/.~/.~.~ Lot No: ..~...~....~....~.~-'.~..7 Street and Number ...~../.~.~./.~.~../..Z~.~....~.~..~c~/.~.~.~i../..~.~J~.~.......~.~..~.~. ............................................................. Municipality 2 State existing use and occupancy of premises apd igtende,d use o~d occupancy of 4~'i~posed construction: a. Ex~stmg use and occupancy ......... ~..Lr.....-/~.....: ............................ __ ! ............................... : .......... ~r: ............................ b. Intended useand occupancy ...... l.~:~),~......~...~...P[../~,/. .............. .,_/. ; ............................ :..;,.; ..................................... 3. Nature of work (check which applicable): New Building ..... /~ ........ Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ..... ~/.~./.~).~).~..,....-J~.. .............................. Fee ............. /.~..~.~..0 .............................................................. (to be paid on filing this application) 5. If dwelling, number of dweIling units ............'~- .............. Number of dwelling units an each floor ......... ./. ................ If garage, number of cars ............ /~0..~...~ .................................................................................................................. 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 ......... ~T...;. ........... Depth Height ............ ::: ............. Number of Stories ...................... ~ ...................................................................................... Dimensions of same structure with alterations or additions: Front ................ ~ ............... Rear ~ . ........ '.; N mbe of Sto les Depth ............................ Height ..................... u r r ........................................ 8. Dimensions of entire new construction: Front ......... ~.. ................... Rear ...... ..~.~.~ .............. Depth .....~..J~-¢ ............... Height ...... l.~,..~ ............ Number of Stories ........ [...//....'~... ............... 9. Size of lot: Front .......... /..~..~,.....~...~.,... Rear ......... ./...~...~.....~.'~.~.. Depth ...... /....~...~.....~..i~.~..' ............. 10. Date of Purchase .... .//. , ............................ Name of Former Owner ... 11. Zone or use district in which premises are situated ........... .~....~...~..~ .......................................................................... 12. Does proposed construction via ate any Ton ng law, ordinance or, regulationP r~ ./~t~, /~ ..'.~..~..,~t-~$ Address ~"~'~ ,..,~,~i/v~."i')~)i'"! ....... ~'""~' ......... '~'"~ ..... 13. Name of Owner of premises ... .......... ? ...................................... ~.! .......... Z., Ph___ N-. ~'~..,.,~.:.~./ Name of ,hT~ Architect .................................................. Address ........................................... Phone No ..................... Name of Contractor ,~.~ .f.~. .~....(%.....Address .~.~.~'~.~....~.~. , .~..~.~ Phone No. ~..~..~..'T?.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. MarCh 30, 19~'~ STATE OF NEW~,~.O.R~ ~ ~ L ) -- COUi~TY OF ~.T...) b.~. A ....... '~""~¥""'"'"~"~' '~'"~'"f~":~ ~ ~ "~ ti" ......... being duly sworn, deposes and says that he is the applicant above no ;~.; ;is iZi.~.~~ ............................................................... (Contractor, agent~corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfo~d~ sai work and to make and file this application; that all statements contained in this application are tr~ ~ ~e e~ ~s I~owledge and belief; and that the work will be performed in the manner set forth in the applla~oJ~e~ Swor~ to, re me this ~ ........................................................................... , . ............. ................................ NotmyPubliG.....~ ..................... County 7~~ ,~ ~pplic~nt) 3. Nature of work (check which applicable): New Building .....~.. .......... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ........~.~....~....O..~....-T~... ........................... Fee ...... /.~,..0...~. ................................................ i'J..i ................. (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 ............. /~.~1.~ ................................................................................................................. 6. If business, commercial or mixed occupancy, specify natureand extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front ........... :...~?E... ........ Rear - Depth .......... ~ ................... ight ~ He ............................ Number of Stories '~ Dimensions of same structure with alterations or additions: Front .............. '---T ................. Rear ............. ~ ............. Depth ............ .,.~... .......... Height ......... ~ ................. Number of Stories ....... ~ ........................... / Rear ~..~/t ..~....~.. I 8. Dimensions of entire new construction: Front ......... ~v.~ ................ ........... .............. Depth ...... .............. Height .......... /~. ............. Number of Stories.....i...J...//..~.. .............. 9.Size of lot: Front ....... 1.~.~,......'.~ ......... Rear .............. Depth ~' /.~ ~¢.. ................ Z.~.¢...~g ......... Z~ ,, I q ~-,~ 10. Date of Purchase ...... ./.,.~.~,.....,..~.~....~.. ...................... Name of Former Owner ...... ..~.../~. ..... 7. ..................... 11. Zone or use district in which premises are situated ............ ~..~[r ........................................................................... 12. Does proposed construction v date anv zon ng, law, ordnance or renulation~ ~ .,,~...~1 , 13. Name of Owner of premises j~ ~., ........... ~l .............. Address ~/~i~ ...... ~.:......tT.l./.....! ...... Phone No.~.q~.~ ..~.~..~. .. ~ - ' .................................... ii ........ i/~,I~,~ ~. ~ ~I~ ~ x ' Name of Arch tect ........ j~/.b./'7~-- Address Phone No ..................... Name of Contractor ~.~.~.~.~i~..~.ii~~Address~..i~2~.~'~;~...~....;..~..~.' Phone No. ~.~..':T...~...~..~..~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. ST*:E OF NEW ~1<$~. ~) ~ ~ CO~TY ,OF ~..: .... ...... !~~~ ~~ ......... ' ~ ~ ' ' ~~...,.~..., ........... being duly sworn, deposes and says that he is the app[icant (Name of individual s~g applica~on). above named. He is the ......... ~~ ...................................................................................................... (Contractor, ag~, corporate officer, etc.) of said owner or owners, and is duly authorized to per{arm or have pe~o~e~ the ~ work apd to make and file this application that all statements contained in this application ore ~u~ ~the k ~f~is~nowledge and belie{; and that the ~ork will be performed in ~k~ manner s~t forth in the a~,{il~ Sworn to before me this / ..... ......... ............ ........ ....... ................. .............................