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HomeMy WebLinkAbout4155-zFORM mO. 4 TOWN OF ~OUTHOLD BUILDING ~IEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥, nEBTIFII3ATE OF' OOnlJ~ANDY No..Z..~.~..~.... Date ............... Nar. ch .....1.1 .... , 1969. ~I]~IS CERTI. FI_ES, th, at the building located at .. ~/~...~att. ~t ......... Street een~ort grxv~ng Park 5~ap No ............. Block No ............. Lot No. ~9~6~e&.,.28, .... 6~e~m~rb,.. N.~, conforms substantially to the Applicati,on for Building Permit heretofore fi]ed in this office dated .......... ~C.~ .. J.~ ..... 19~. pursuant to which Building Permit No. ~.~Z .. dated ......... g~.,..~ ........ 19.6~, was issued, and conforms to all of the require- ments ,of the applicable provisi.ons of the Iaw. The occupancy ~or which this certificate is issued is . ~$~.q$~..~. f~2F. ~We~2ing .......................................... The certificate is issued to ... ~BCa~. ~.O~d~ .~.~.(Fc.~me'~· ~e~. ~1~. -Easter) (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...~]~, ................................. .... :"*: ':/' *' ........... t ............. Building Inspector TOWN OF sOUTHOLD BUILDING DEPARTMEHT 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? 4155 Z Do¢e ....................................... Permission 'is hereby granted to: .............. g~...~Ol~..(,D~t~ae~) ........ ................ j~e, enpo~.t~ ......... .Jl,~,, ....................... to ...... ~ul~4.. ~m.. mf~T~,,tims.. &..~al~.. ~.e~Jt .. O~.-'~ ~,"[ t~;~L~.. ~well.~t~....'" ............. ot premises located at ......~;~"~'~O"~"(~l~e~q'PO~"~"~t:J~g'"g~ ..................... ......................... ~g.~.....L~une.tt..S:t.~..lt/2., ~o~m-'~t' ...... G~'ee~'tP~'~ '"' tt*~'* ................... pursuon,t to application dated .. ..,..J)l~..*..~ ............... , 19..(~., and approved by the Building Inspector. Fee $..~· ~0'1~ ............ ~F'ORM .NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..................... 19. Approverl ............ ~ ..... 10 .... Permit No .................... Application No ....... APPLICATIO,N FOR BUILDING PI~RMIT Date ............ De~ · .]~2',']:968 ..... 3.9 .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitie,d in duplicate to the Building Inspector. b. Plot ,plan showing location of ~t and ~.o{ buildings o n premises, relationship ~o adjoining premises or public streets ,or areas, .and giving a detailed description of layout of prope'rty must 10e d~awn ~o~ the diagram which is part of this application. c. The work covered by this applicati,~n may not be commence~ before issuance of Building Permit. d. Upo.n approval ~of this applicati,3n, the'Building Inspec~er will ~ssue a Building Permit to the applicant. Such permit shall be kept ~3n the premises available for inspection through,out lhe progress .of the ~vork. e. N~ building shall be occupied or used in whole o~ in part ~r any purpose whatever until a Certificate ,o~ Occupancy shall have been granted by the Building Inspeci~or. APPLICATION IS HERE;BY MADE to the Building Department f(~r the issuance of a Bull,ding Permit pursuant I~o the Building Zone Ordinance of the ~own of S~uthold, Suffolk (kmnty, New Y.,ork, and other applicable Laws, Ordinances .or Regulati,ons, for the construction .3f build ings, additions or alterations, or ~or removal or demo- lition, as herein described. The applicant agrees t~ com ply with allI applic~e laws, ,ordinances, building code, housing code, a~d regulations. /~. ~¢ ~.-~_~ .... G.~,e e.~t~o~.d; ,..NY..119.4,4 ....................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contract,~r, electrician, plumber or builder ................. ~.uy. er under ~ontracl Name .of .owner of premises ......................... Y~!u. ~e ~.~.~r ........................................ If applicant is a c~rp. erate, signature of duly auth,orize d ,o~ficer. (Name and title of corporate officer) Location ~of land o.n which proposed w, ork will b e done. Map No ................. Lot No .............. Street and Number .......... Municipality State existing use and ,~ccupancy ,o~ premises and intended rise and ,occupancy of proposed construction. a. t~xisting use and occupancy .......... ~rgcarzi ............................... b. Intended use an,d ~occupancy ......... ;l,i~.i.~g. o~u~t~r$ ........................................ 3. Nature of work (check which applicable): New Building ........ Additi,o~ ........ Alteration ....... Repair .... X... Removal ........ Demolition ........ Other Vfork (Describe) .................... 4. t~stimated C,c.st . $.2.5..0 .......................... Fee ....... $.5. ..................................... (to be paid ,3n 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 ~r mixed occupancy, specify nature and extent of each type of use .............. 7. Dimensions of existing structures, if any: F~nt .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions ,of same structure with .alterations .or additions: Front .............. Rear ............... Depth ................ Height ................ Number of Sto~ies ..................... 8. Dimensions .of entire new construction: Front ................. Rear .............. Depth ............ Heighl ............ Number ,~f S~orles ............................................................. 9. Size of Lot: Front ................ Rear ............... Depth ............... 10. Date of Purch.ase ............................... Name (~f Former Owner ............................. 11. ',Zone or use district in which premises are situated .................................................... 12. iE~oes proposed construction violate any z,~ning law, .ordinance or regulati,~n? ........................... 13. iName .of Owner ~of premises .....................A~ddress ...................... Ph,~ne No ............ iName of Architect ............................. A'ddress ...................... Ph,~ne No ............ I~ame .of Contracto~ ............................ Address ...................... Ph,~ne No ............ PLOT DIAGRAM Locate c~e.arly and distinctly ail buildings, whether existing ,or 'proposed, and indicate all set-back dimensions from p~eperty lines. Give street and block number ,or descripti, on according to deed, and sh,ow street names and indicate wheiher interior ,or co~ner 1.or. existing trailer--would like to put block foundation under same and replace broken glass and refurbish entire trailer to the satisfaction of the ~uilding inspector--lite, water, heat, sewer and painting. new floors and painting outside~ STATE OF NEW YORK, )S.S. COUNTY OF .............. ) 0sca r Go ldin .. being duly sworn, ,deposes and says that he is the appli- (Name of individual signing applicati, on) cant above named. He is the ......... buyer' under' co. ntr~a~ ~;an~t.. s'elf':contra~. ~e~...f~r .,~era. i~s [~on~ractor, agar, o~.~a~e .OIilCer, e~c.) of said owner .o~ ,owners, and is duly auth, o~ized to p~rm. o.r have perSo~ed ~e said w~k and to. make and file th~s application; that ail statements contained in this application a've true to the best of his kn,o~ledge and belief; and th.at the w,~rk will be pe~me.d in the mann er set ~or~ in the application filed therewith. Sworn ~o before me this l~ day.of ~c 19 '' ' //~ ~ N,~ary Public, . ................... Gounty ~f' ,FORM ,NO. 1 TOWIq OF SOUTHOLD, BUILDING DF-.PARTMENT TOWN ,CI~E;RK'S OFFICE SOUTHOLD, lq. Y, E~amined ..................... 19 .... Approved ..................... 19 .... Permit No .................... Disapproved a/c ................................................. ~.. Application No ................. (Building Inspec~Jr) APPLICATIO,~ FOR BUILDING PERMIT Date. ............ D~' '[~ ]~g65 ....... 19 .... INSTRUCTION. S ~ This application must be completely filled in by typewriter or in ink and .submitte,d in duplicate to the Building Inspector. b. Plot ~lan showing location of i~t and ~of buildings on premises, ~elation.ship to adj,oining premises or public streetS/~r 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 applicat~mt may n~ot be commence~ before issuance of Building Permit. .d. Upon approval ,of this applicati,on, the Building In spec~0~r will issue a Building Permit to the appl!'cant. Such permit shall be kept ~n fhe premises available for insp(~cth~n throughout the progress ~of the work. e. No building shall be occupied or used in whole e~ in part for any purp~ose whatever until a Certificate ,of Occupancy shall have been granted by the Building InspectOr. APPLICATION IS ~IE~E~Y MADE to the Building Department fqr the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S,~,athold, Suffolk Ob~mty, New Y, ork, and other applicable Laws, Ordiaances ,or Regulat}ons, for the censtruction .~f buildings, additi~s or alterations, ,~r for ren~oval or demo- lition, as herein described. The applicant agrees to comply with.alia_ ~ld~' ' e, h.~using code, an, d re gulat ions. ~..~d ' ' ' ~(~f~a~J~, ~.~eCJP ~ati.on)' ' ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .................. bl~e~'..tvd~del'..(toZltl'~0~... Name of ,owner of premises ......................... ~U.l.t~..F~2.~e~ ........................................ If applicant is a earl)orate, signature of duly authorize d .officer. (Name and title of corporate officer) 1. Location .of lan,d on which pro~0osed work will be, done. MapNo ................. Lot No .............. Street and Number .......... .~.q~..~.0..G..~.e.e.~]~..~t....~'..~?.i. ~..l~.~..k ................................ Municipality 2. State existing use and .occupancy ~of premises and intended use and .occupancy of proposed eonstruction. a. Existing use and occupancy " ... !r~Oe2~ .................................................. b. Intended use and ~occupancy ......... .~:[~l~. [11~~ ........................................ 3. Nature of work (check which applicable): New Buildiug ........ Addili,an ........ Alteration ........ [~epair .... X"' Removal ........ Demoliti. on ........ Oth.ei~ Work (Describe) ...................... 4. E.sttmated C,a.st . ~2g0 .......................... Fee (to paid .~m filing this application) 5. If ~dwelling, number .of dwelling units .......... Nnmber .of dwelling units on each fl,oar .............. If g. aruge, number ,of cars .......................................................................... ¢. If business, comme,reial ~vr mixed oceupaney, specify nature and extent ,of each type of use .............. 7. Dimensions of exis~cing structures, if any: Fm~nt .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ 'Dimension's .of same structure with alterations ~or additi.ons: Front .............. Rear ............... :Depth ................ Height ................ Number of S~ories ..................... $. Dimensions .of entire new construetion: Front ................. Rear .............. Depth ............ Height ............ Number ,,f S~ories ............................................................. ~. Size of ~ot: Front ................ Rear ............... Depth ............... 10. 'Date of Purehase ............................... Name <x£ Former Owner ............................. 11. gone ,or use district in which premises are situated .................................................... 12. Does proposed construction vi.o~a~e any ~ning law, ~ordlnanee or regulati,om? ........................... 13. Name ,of Owner,of premises ..................... A, ddress ...................... Ph,~ne No ............ Name of Architect ............................. A, ddre~s ...................... Ph,~ne No ............ Name ,of Contrac~ar ............................ Address ...................... Phone No ............ PLOT DIAGRAM Locate cle.arly and distinctly all buildings, whether existing ,or 'proposed, and indicate all set-back dimensions from p.r~o.perty lines. Give street an,fl bl.ock number .~r descripti.on according to deed, and sh.ow street names and indicate whelher interior ,or corner l,ot. replao~ broken glass and refurbish entire %ra~ler to the sati~faotion of tl~e building inspeoter--lite, water, heat, sewer and painting. ~ew floors ~nd p~,inting outsides STA']~ OF NEW YORK, )S.S. COUNTY OF .............. ) ..................... 0eO~ r. ~ldll~ ................ being duly sworn, ,deposes and sa~s that he is the appli- (Name ,of in,dividual signing application) cant above named. He is the ........ of said owner ,ar ,owners, and is duly auth,orize.d to perf,,rm or have pe~orme.d the said work and to. make .and file this application; that all statements oontained in this applioati, on a~e true to the best of his knowledge and belief; and th.at the ~rk will be perfo~me.d in the mann er set forth! in the application filed therewith. Sworn to before me this .~1[~ ............ Public, day ,of .... ~ ............ 19. ©aunty {Signture of a cant) N,~tary =FORM ,NO. I TOWN OF SOUTHOLD i BUILDING DEPARTMENT TOWN CI~RK'S OFFICE SOUTHOLD, N. ¥. xa i ed Approved ........... ~. [ ....... , 19 .... Permit No.4~. [ .~..~. Disapproved a/c ........ ~ ........ -~.. .... ~.- (Building Ins~ee~m9 ~ APPLICATIO2~ FOR BUILDING PERMIT Date .................................. 19 .... INSTRUCTIONS a. This applicati.on must be completely filled in by typewritbr o~ in ink and .submitted in duplicate to the Building Inspecbov. b. Pl, ot .plan showing 1.ocation of 1,~t and ~o{ buildings o n premises, ~celati,onship to adj~oining premises or public streets ~T areas, and giving a detailed descripti.on of layout of property must be drawn ,on the diagram which is part of this application. c. The work covered by 'this applicat~3n may n,o~ be commence~ before issuance of Building Permit. .d. Upon approval ,of this applicati,zn, the Building In specgo{ will: issue a Building Permit to the applicant. Such permit shall be kept ~n the premises available for inspection :througho~t ~he progress .of the ~ork. e. No building shall be occupied or used in whole c~ in part ~ any purp.ose w.hatever until a Certificate ~ Occupancy shall have been granted by the Building Inspects. APPLICATION IS }~R~Y MADE to the Building Department fdv the issuance of a Building Permit pursuant ~o the ~Uilding ~one Ordinance o~ the Town of S~uthold, Suffolk O~unty, New ~rk, and other applicable Laws, Ordinances ,or Regulations, for the construction .~ build ings, oddities or alterations, ,3r for remeval or demo- lition, as herein described. The applicant agrees ~ corn ply with all~cable law~n~s, building code, h.~using code, a~d regulations. ~//~ -~ ~/~-~ ~ (Signature .of .applicant, o~ name if a ~rporation) /Aaaress o[ applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ........... ~4~eX'..Ull~e~'. ~O~r~ ............................................................... Name .of ,owner of premises ..... ~t~l~..~s~;$~. .......................................................... If applicant is a corporate, signature of duly auth,orize d .fffficer. (Name and title of corporate officer) 1. Location .of land o,n which pr~p.osed work will b e done. Map No ................. Lot No .............. Street and Number ~.'-~0-'2({-2~ (]~,eell~O:~{; l~l~r[i~ ]~:rk ................................. ........ .................... 2. ,State existing use and ,occupancy ,oi premises and intended t}se and ,occupancy of proposed ~onstruetion. a. Existing use and occupancy ....... .~0~,1~ ..................................................... b. [ntended use and ,occupancy ....... ~rj~lel~ .q~l~el~g ....................... ~ .................. 3. Nature of ~v.ork (check which applicable): New Building ........ Additi,on ...~... Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Deseribe~ 4. C~o.st ~o be paid ,3n filing this applicati,on) 5. If ,flwelling, number ,of dwelling units ..... [ ....Number ,of dwelling units on each fl~oor .............. If garage, number ,of cars .......................................................................... 6. If. busine.ss, commercial or mixed occupancy, specify nature and extent ,of each type of use .............. 7. Dimensions of existing structures, if any: Feo~nt .............. Rear ............. Depth ............. Height ................ Number of Stories ......................................................... Dimensions ,of same structure with alterati,ons .or additi.ons: Front .............. Rear ............... Depth ................ Height ................ Number of S~o~ies ..................... 8. Dimensions ,of entire new construction: Front ................. Rear .............. Depth ............ Height ............ Number ,*f Stories ............................................................. 9. Size of }or: Front ................ Rear ............... Depth ............... 10. 'Date of Purchase ............................... Name ~f Fomer Owner ............................. 11. Zone ,or use district in which premises are situated .................................................... 12. hoes p~0p~sed construction vi.ol~te any z3ning law, ,ordinance or regulati,3n? ........................... 13. Name,o~ Owner ~of premises ..................... ~ddres.s ...................... Ph,~ne No ............ Name of Architect ............................. ~ddress ...................... Phc*ne No ............ Name ,of Contract,or ............................ Address ...................... Ph~e No ............ PLOT DIAGRAM L,ocate clearly and distinctly all buildings, whether existing .or ~proposed, and indicate all set-back dimensi,ons from p~m,perty lines. Give s~reet and block numb.cz ,~ descripti, on according to deed, and sh,ow street names and indicate whether interio~ ,or corner 1,or. e,x~t~n~ b~th too ~;~ll--w~uld 11~ to add 3~'~y 42~by ~h~ STAq~E OF NEW YORK, )S.S. COUNTY OF .............. ) cant above named. He is the . .~,. ~n4~' ' ~'0n~ .... l~ontra~[or,l~ ~ · ~'t'l~agen~, ~O~,OIom~_p.o~.ate' ~'~'1~ 'et!ricer, 'I'~ l~l~e~.) :~' ..... of said owner ~or ,owners, and is duly autb,orized ~o perf,.arm or have pe~orme.d the said mo~ck and to make .and file th~s application; that all statements oontainod in this applieati,on ar~ true to the best of his knowledge and belief; .and that the mc~rk will be performed in the mann er set forth~ in the application filed therewith. Sworn t.o before me this ..... ......... ,of . ................ .... N,~tary Public, . ................... ©~unty (Signture of applicant) U ~FORM ,NO. 1 TOWN OF SOUTHOLD BUILDING DI~PARTMENT TOWN CI~ERK'S OFFICE SOUTHOLDo N. Approved ........... ~. ~. ....... , 19 .... Permit No..~. [ ...'~-...~.. Disapproved a/c .... .._~~~-~~ ;: ---- .................. ' .................. APPLICATIOi~ FOR BUILDING i'EBMIT Dec 12., 19$8 Date .................................. 19 .... INSTRUCTIONS a. This applicati.on must be completely filled in by typewriter or in ink and ,submitted in duplicate to the Building Inspector. b. Plot 'plan showing location of l~*t and of buildings o n premises, relationship to adjo.ining premises or public streets ~r areas, and giving a detailed description of layout of property must be drawn .on the diagram which is part of this application. , , _ c. The work covered by thi.s applicatkm may not be c0mmeneed before issuance of Building Permit. d. Upon approval ,of this applicati,~n, the Building In spee~r will;issue a Building Permit to the applicant. Such permit shall be kept ~n the premises available fo r inspecti'o~ i throughout the progress ,of the work.. e. No building shall be occupied or used in whole c~ in part go~:any purl~ose whatever until a Certifica~te ,of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department fOr the issuance of a Building Permit pursuant to the Building Zone Ordinance of the T~wn of So'uthold, Suffolk Gsunty, New York, and other applicable Laws, Ordinances .or Regulations, for the construction .3f build trigs, additi6ns or alterations, ~r~$or removal or demo- lition, as herein described. The applicant agrees Vd com ply with all aj~i~able laws .)r?~_'2ances, building code, h.mising code, an, d regulations. ~/'~ ~ (~ar~'~' ~o ldi n buyer (Signature .of a~0plieant, or name if a corporation) .......... Gr'e en.l~er.$ ,- .I~...~.1944 ................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder buyer under contract Name .of ,owner of premises ...... T~!~I..~,a.~Ji$? .......................................................... If applicant is a corporate, signature of duly auth,orized ,~fieer. (Name and title of eorpo,rate officer) 1. Location ,of land .on which proposed w,ork will bb done. Map~ No ................. Lot No .............. 59-60-a6-7~ Greenport Drivi:ng Park Street and Number ....................................... ..... Municipality 2. .State existing use and ~accupancy ,of premises and intended Use and occupancy of proposed construction. a. Existing use and occupancy vacant b. Intended use and occupancy ....... l£vi n,g .qtlat; e:n.a .......................................... 3. Nature of wo~k (check which applicable): New Building ........ Addi~ci'on ...X .... Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) .s.~.~..~.~.O.W .......... 4. F_,stimated Co.st ........ $.5..QQ .................. Fee .... $.5. .......................................... (to be paid (m filing this applicati,on) 5. If ~d~velling, number .of dwelling units .... 1 .... Number ,of dwelling units on each floor .............. If garage, number ,of cars .......................................................................... 6. If business, co,mmerciaI ,~r m~xed occupancy, specify nature and extent ,of each type of use .............. 7. Dimensions of existing structures, if any: F~:~nt .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions ,of same structure with .alte~atlons .or additions: Front .............. Rear ............... Depth ................ Height ................ Number of S~ries ..................... 8. Dimensions ~of entire new construction: Front ................. Rear .............. Depth ............ Height ............ Number ,3f S~ories ............................................................. 9. Size of 1,~t: Front ................ Rear ............... Depth ............... 10. Date of Purchase ............................... Name ~ Former Owner ............................. 11. Zone .or use .district in which premises are situated .................................................... 12. ]hoes proposed construction vi.ola~e any ~ning law, ,ordinance. or regulati,~n? ........................... 13. Name ,of Owner,of pre{nises ..................... A, ddress ...................... Ph,one No ............ Name of Architect ............................. ~ddress ...................... Ph~ne No ............ Name .o{ Contractor ............................ Address ...................... Ph,~me No ............ PLOT DIAGRAM L,ocate clearly and distinctly all buildings, whether existing or ~p~oposed, and indicate all sci-back dimensions from p~operty lines. Give street and bi.ack number ,~r de scripti,on according to deed, and show street names and indicate whether interior ~or corner lot. existing bath too small--w~uld like to add $$~y 42"~y 9~high would also ~o~plete all renovations mentioned~ in building ~inspectors report of 12/266 STA~i~f~ OF NEW YORK, )S.S. COUNTY OF .............. ) .............. Os.oar.. Go.~d~ in. ...................... being duly sworn, ,deposes and sa~s that he is the appli- (Name ~of individu.al signing application) cant above named. He is the . .buy.er. undar. ~onl~a¢.~..a~.d ...s.~.l.f.. ~.r~.~r.a.~ .t.~.r...f.o.r...r.e.p. ai..r.~. ..... (©ontractor, agent, eo~p.ornte officer, etc.) of said owner ~or ~owners, and is duly authorize.d ~o pe~rm o{ have per~ormed the said w,~rk and ~o, make .and file this application; that ail statements contained in this application ~re true to the bes{ of his kn,o~vledge and belief; and that the w~rk will be perf~rme.d in the mann er set forth! in the application Filed t~?ewith. Sworn to before me this /~'1 12 Dec 68 ................ day ,of ........ ............ 19 .... Go ldi n /- ~ N~(~tary Public ..................... County (Signture of applicant)