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HomeMy WebLinkAbout3780-zFORM ~0. 4 BUILDING DEPARTMENT TOWN CLERK'S OFFICE SO~JTHOLD, N. 1r. CERTIFICATE DF DCCUPAND¥ NO. Z 3067 Date ..}~..~'.. 6 , 19 THIS CERTIFIES that the building located at .][ll.le.~ .&. Bay. ]toad ......... Street Map No...~.~ ....... Block No...~1; ...... Lot No..~;g~ ..... t~.~.0ellPO~.$t~..~,~, ..... conforms substantially to the Applicati. on for Building Permit heretofore filed in this office dated ......... .F.O.]0 ..... R(~ ..... 19..68 pu.rsu'ant to which Building Permit No. 3~-801~ · · dated ....... ....F.o.b. ~ ..... .2.6..., 19.6.8., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .occupancy f. or which this certificate issued is ...P..~.~.~t.~.O.. 01~0. ~.amily..dwoll:~g ......................................... The certificate is issued t.o ... ~.Cl~.~O,~t..~O])e:P, .......... 0t¢llOI'. ....................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ...}~.g~...~t*..]~.~...t17. ~,..~i].llt .... FORM 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) 3780 Z Permission is hereby granted tj~lsmeqJajj ............... ~~ ....... ~.~.~.~. .......................... ~d ~ o~ f~ly at premises l~ated at ..~.~..~...~..~...~ ................................................................... pursuam to apprication dated ............................. ~e~.t ........ ~ ......... , 19.~..., and approv~ by the Building Inspector. Building Inspectr S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located ~ (Give deed location) / have been inspected by this department and found to be satisfactory. Distriot Engineer District Engineer FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. ...... .......... Approved ........................................ , 19...~.'.*** Permit No** ..~ .... ....................... ~....../~....;L.~.-~*** ............................... (Building Inspec~fr) APPLICATION FOR BUILDING PERMIT Dote~ .......... ~.~. ................. ...................... ~9~.E .... 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 port 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. ................ ~.~ ....... ~.~ ........... .??~....~..-. .......... (Address/of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. .6t.~x ~ ~,,,,r.~,,~ ........................................................ Name of owner of premises .................................................................... . ............................... If applicant is a corporate, s~mature of duly authorized officer. ...................... ......... (Nome and tit,?of corporate officer) 1, Location' of land of~ which proposed work will be dane..Map No,: ........................................ Lot No.: ......._.. .......... ... Street and Number ..../Y../~'~.*...~-~c~*~,- ........ /./,/J~....Z,,~......'/.,.~.f4~....../~ .............. .~/%,~.ac-~F/-:~..,,'~.. ................ / 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 ................ ~7~{,~ ...... ~'~.~ ........ .~.~'~2~'~'~.~./~.. ......................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration : Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..................... .J..~/.~..~Zf~:....~.....'~.. ................ Pea .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... J ............... 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 a.lterations or additions: Front .................................... Rear .................. . .......... Depth ................................Height ............................Number of Stories ................................ 8. Dimensions of e~tire new construct on: Front ................ ..~.....~.. ....... Rear ....~x~.~:......~.. ......... Depth ....~...~....~.. ........ Height ...... ./~....~. ..... ' Number of Stones .................................................................................................................... O. (.'). ..... I : 9. Size of lot: Front ...... ~. ................... Rear .................................... Depth .......................... 10. Dote of Purchase ........................................................Nome of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed.construction violate,. ,~ ~--z~'~.~ ~,any zoning law, ordinance or re lotion? ..... ..................................................... ~/.~.~,.~.~ i . 13. Name of Owner of premises ~,..t..~..~.../.~.~..~/.,~. .............. Address g,~u ..... o'ne Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ../9¢6.~7/,l/:....~.~..~..../~%Address ........... ~.....~u~..~.~'t~Phone No.~...~.,..--~..,~..~.../..~.., ~ -- PLOT DIAGRAM Locate clearly and distinctly all buildings,:~hether existing or proposed, and indicate ~ll set-back dimensions from property lines. Give street and block humidor or description according to deed, and show street names and indicate whether interior or corner Jot. STATE OF NEW YORK, 1, ¢ ~ COUNTY OF ................................ ,f .... ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ..................................................... C-~.~S,~'~,I~ .~.~.. ......................................................... i ........... (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 file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to befor~ me th s ~Term k×p res ~a~0i~ 30 t ,~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , Permit No ............................. Disapproved a/c ~~--,~.._...~..~ APPLICATION FOR BUILDING PERMIT 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 comp y with all applicable laws, ord nonces, building code and regu arians. ............... ....... ........... ........... (Address/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,z~lgnat,~re of duly aut,b, orized officer. ...................... ............. ........ (Name and t~e of corporate officer) 1. Location of Jand on which proposed work wiJl be done. Map No,: ........................................Lot No.: ........................ Street and Number ,..~,,.~.,~.. ....................................... ~... ..~X.....,"~? ................. .~....?.~.....~..... ................. / 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 .............. E~/~.......~ ....... ~..,~..'.:~.(?.)...~...,~.~. ........................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. 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 dwell!ng units on each floor .................. : .......... If garage, number of cars ................................................................................................................................... ' .......... 6. If business, commercial or mixed occupancy~ sb~ci(y 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 e~tire new construction: Fro'nt. ............ :.~....~.....~.....'.....,'. ReQr..,.~...~ .........Depth ....~.~..~ ........ Height ....... ~ ......... Number of Stories ...................................................................................................................... 9. Size of lot: Front ...... ~:'..~. ........ Rear '~'2. ~ ~ Depth / ~/ / 10. Date of Purchase ........................................................Name of Former Owner ........................................................ ] 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordnance or regu at onP ~ Name of Owner of rem sas ~t ~' ~ Address /~ ~ ~ ~ $'f ~"~"~'~/~ 13. p ...................................................................... . ................... ~ ....... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~/4~.~...~.~.pko~lAGRAMAddress ........... ~ ~...~..~g~Phone Mo 4~'~/~/ .................. [.oc~to clearly ond distinctly oll buildings, whether existin~ or proposed, ~nd indicato oll set-back dimensions from property lines. Give stroot ond block numDer or description occorOin~ to OoeO, ond show streot ~omos whothor interior or cornor lot. STATE OF NEW YORK, 1, COUNTY OF ................................ ~S.S. ................................................................................................. being duly sworn, deposes and says that he is the applicant (Nome of individual signing application) above named. He is the ................................................... ~t~...~r/f/~;l~ .(,~..f~.. ........................................................... , ............ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make a.nd file this application; that oil statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to be~ore me this~ -- ~ , ........ , . // _ ... .............. ......... ............ ............ Notary Pubic, ~~"'"{.{~,i]~~' County (Si~;[;~-~Ulicant) , livJrjg room bedroom //! -kitchen bath ,~.?,, ~ bedroo,'q FOUNDATION PLAN ECHBUIL REVISIONS SIDE ELEVA ~ION ECHBUI