HomeMy WebLinkAbout3793-zTOWN OF SOUTHOLD
BUILDING DEPARTMENT
'fOWN CLERK'S OFFICE
SOUTHOLDo N. Y.
ClEF~TIF'II~,ATIE I-IF I-Ir.r. UPANI~.y
No. ~.~002... Date ............ I~1~(,~1 .... 1~ ..... , 19~.
THIS CERTIFIES that the building located at 8/[[.. [ller~. l~a~ ........... Street
Map No~,. l~l~e, ak. gal[lock No..lOt. ........ Lot No.. ~[.~. 8~,~1.~1~.~t. ]q,¥., ..........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .......... i~l~]a-. ~ .... , 19(~. pursuant to which Building Permit No. '~'~9'~-~'
dated ......... l~a~l,¢h..-6 .......19.~, was issued, and conforms to all of the require-
ments .of the .applicable provisions of the law. The .occupancy f. or which this certificate is
issued is . l~'~I~g~ '~ld '~1~ .~(~a~s~Fy. t]~e.~ ...................................
The certificate is issued to ... Oa(~'ge- ~.~8~1 '& ~;[~'" '~ .... ~. ~: ,.O~a$~ ..........
(owner, lessee or ~enant)
of the aforesaid building.
Suffolk County Department of Health Approval .... ~[~ ...............................
Building Inspector
FO~ NO. ~
TOWN OF $OuTsOLD
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? 3793 Z
Permission is hereby granted to:
........... .....
~e~t,e~a~lL:..~.~,,.... .................
to ~t.~...~ ~.e...e.-~.e.~...~.~.t.~.¢~....i...i......:...' ................... ' ........................... :i ....................
at premises located at ,,,.~..,~t~.,...,..~ie~..~3~ee]~;.~t~SL..:.:. ....... ~....;.;;;.::.~:.'...:...~:.,....,..,....
........................ ,~....~. ~o.~,.:: .~tt~.~a,.,.,~ ...... ;.~ ........................ :.k.,.,.: ........ : ................. : .....
pursu(~¢ to apphcetmn dated ..';..;...r..,.:. ......
Building Inspector,
NO, !
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Application No..~...~...~....~.. .........
Approved ........................................ , 19 ........ Permit No .............................
· (Building Inspector) /
APPLICATION FOR BUILDING PEP. MIT
Date .................. .~,...: ................................... , ] 9..~....'~.~.'...
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 thie 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 wilt issue o Buiiding 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 o Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o 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, hc~using,code, and regulations·
.........
(Si~i~ature of app icant, or name, it a corporation)
(Addrcfss of applicant)
State whether applicant is owne~4~..~Z"'~'L'-~L'~L'~les~ee' agent, architect,~ engineer, general contractor, electrician, plumber or builder.
Name of owner of premises .~.. ....... '.?~;.:. .................................................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer) , ~
1. Location of land on which proposed work wj~llJ?e done..Mo~ No.: ...................................... Lot No.: ...../...~.~.. ............
Street and Number ~ ~¢~9~'t /c~, ~/~'.~Z~¥~' /~', kk/
Municipality
2. State existing use and °ccupancY~O~/"premises,~zD and intended use and:.~,~% ~/-~,Z/~°ccupancy of proposed construction:
b Intended use and occupancy ..................... ~ ..~..'~'~. ....... ~, ~ ......................................................................
./
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................
4. Estimated Cost ...:/~......J...(.~.~..,~.~ ................................. Fee
(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 .................................................................................................... : ........................................
6, If business, commercial or mixed occupancy, specir~pature and extent o~.e/ach type of use ......................
7. Dimensions of existing structures, if any: Front ........... ~ .......... Rear ........ ~ .................... Depth .....~...
Height ~'J' Number of Stories
Dimensions of same structure with alterations or additions: Front .................................... Rear ............................
Depth ................................ Height ............................ Number of Stories ................................ /
f'f 9~ r /O '
8. Dimensions ~If entire new construction: Front ............. ~. .................... Rear ......... ~?.. ............... Depth ...../. ..................
I
Height ..~....~.. .......... Numbe. r of Stories ............. ,-~, ~ r: .................................................. ,, r-~ -?;"* ...............................................
9. Size of lot: Front ...... ./. .?. Z~. . /. .......... Rear ........ ':L.L." ................ Depth ..... ..~...'.9..~..~/..:~'..~,. .....
10. Date of Purchase ..... /...O....'.C.:...;~/f.....:.~......~.:...(e ................ No~e,o,f/Forme~r O~ner~,,, ~-c--~, ~ ~'6'/'G~'~J'/"L'~'""("~'"~'"" ..............
U
1 1. Zone or use district in which premises are situated t~~
12. Does prop0~ed constiuction violate any zoJqing law, ordinance ~r, reaulation~ ............................................................
Name of Owner of premises .~.? ~ [~4,~ ~-~/ Address2 ~ ~ ~..~...:.~.... Phone No. ~..~!..~....~....
13,
Name of Architect ............. .'........'.............................Address.~~.~~~~~~~~.~~~~~~.~~.~~~~~~~~~~~~~~~~ iii .~:..~...il;.~~.j'/~"~" x~ ~./'""7_ ....... Phone No.
Name of Contractor ...... :'~~.....; .................. Address ........ ../~....~'.. ...........//'7 ~<'~]..,:..i ........ Phone No .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali set-bock dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW Y4DRK._ . ~ c c
COUNTY OF ..... .,~....U...~/.. :..o..L.;/..~...... )' ....
.......................... ..~Z-~.~?...~...~...L.~ ...... .~/'......~.t./.~.O.~.. ............ being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
abow; named. He is the ....... ..~.?..~.~.T..?...~.~..4Z.,...-T....~....~...~:...,~..T.. ......................... ~,; ............................................................
(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.
Sworn to_before me this ~.~.~.~...~ ,~..~.~. ~ ~
Not~'~'i~:lic,..d.~,~ · .~;/'r--~ .. ~:.~~~ .... ¥ i .............................
FOJ~M NO, !
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERKfS OFFICE
SOUTHOLD, N. Y.
In~poctor)
APPL~CATJO~ FOR BUILDING
Doto ............................................................ , 19 ....
ApplicotJon No..~...2.~..~ .........
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 locution 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 thio 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 Southotd, 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 app icab e aws, ordnances, bud ng code, ~ousing code, and regulations.
............................... ...............................
State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder.
If applicant is o corporate, signature ef dui,/ authari~ed afficer.
(Name and title of corporate officer). /~.~ ~ (-/~> c(~'a /
1, Locatio~ o{ rand o~ which premised work ~fll ba done. M~p No.:'. ........................ :'"-'v'w" Lot No.: .......~. .............
S, ree, and Number .......... :'~.....,'~' .......... ~:~::E ........... ~:...:.....; .....................................
Munici~li~
2.State existing use and occupancy of p~emises and intended use and pccupancy of pro~os~ construction:
a. Existing use andoccupancy ..... ~~~ ....... :~~ ....... ~~ ........................
b. Intended use and occupancy .................................................................................................................................
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................
4. Est.mated Cost ................... ~x...r..~..~ ........................... Fee ..........................................................................................
(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 .............................................................................................................................................
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 ............................ Nu~nber of Stories ............ 7 ................. /
8. Dimensions o.f/entire new construction: Front ............ .E .................... Rear ....... ~ .................. Depth ..../...0. ................
Height .....~~' ............. Number,_ J of Stories ................. ,9~x ) ........................................ ~z...~ ....................................................
9. Size of lot: Front .......,;..?....o...j .......... Rear ........ /..../.. ..................... Depth ..... '.~!.~ ................ ,-q
10. Date of Purchase 1° '~'?'~ ' ~Name of Former Owner~../~.'~. ~.~...~..~ ..................
,,. ........ ii ........... ................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................
13. Name of Owner of premises,~].'~('X' Address Phone No.
I,w-? /Z.~J~/)
of Arch.tact .................................................._;:,: Address L"~¢~'~ ~ ~
/
Name ' "' .... ;'ZZ': .............. ~" ~.' ......... Phone No ....................
Name of Contractor ...... z~g~... ....................................... Address ................................. : .......... Phone No .....................
i I '7 >~
PLOT DIAGRA~
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW Y, ORK, ~-¢ c
COUNTY OF .....
................................................................................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
abow~ named. He is the ...~.~.~..~L~...T.....~..~Z ............................................................................................
(C~ntractor, 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 t~fore me this ,
.
..... ............................................
Notary Public, .~ ............... ~..~fl..:..~.0:...~A,~g~y~c~,~ ~ (Signature of applicant')