HomeMy WebLinkAbout3809-zFORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located at .p~;~V.a.te..~O~..Of~..]~[~.F~.,~Og,~reet
Mop ,No: .~.e.[~.E..$..t...a..tel~ck No ....................... Lot No. ~.~,..1. ......... ..~.~..s.~.e..~.$....~..$.~..a.~,.....N..,.~.~..
conforms substantially, to the Application for Building F~ermit heretofore filed in this office dated
...................................... ~,.~.~......~,.~......, 19..6.~,. pursuant to which Building Permit No ..... 3.~...0.9..Z
dated .............. f ....... :~t,3~.0~ ....... ~,~.. ...... , 19...~..~, was issued, and conforms to all of the requirements
of the opp]ic'ab[e provisions of the Iow. The occuponcy for which this certificate is issued is ........
...... ~,.v.~.~.e.....o..n...e....~,;~....~r..e..z.:~.:~ .~ ........................................................................................
The certificate is issued to ...~oh~'~.~l ........................ O'~e~. ..................................................
(owner, lessee or tenant)
of the aforesaid building. ~
FOP/~ 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)
N? 3809 Z
Permission is hereby granted to:
............ J~he~..Z~l~m~l .......... I.Z. ..............
at premises located at ~G~,..'~,~.....,' ,~,L,~/~,e,..,~&..~t,&f,~l;..~j~ ...................................
..J'~.. Jm~ ..et'Z..~,.ZIL .~aJ,3~...iJa.~.te,~ee.t,.. ~e...e.. ~.. ilemee. ................................
.............................. Z/Mm~..Z~lmzl.... ~l~t:o .................................................................................
pursuon~ to opplicotion doted ............................ ~**~..****~. .............. , ]9~.., oncl opproved by the
Building Inspector.
Fee $ .~.e.O..g. .............
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ........................................ , 19 ........ Permit No ..............................
Disapproved a/c i~..~-~~...i~ ..... ~.
APPLICATION~PERMIT
INSTRUCTIONS
o. 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 o detailed description of layout of property must be drawn on the diagram which is part of this applica-
tion.
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 a Building Permit to the opplic.a~nt. 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 pa rt for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MA.DE 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, alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
(Signature of applicant, or name, if a corporation)
JBox E~ F'$het's s aB.d, New Yot-k 06~.0
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.......... .¢.t, .........................................................................
Name of owner of premises ................,l~./~r~...~/.,...l~.~n.~s .....................................................................................................
If applica~/i~: corp, ora~te,,,.~igt3,ature~'pf dul~/, g~thorized officer.
........ ................
1. Location of land on which proposed work will be dane. Map No.: .T.~,~..~f~....~.~.~..~.l..SLot No.: ...~..~..':.! ..........
Street and um er .......... .........
Municipality
2. State existing use and occupancy of prem,ises and intended use and occupancy of proposed construction.
a. Existing use and occupancy .......... ~.~...i..v.~.~.~....l~.¢.$..I..d~rl.c;~ ............. : ............... : ........................................
b. Intended use and occupancy ..... P.~.i..¥.fl.~.¢....l~f~.~id.e~e ............... .~ ...................................................................
3. Nature of work (check which applicable): New Building .................... Addition ....... ~ ......... Alteration ..................
Repair .................. Remove! .................. Demolition ......... X ...... Other Work (Describe) ..................
4. Estimated Cost .....$.[,~.,.f).0.O..,.0..O. ................................. Fee ...... .$.,~.,.Q.O ......................................................................
(to be paid on filinfl this application)
5. If dwelling, number of dwelling units ..... I .......................... Number of dw611ing units on each floor ........ I ...................
If garage, number of cars ........... .-..-...-..-...-..-..-.. ................................................................................................................
6. If business, commercial or mixed occupancy, specify nature ,o,nd extent of each type of use ....-...-..':.."..-..-.,.-. ................
7. Dimensions of exist[nfl structures, if any: Front ..... .4-..4.~. ................ Rear ....,~.6...~ .................. Depth .....4.0..~. ...................
Height ...J.~l.~. .................. Number of Stories ............ ! ...................................................................................................
Dimensions of same structure with alterations or additions: Front ...5.~.: ...................... Rear ...... ~.~ ...................
Depth ....,~.~.~ ..................... Height ......... I,,~,~. ................. Number of Stories ,..]. ...........................
8. Dimensions of entire new construction: Front _,~.e.t~...D.~.g, .........Rear ........ .-...-..-..-...-..-. ........ Depth ...-.::..':.-...-. ................
Height ........ J..4..~. ............... Number of Stories ...J ..........................
9. Size of lot: Front .....7.,..8.2...ac~.e,s.. Rear .....-.-...-.=..-..-..-...--. ........... Depth ...... .-...-..-...-..-...-..-. .......
10. Date of Purchase .,.L9.54. ............................................. Nome of Former Owner ,,T,Q~/,~.,,o,~,,,,,~p,~l.~b,o,l.d
11. Zone or use district in which premises are situated....R..e..~.J..d..~.D~..J..P.! .........................................................................
12. Does proposed construction violate any zoning ]ow, ordinance or regulation? ....... ~.O. ..................................................
13. Name of Owner of premises .~l.~h.o.,.~,,...~a~e.~. ..... Addressd,~0...R~k...A.v.e...N,.~.,..(l .... Phone No. ,~..;~.-.,~.~.;~
Name of Architect .[vJ,e.c.f. ed.yc:~...fc...lf~.~J.~.~ ..... Address2,~O,,,E,.,6.l,,,~,t,,,,,,~,,~,~,,,fj,,, Phone No.
Name of Contractor F..... J.,..l, jt .j.J..i .'1:.~'...(~.o.,,....|~C... Address B.~x...E.~_.F.....[...~..,.~I,.....~ ........ Phone No? 8 B..-.~..2~5 I..
PLOT DIAGRAM
Locate clearly and distinctly ali 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 shaw street names and indicate
whether interior or corner lot.
See attached drawing ~er details,
STATE OF NF-cW Y~p~RK, ~, ) S S
COUNW ........ /"
.............. ~..~,.~.'.~.~. ................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
abow~ named. He is the ....... ~.~~ ............................................................................................................................
(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
........................ ...... f' ............................
No
Notary Public ...~....~"...~~e~8e.... ~ounty
Tetra exp~ Me,ah 30, 19~ ~ '
~OE~f NO. 1
TOWN OF SO~TSOL~
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ......2 ~'/,:~::~.....~,. Z ......
Approved ........................................ , ]9 ........ Permit No.
Disapproved a/c ~ZZ:;; .......
..... · ......e....~ ........... (Building'"'"'""""""""'"lnspe~"'""'"'"'"'"'""
APPLICATION FOR BUILDING PERMIT
Application No....~.....6....::./. .........
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, rela¢ionship 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 applica-
tion.
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 applica.nt. Such
permit shall be kept on the premises available for inspection throughout the progress of the work.
e. No building shah 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, alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
· F..i.~b.,~..~...I.~.l.e~d...Ut;.i.i..i.'b~...f~e.,,,,....l~c., ..................
(Signature of applicant, or name, if (~ corporation)
(Address of applicant)
Sta.te whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder·
......................... .¢..e...,..e..~.!... g.~.~.~ ~..~.~.~.~r.. ..........................................................................................................................
Name of owner of premises ...............~.~fl...W.,...ll.all.~.~t ......................................................................................................
If applica, pt~a corporate,,siflna!.~i~e of d~ly authorized officer.
-i/ ..,~; 5
....... ~.'x ..... (Name and" "---~'"" ~'~~ ;~ ~;;'¢¢ .................
1. Location of land on which proposed work will be done. Map No.:T.e~..~...~b.~¢.~..~J.~ Lot No.: ..~.~J. ...........
Street and Number ......... [.i.~.~.~...l.~.!.~.~...~¢.~...~k ....................................................................................
Municipality
2. State existing use and occupancy of prem.ises and intended use and occupancy of proposed construction.
a. Existing use and occupancy ........ .[]~.J.~.~...l{.¢~.J.~t ..................... ;:.:: .......... .;'. .......... ~ ..............................
b. Intended use and occupancy ....~r.J.~.~...~.t~.J¢~.~.~ .......................... :~ ...... ~.: ................... ;:; .........................
3. Nature of work (check which applicable): New Building .................... Addition ....... X ......... Alteration ..................
Repair .................. Remova! .................. Demolition .......... X ...... Other Work (Describe) ..................
4. Estimated Cost ....$1.5.,.0.(~0...00. ................................. Fee ...... $$...00. .....................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ..... I .......................... Number of dwelling units on each floor ........ I ...................
if garage, number of cars ........... ,~..~.~..,..~ .................................................................................................................
6. [f business, commercial or mixed occupancy, specify nature ,and extent of each type of use ....-...-..-...-..-...-..-. ................
7. Dimensions of existing structures, if any: Front ..... ~[4.~. ................ Rear ...~6..~ .................. Depth ....~,0.~. ...................
Height ....I.6.~. .................. Number of Stories ............ I ...................................................................................................
Dimensions of same structure with alterations or additions: Front ...5.6~ ...................... Rear ...... ~6~ ...................
Depth ....~,4..~. .................... Height ......... I.$.~. ................. Number of Stories ...I ...........................
8. Dimensions of entire new construction'. Front ,.See..~wgo ......... Rear ........ .-...~..-.~.~..-. ........ Depth ...-..-...-..~.?. ................
Height ........ [~,.~. ............... Number of Stories ...[ .........................
9. Size of lot: Front .....~..~2...ao~..e~. Rear ....~-,.~.,.~.~.~..~. ........... Depth ...... .~.~..,.~..,..~., .......
10. Date of Purchase ...[~.$4 .............................................. Name of Former Owner .]'awa..,',~...E~ou~l~.o.IJ ................
11. Zone or use district in which premises are situated...l~em.i.d~.rL~Jal .........................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~.~ ..................................................
13. Name of Owner of premises .Joh~...~Jo...tlaae& ..... Address460...P.e~k...A¥~...N,.¥.P~o... Phone No.
Name of Architect .Ma~fad.y. em.~...Kno~.l.e~ ..... Address2~O...E...6.1...$t.,~...N...¥...C... Phone No.
Nome of ContractorF....I.,JJt.t.l..i.[¥...C~o~....lae... AddressB~x...£~...F....,l....,....[~l~...¥.. ...... Phone
PLOT DIAGRAM
Locote clearly and distinctly ail 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.
See a~ached drawing For deeails.
above named He is the ..... ~~ ....................................................................................
(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 ali statements contained in this application are true to the best of his knowledge a:nd belief; and
that the work will be performed in the manner set forth in the application filed therewith.
Sworn to bef~ore me this_
........ ~.~..~.:~... ~day of .~...~, ....................... 19.~.~..
x , . ....
t r I ~q~z~J'~J~L~' ~g~ ~! New Yo~ .~..../ ...... ?., ..............................................
No o y Pubrc ................ ............ County L/
T~m
'7
~LA~d