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HomeMy WebLinkAbout4534-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Zt~233 Date F. ay ? , 19 71 THIS CERTIFIES that the building located at h'ickha~ Ave Street Map No. to. ti; lt~;s Block No. Lot No. 9 & 10 ~'attituck i~ .¥. conforms substantially to the Application for Building Permit heretofore filed in this office dated Oct. .29, 19 7~. pursuant to which Building Permit No. dated ~. 6c~; 31 , 19 70, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Private one family .dwelling ................. The certificate is issued to Frank Ray, or .... 0',~er ....... (owner, lessee or ten,t) of the aforesMd building. Suffolk Co~ty Department of Health Approval ~ay 3 1971. h~' R.. ~illa. Souse ~ 3375 / ...... ~uiidin~ ins~e&;o~~ " FOE]Yl 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) Building Inspector. pursuan¢ to application dated ,.~ ~7~, 7~- 19...~,..~,, and approved by the Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ]~Y 3, 1971 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located South side Wickham Avenue ...... Mat~ituck at (Give deed location) have been inspected by this department and found to be satisfactory. BUILDING DEPARTMENT c?,e~--- TOWN CLE.K'S omc: Sou'ri. IOLD, N.Y. Application No ............. /... ........... Di~PProved a/c ......... ~ ............ .~~ ............... (Building Inspector) APPLICATION FOR BUILDING PERMrI' Date ........ .(~ ~.~.b.e.l~.. ~.., .......................... , 19.....6c~... INSTRUCTIONS a. This application mus~ 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 issuc~ce 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY/MADE to the Building Department for the issuance of a Building Permit pursuant to the Bu ding Zone Ordinance of the Town of Southald, Suffolk County, New York, and other applicable Lcrws, Ordirmnces 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 cede, housing code, and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ........................................................................................................................................................................ Name of owner of premises ...~/X%...~l:a33~...~qGTtrLO. l~' .......................................................................................................... If applicant is a corporate, signature of duly authorized officer. ~ ....... ................... - (Name ai~ title of corporate of ice ) I~.c~ _// ~ ~ ~ ~ / ~ t. ~aLon of land on,ich propo, d work will be done. ~ap No.:. .............. ;.......:...Z .......... Lot No.: ........ f-.;.. ......... Str~ and Number ............ ~..~..~ ...................................................... ~~..~:~. ..................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. ~.. .............................................................................................................. 3. Nature of work (check which applicable): New. B'uilding ..... ~t' .......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..... ~.~l~l~ ..................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... i~ ............. 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 altercations or additions: Front ....................................Rear ............................ Depth ................................ Height .......... 'i ................ Number of Stories ................................ 8. Dimensions of entire new construction' Frq~t &~ I# Rear 4~'t 8l~ Depth ...~....~...m. ...... Height ....J~ ........... Number of Stories iOIl~ 9. Size of lot: Front ....X....O?.I. ............... Rear XO01' Depth ~0~1 10. Date of Purchase ...... ~.....~. ............................ Name of Former Owner ...~T&all~..lJtW~ ............................ 11. Zone or use district in which premises are situated ~B~EIEI~ 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ...1~. .................................. 13. Name of Owner of premises ..~...~ ......... Address ....~1~...~....~....~.,~ ...... Phone No..~..??...~ Name of~Architect ...................................................... Address ' Phone No ..................... Name of Contractor ......]~. ~..l~.....~...~....~..Address ....l~....ff...~l~....X~...~...~..~.ff.. Phone No.?...'~.....*~..~. PLOT DIAGRAM Locate clea'rly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from p. roperty lines. Gi~,e street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ ¢ c COUNTY OF ................................ ~ '~"~' ......... · ~'""~"'"~...~ ....... ............................................. being duly sworn, deposes and says that he is the applicant (N6m~ of ihdividual signing apPlication) above named. He is the ...~..~?..,..t~....~.~..~. ............................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to peHorm or have performed the sc~id work and to make and'fiie this application; that all statements contc~ined 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 3Xwt - f Ootob ........................ ................ Notary Public, ~;~~,, County'~'~'"~i~'~'~'t:u;;;';~';~l~iicont) '" ~'~ EOTARY PUBLIC, ~i~[e of New York' No. 52-$12585n, Suffolk County Term Expires March 30, 3. Nature of work (check which applicable): Ne~ B'ufl~'".:....~t. ......... Addition .................. Alte~a~l~n .............. :... Repair. ................. L Removal ................. ~: Dm,n~lit~6n ............... ,.. Other Work (Describe] ........................................ 4. Estimated Cost.....~"' ": .... Fee ........ : ..................................... ,. ........................................ (to be pa[cl on filing. ~,~, ali~Jlcation) 5. If dwelling, number of dwelling units ........ ~ ..........~.".l~u~ber of dwelling units on each floor';...~ ................ If garc~g~ n~tnber of:cars .......................... ' 6. if business, commercial or mixed occuF:~ar~:_ y~. specify ~tum:a?l exteat of e~ich-type ~f ~ ............................ 7. Dimensi0~$. of existing structures, if any: Front ............................ Rear ............................. .x.~ ~ .................... Height ..;; .................... Number of Stories ' ' '~ ...... "· Dimensi~ of sam~ structure with olter~ions o~,additions;. Front .................................... ~ ........................... Depth ...~ ........... :: ............ Height .......... .], ............ :.~?t~u ,~l~r, of Stortes ................ ~. .............. 8. Dimensi°l~s of e~tre new construction:' F'T~..~i~!i~L.. ~. Rear .4..~.?. Height .~ ......... .; Nut?ber of Stories .i~..,.:,iff..~;~;.'.;'. ........................................................ ~ ............................... 9. Size of lot:. Front .,.~ ............... Rear .......... ~.?...] ...........Depth ....... ~..t. ............... 10. Date of Jrr~rchase~ ...... tlJg~,..~ ........................... ~h~me ~of F~,rr~, ©ws~e_ r ..,~ll~,~; ........................... 11. Zone or ~ distr'~t-in which premises are situated ............... ~~ ........................ i...~...,~ ....................... 12. Does ordinance or regulation.> ...Iii ........................................ 13. Name l ~f premises ..~...~.....~..Address ....l~l~.~...~.'.~ll...,..' pflo~ No..~ Phone No.~. PLOT DIAGRAM G STATE OF Nk-VVt YORK, : I. S S (Cont tor, ngent, como/ate o ir, ............ of said owrmr, or~.ow~ere, and.is.duly authorized ~o.pett~oem-or .have Performed. th~:~c~: ~ ~FO,~ and f · ~ ~ ~l. lt.l~:~forn;~d in. the manrmr Set to~th, in the.application filed,therewlth. , - .~_.~v ~ ' Ho 62-8125SSn Suffolk Coun~ : erin ~P res Ma ch 30 ~ ~, , FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~,O¢~&..~A~ .c~..., 19 ~."~ Approved .Ta-w~ga~---~.c].., 19~..]. Permit No./.~.'~! .~. ~ Disapproved a/c ..................................... (Building Inspector) BOARD OF HEALTH 3 SETS ~ PLANS SURVEY CHECK SEPTIC FORM NOTIFY CALL MAIL TO: APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. 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 appli- cation. c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Budding Permit to the applicant. Such permit shall be kept on the premmes available for inspection throughout 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 Budding 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 m Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulations, and tc admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) . . ?. . . ..f /. r. . ..... (Ma~hng address of applicant) State whether applicant is owner, lessee, agent, architect, eng/neer, general contractor, electrician, plumber or bmlder. ........... ..................................................................... Name of owner of premises .... /..~- ..~._..~.~..x~...~.. ?..../.~....,,y~_~..~.x~..o. ~ ....................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..../.."~....~..~...~. ?..-(...~..~.. Plumber's License No ...................... Electmclan's License No ...................... Other Trade's License No ...................... I. Location of land on which proposed work will be done ................................................. .~,~.,7~ .... ~ (.~..~../~...~7~.. g;7. ~. ~2.~ ..... ..~ ~.~/.~"~ ?./.C. ........ ~amt'd-'-~' . 1;' .... House Number Street County Tax Map No. 1000 Section ...//..o. ~. ........ Block ...Q..~. ~ ......... Lot.. ~../..~.'. ......... Subdwlsmn. ?..~..7~.//.~.,,.~/.c.././. ¢/.,.~..~? ........... Filed Map No../../..,~..~. ..... Lot .. ?'.~..g..o ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction' a. Exlshng use and occupancy . . . . .~..?~..e~ .~.~.~.~..~. .................................................. b. Intended use and occupancy ..... .~...~.~...L3.~e~..~J'~L. ...................................... 3. Nature of work (check which apphcable). New Building .......... Addition ...../f~. ·... Alteration ........ Repmr ............. Removal .............. Demolition .............. Other Work .,~..~'..~./~. .... (Description) 4. Estimated Cost .~.~'.~..q .............................. Fee..~-~... :. ~ ......................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... /. ........ Number of dwelling umts 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 ~.-2 .~ .......... Depth . .~..9'~? ....... Height ............... Number of Stories .... .-~ ................................................ Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth ...................... Height ...................... Number of Stories .................... Dimensmns of entire new construction: Front . .~..~. '. ......... Rear . .~..?..~ ......... Depth ./.~..~ ......... Height ............... Number of Stories . ..~ .................................................. Size of lot. Front .... ~ ................. Rear ....~.~. ................ Depth . ~P..o:~....; .......... Date of Purchase .~. ~f./~. ~.~ ?. ................ Name of Former Owner~'c,,~.~,? ?.,-.~...-~..-~.~,>f~ ....... Zone or use district in which premises are situated..~??,9. 2T..~ ~'. o.%/..c.,. .................................. Does proposed construction wolate any zomng law, ordinance or regulation' . ~ 9. ........................ Will lot be regraded ....~..q> ...... ~, ............. Will excess fill be removed from premises: Y?s i' Name of Owner of premises,/f-,~..~ .~//. ,~/*~,,~'.. q~.... Address .g4~.~F/~trt,. ~ ~. ~.~.,q'.: Phone No~.~..,~.~. .9.8 .~.... Name of Architect ........................... Address ................... Phone No ...... j, ....... Name of Contractor . ./~.,?..,%..~.,,.-,e..~..,~.o..,~: ........ Address ~-~.a.r~,~.,~. p.e.7., .~,9./7;.. Phone No.2.f...~.~..g.$'..L.... 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRA~ 10. 11. 12. 13. 14. Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions frc property lines. Give street and block number or description according to deed, and show street names and indmate wheth interior or comer lot. STATE OF NEW.YORK, ,. ,. COUI~_ Y OF ~ ....... ~'~ ....,~.,~....~,f~f?.c.. ~...,r~..../q~...~_r. ....................... being duly sworn, deposes and says that he is the applica (Name of individual sigmng contract) above named. He is the (~ Co ~ ~ (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 tl apphcat~on; that all statements contained in this application are true to the best of his knowledge and belief; and that t work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ....... 2 -~7'~.. ........... day of. 7~ ....... , 19 .~..~ Ngtary Public, ~ ..... County Notary Public, State of New Yorl~r~-~,~/ (Signature of applicm ' No, 4822563, Suffolk County/~ ~ Term Expires December 31, 19_L/_~