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HomeMy WebLinkAbout4299-zFOI~M NO. ~ ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. THIS CERTI~ Map No. . ~,~ Certificate Of Occupancy Date ............. &~.~..~.., 19.69 IES that the building located at ...&ll~l~ .&.~ll ......... Street ·. Block No. x,~ ....... Lot No. l.. ,. I&ll~ · .~l'~ ..... ii.~,. conforms substantia11~Ito the Application for Building Permit heretofore filed in this office dated ............... 16 19 69. pursuant to which Building Permit No. II~)~... dated ........ ~ .~... 21. 19.~, was issued, and conforms to all of the require- ments of the apphcable prows~ons of the law. The occupancy for which this certificate is issued is .... l~$e. ~. faally, d~ell~ The certificate is j~sued to .... 9~t'otl~. of the aforesaid~),~ild~ng. Suffolk County ] )epartment of Health Approval ...N.~[. ............................ .... Building io $ t FORM NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~299 z Permission is hereby granted to: ..... I~e~otikV..~e~l'~r~..&..Zme ..................... ..... ~.....~...~.t, ........................................... ..... gll~ ...... l~,&,.....(~8 ........................ to ....... l!~M,l~..~..~,~l.O.~..t,~o~., m~..~l~..e~l,~.tJ.~ ..~,~J.~ ............................................... at premises located at ........... JdJ3;l&...~.:LiJ¥..~.~.ll ................................................................................. ...................................................... ~.~.t,..J~.r~.o~ ........... ~,Zo..~ ...................................................... pursuant to application dated ....................... )il, Jr .......... l~ .............. , 19..~, and approved by the Building Inspector. .Fee $.~e~ ............. Building Inspector AI~PLI~'TION FOR BUILDING PERMIT 16, 69 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationsh p to adjo ning premir, es or public streets or areas, and giving a detailed description of layout of praperty muSt be drcnvn on the diagram which is port of thie application.. c. The work covered by tl~is application may not be commenced before issuance of Building Permit. cl..,. U,pon approval of .this c~.licatJon, .the Building Inspector will Issue a Building Permit to the applicant. Such permit sna. oe Kept on the prem,ses available for mepact on throughout the progress of the work. e. No building shall be occupied or used In whole or in part for any purpose whatever until a certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS H.EREBY MADE to the Bu!!d ng Department for the issuance of a Building permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature~f app icont~-i~';-~o'o~ration) 1 ~,$.~r~ond Street Chatham New Jeree (Address of applicant) 07928 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, Plumber or builder. ......................................... .O. wn r. ........................................................................................................................................... Name of owner of promises ..D. orothy K. Crawford & Walter K. Schumacher If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which p~ work will be done..Map No.: ........... ; ............................ Lot No.: .................... ~ ;rI - Street and Number .................A~u,e.u.Lem..TLG~L~...~d~,,%~.. ~r.~,~.~. ,.....N..~..Y.... ................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ExiSting use and occupancy ................ ~IrAgl.$...~.~l~,lI .h.o.~.~.e. ........................ ; ............................... b. Intended use and occupancy' ............. ~.~..rq.e. ............................................................ 3. Nature of work (check which applicable): New Building .................. Addition ...~. ............ Alteration Repair .................. Removal .................. Demolition; ................. Other Work (Describe) ........................................ 4. Estimated Cost ..... ~Q~).~Q.Q. ......................... . ........... Fee ,...~....0...0. ...................... ~ ................................................. (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 curs ............................................................................................................................................. 6. If business, commercial or mixed occu. poncy, specify nature and extent of each type of use ............. ~ .............. 7. Dimensions of existing structures, if any: Front ...3~.*~.~;; ............ Pear ..3.0.....~..~, .................. Depth .~.~...~.t;.. ....... Height ........................ Number of Stories ....... ~.W.O. .................................................................................................. Dimensions of same structure with alterations or additions: Front ...~..~...~.~.~ ....................... Rear 3© Depth .....~-3..~.~ ............... Height ............................ Number of Stories ....~.o. ..................... 8. Dimensions of entire new construction: Front ........ .~ .,,~ .................. Rear ..(~.~...-._~.~. ..............al Ot~ Depth .....u....-. .............. Height . 8 ~ -.~ n Number of Stories OTte ......................................... 9. Size of lot: Front ............................ Rear ~ ................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ~.~.~.t....~..c..~....u~....a..q..~..e..~.. .................... 11. Zone or use district in which premises are sitUated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;) ....~D .................................................... 13. Nome of Owner of premises Doz'oth?r K. Oz, awfo:]3~.,~ 7 Ra~rmo~d St C~athe~3 NJ.. 201-6~- ....................................................... ~ ................................. ~ona ~o ........ 7'837'" Name of Architect ............ .O...w..~...e..~. .............................. Address ............................................ Phone No ..................... Nome of Contractor .................................................... 0w~zez' Address ............................................ Phone No ..................... 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 number or description according to deed, and show street names and Indicate whether interior or corner lot. ~IeuRwEw ,'e'D. .................................... .D..9.~.o...'p.h.~;;~........C.~.~.w..~...°..~..d.. ............... being duly swam, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ....... ge~3~.~,ee.~,(>~ .......................................................................................................................... (Contractor, agent, corporate officer, otc;) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make end 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 inthe manner set forth in the apPlication filed therewith. Swam to., _b~ra me this ........... ...... da of ..... Notary PuJblic, . ........................... .~...._...../~...o..~.:.~ ...... ~o~nty"", ~~'t~;~;~';~ ......... ~ ....