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HomeMy WebLinkAbout3711-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERKS OFF~E SOUTHOLD, N.Y. GERTIFIINATE OF nBEIUPANEIY t%.. ~, ,3t2.5. ·. Date .............. ~.~lCte .... 2¢..., 19 .... , ¥ THIS CERTIFIES that the building tocate~ at Wlekham AVa .&. P~e.. ~. Street Map No..~ ....... Block ~o... ~ ....... L~t No.~ .... ~a~lt-l~k.~..~,~.~ ...... conforms substantially to the ~pplication for Building Permit heretofore filed in this office dated ......... ~. - 10.- 19~. pursuant to which Building Permit No. ~ll. ~ dated ......... ~ .... ~ .... , 19~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy ~br which this certificate is issued is . .. ~ ~a~' ~1~ ' ( ~bli~' ~S ~o~b~y}',,~' ~e' h~e .......... The certificate is issued to .. ,..H&tt~ck. F~ .D~¢.2~iC~ ............. ~ne~ ..... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ~*~ ......... - ................. ........ ~ . ~.C¢,~.. .~ .... Building Inspector House # 1000 FORI~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ,,AUTHORIZED) 3711 Z Permission is hereby granted to: .... ~......~.A~.e., ........................... ~ ................. .... ..l~..~,...~., .................................... , ...... : to .i..~;L~...~...~.~,~,~.. ~ ,.a~..e~..£~,~ ..~ ................................................. pursuant to application dated ........................... ~.~.~.~J~....' .......... , 19,.~.., and approvedby the Building Inspector. JJO*~,iJ jltt~e~ ~) ~tr~[(~ ~.~t~'[~ ~(J~J,J'e~J~ Building Inspector-- FO~M NO. 1 TOWN OF SOUTHO[.D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ......................... ~.~ ............ , 19...*.~... Permit No.........................3 Ii .... Disapproved a/c7 ~ ....................... (Building InspectS') 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 applicotion~ c. The work covered by this application may not be commenced before issuence 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, 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. General Oon'~ractor Name of owner of premises ..~.~.~.~..~..u.9.~...??.$.~..e....~.~.~.t;...r.~p..~ ...................................................................................... If applic~cu~F~oT,-~ture of duly.~.~d officer. (Name/an"d title of corporate office~) 1. Location of land on which proposed work will be done .Map No.: ........................................Lot No.: ........................ Street and Number ............. ~.J~e...,q..~.~.~ ........................................... . ................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............... ~.2~'.9...Al~.]~&~2~'~k~,B ................................................................................. b. Intended use and occupancy ............. ~...~..~...o.....~.~..~..~..~..~.~.~ ................................................................................. 3. Nature of work (check which applicable): New Build'ing .................. Addition ....... X ......... Alteration ......... X ....... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....~.G..Q.,.Q.O..Q.: ..................................... Fee ........... .R...u..~..~.q.$.~..g.Z. ......................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... .-. ........... Number of dwelling units on each floor ........... .-r ............... If garage, number of cars ............ .~.Q.L~'..,¥9.hx.~Le,~, ................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .~J,~'.a..~o.9.~ ..... 7. Dimensions of existing structures, if any: Front ..... 5.0.! ................ Rear .......... .~O.! ............... Depth .......3.6.! ...... Height 26' Number of Stories Dimensions of same structure with alterations or additions: Front ......... ].~..! .................. Rear ...... ~..~2,.~ ............. Depth ............. &..~..! ............ Height ......... ~..~ .............. Number 'of Stories ............ 1 .................. 8. Dimensions of entire new construction: Front .......... .~.~ ................... Rear ............ ~, ........... Depth ....... ,zh.,,L[:..~, .......... Height ......Z. 2 ........... Number of Stories ..................... ~. .............................................................................................. 9. Size of lot: Front ...... .]..~.5.! ............. Rear ........... 1.~.5.! ................ Depth ..... ~-.°Jg.! .................. 10. Date of Purchase ............~.u,..z.z.%.o..~'9.g~ ...................... Name of Former Owner ......... .[ll~'~ti.e~J,9~i, ........................ 1 I. Zone or use district in which premises are situated .......... ~v,~t~,±OJ. pa~ ..................................................................... 12. Does proposed construction violate qny zoning law, ordinance or regulation? ........... .[.~..o. ............................................ Ma~tmtuck Pire ]~. Name of Owner of premises '"'t)~'s'~'r~_'~ .................Address ............................................ Phone No ..................... 8~ Meadow Lane Name of Architect ...'.D..°..z.~..~[l:~...A.z...~.e..~..~.~ .............. Address ..~:merhe.ad.;.-~:.~.., ..... Phone No ..................... Name of Contractor ..G.'..q?..'.l..e..q.~....~.°...~.:.~.?...~..°.~.$.~..~....Address ...2...2..~....~...a.~....A..M.e..z~..e. ....... Phone No...4:..~..2...~.0...8.Z~ Carp. Baypor'b, N. Z. PLOT DIAGRAM Locate clearly and distinctly all 6uildfngs, whether ex/sting or proposed, ~nd indicate all set-back dimensions from property lines. Give street a~d block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~YQ~K ~ ) ¢ c COUNTY OF ...~.~..Z...z. iO.'..~.~ ............ ~'~' ............................ J~.~,~Q~.~....O.I~..~.~Z'J.,~ ............................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .......................... .?.?..`e..@~.~...e..~..~.."~..f.....Czft~'.~.fi~..~.~D.~.~;~.~i.~...~.^.~ .............................. (Contractor, agent, corporate officer, etc.) ~f'~~ and is duly authorized to pert:arm 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. Sword to be 'o~e me this ......... ........ day of ...... Notary ...... County 5 p,,cant) L£T,~E,R,,,OF ~ONAL0 A, DEN]~S A$$OCZATE$ Arch{ tect 8~ M~ado~ Lane I~Jverhea~, Lo]. NoY. 11901 516- 727-5~0 DATE: PROJECT: _,~o.