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HomeMy WebLinkAbout3449-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFII~ATE OF BBCUPANBY No. .,,,~ ~.~ Date ' '~£~, o .............. 0Ct'(~b~v' · '3~9 ....., 1967' THIS CERTIFIES that the building located at .Bennett. & .Cta~t~,~ Ave Street M F~ie~ Pa~k~, ap l~o ........ ~ioci~ No. Lot No conforms substantially to the Application for Building PermR heretofore filed in this office dated ....... g~ll . .~, , 19.67. pursuant to which Building Permil No..3[~t~2 .Z dated ........... A~.,:cz3. ,~ 19.~.~,., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate issued is ... ~!V~8. ~ .,~,~.~3~y. ~]~,~ ~ ~;.~ .................................... The certificate is issued to ... ~O~t:~. ~..~. ~'~lO!e-. ~Of~,..O~e~8 ...... (owner, lessee or tenant) of the aforesaid building. ~uffolk County Department of Health Approval .. ~.q~.. Y~. · tU' :" "Building InSpector FOR~ HO. 2 TOWN oF $OuTHOLD 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? 3~49 z Permission is hereby granted to:~e~ O~:~13~a]~t ~ {~i~e:l~13:!~t~I & M': ~I ............. ~~::: .......................................... Building Inspector. ~e pursua:nt to opplicatiOr~ dated ': '"" ¢~' .... ; ' - 7;' i-" ' -- '"", ~ u' d ng nspect6r . . g InsPector FORM NO.-6 . TOWN OF SOUTHOLD Build!hi] Department Town Hall 8outhold, N,Y, 1 APPLICATIQN FOR CEliTIFICA'fE OF'OCCUPANCY In~tructioItS A, This application must be filled in Wpewriter OR ink, and submit[ed in duplicate ]e ~he Building Inspec- tor widi Um following; for new buildings ~r new 1. Final survey o~ proporW with accufa[e locadon ol all buildings, properW lines, s~ree~s,,and UnL~SUai natural or topographic features. 2,Final approv~ ~t Health [3ept. o( wa{ur supply and t,ewur~gu 3.Approval of electrical illsL[iJJaLJon l[oliJ Boa~d of Fire LJRdJJrWrlLors. 4. Commercial buildings, ludusLrial buildings, Muff!pie Ih~siclonc[)s and similar buildings and installa- tions, a certificate ol Codu compllanc~ from [he AiciuLoc[ or Engineer responsible for ~!lo. buildin9. 5.Subrni[ Planning Bodrd approval of cuntpiu~d ~m~ pi,u~ B, For exisdng buildings (prior 1o April 1957), N~n.coldorufirig usus, or buildings and "pre-existing" land uses: [opo[jraphic luaLurus. 2.Sworn s[alomsu[ ol ow[mr or previous owr~r as t.o Li~¢, occupalicV dnd condition of buildings. 3, Date oi any housing coclu or sah~W inspectidn al buildings or t)rmnises, or odmr pertinent inlorma- tiou requJr[~d to propar{¢ a C. Fues: 1. CurLihca[u of occul,~ancy 3. Copy ol certificate ol occupancy $1 N w lJuildu g ............ Old o' )re-ox si. g Bu Id mi · . ,%., , ...... Vacaf!t Laird ............. l_.ocatm~] of Propt:rty , . Bennet.% ', s. Lane ,..South~old,. ~ew, .~.Qrk ....... / Iou,~¢) No, Owner or Owners of Propurty . C,Q~a, ~,, .J¢~.~:ggA ...................... Haml#t COLH~Ly Tax IVlap No. 1000 5ct:Lion . ........ 7Q ,. , . , -¢]lock .... ,8. ..... ... . Lot, ,3,,5 ........ . ., , Sub(by,sion .Fairvie,~..Park ,Filed Map No, 3388 ,LDt No, ,13 i~t:flllll IW[) .......... Dau,' of f)IIFIIUl ......... /\pl:)licant , ,]~$ta,te, o~. ,Cora. ,T.,., ~nrlings, kleallh Dupl Al pi wal Labor Da[)[ Approval Underw',r m.'r], Approvdl ....................... PJannin~ Board Approval ....... ReqLu,~st Ioi I't,~lltlJordry Ce, ruhcam Final Certificate Construction un abovu £1¢scribad bulldul.q and p¢rmil: meets ail applicubi~ ~30des anti regulations, SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH Da,re Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Oi~e deed l'ocatiou) have been inspected by this department and found to be satisfactory. District Engi~eer District Engineer FO~V~ NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~' ~J ...... .......... Approved ........................................ , 19 ........ Permit No......... ~ .......... ~ ct.............. ~ ~ Disapproved a/c ""~~'~'~"~""22....~ - 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, end giving a detailed description of layout of propertymust be drawn on the diagram which is port of this 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 Southold, Suffdk 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 and regulations. (Signature of applicant, or name, if a corporation) .......... ............................. (A~ddress of applica,4t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name o~-~e~of premises .~:?k~....~.~~..~...¢'..~ ........... f~ ............................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: .% .~...../..7....~...~.~?..¢~ot No: ../...-.~ ............. Stre and Municil~blity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~....~ ................................................................................................ use and occupancy ......... --..~.~.~...~,..~-- .................................................. b. Intended 3. Nature of work (check which applicable): New Building ~]( ............... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .~J~..2..~.,.~Z.~,,~0 ................................... Fee ............... ./...O..:..?~.. ............................................................ (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 ...... 2. .................................................................................................................................... 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 alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Numb~er of Stories ................... ~ ............ 8. Dimensions of entire new construction: Front .......... .~...,~, ................. Rear ....... ~..,~. .............. Depth ......~..,~.. ............. Height ...../...6..~../ ....... Number of Stories ...... ~.. ...................................................................................................... 9. Size of lot: Front 200ft. Rear 200ft, Depth ~.:~..0.~.:.~.2..~.....S..:?:.lO,00ft. I0. Date of Purchase ...... ,~./1.],/(.A7 ................................. Name of Former Owner ....R~:~....T.,,..~.~.O.~ ................ 11. Zone or use district in which premises are situated ..... ~/,',',',',',',',',~. ................................................................ 12. Does propo~b~struction violate any zoning law, ordinance or regulation? ...~e,~......'? .............................................. 13. Name~of/Ownel~f premises( .~.c~&..L.,~...~.~.~,.Address ~,~..~.,.,..G.?..~.e...~.P.~?.~Phone N,~77-0~2 ...... (~Melita C, I-[ofman~ .. 506 E.TU St.,N.Y.C, r~ame or ~rcni~ec~ ...................................................... ,~aaress ............................................ Phone No ..................... Name of Contractor ~..~.~,~: ............. Address .~~..I...~...:..~.f.. Phone No.~/.~.~..?.~...~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail 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 YORK, ~, ¢ c COUNTY OF ................................ ~ '~"~' ..... .(~~.....~..~..~..~ ................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) , above named. He is the .................................................. .t~....~....: ................................................................................ (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is ~uly 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 ....... ~.~.. ...... day of .~ ........................ , 19~...~... //~ f,~ '~. //'~(~,~ ~ ~ ~ , Notary PuB~~-......~..,...~.:...~z¢'.~,~...... C.,ou,~ty;i .................... .............................