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HomeMy WebLinkAbout5250-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at l~.aradise, l~horoa .l~d..(l~tT}Street Map No.. ~ ....... Block No..~ ..... Lot No~.. ~O~o~d.. ~,Y~ .......... conforms substantially to the Application for B~lding Permit heretofore filed in this office ~ ~ 69 ~ dated .... A~. ~ ........ , 19~.. p~su~t to which B~ld~g Permit No .... ~Z-~ dated Aug. ~ ............... ~' 2%" 19. , was issued, ~d conforms to all of the require- ments of the applicable provisio~ of the law. The occup~cy for which ~is ce~ificate is ~sued is ...~ri~a~. ~e. f~ly. ~1~ ..................................... The certificate is issued to .. ~e~ .~. E~i~ .Hi~ .... ~Or~ ............... (owner, lessee or tenant) of ~e afores&d build~g. Suffolk Co~ty Department of Health Approval ..... ~ e~.* .................. UNDERWRITERS CERTIFICATE No .... ~ ~.* .......................................... HOUSH NUMBER..2~0 ....... S~reet... ~ar~ls8. ~res. Roa~ ...................... FORM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE~ SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) .21 / 71 5250 Z D~e ............ : .......................................... '.., ~.....~.. Permission is hereby granted to: ?. ~t..l ~' ~; ,~ ~c at premises located at .................... pursuant to appJicotion dQted ............................................................ , 19.....~., and approved by the Building Inspector. Fee $ ........................ 'Building Inspector Disapproved a/c ~ ....... ~ ..................... ::':."~z. ......... (Building Iml~r) AI~LICATION FOR BUILDING PERMrT ,.mUCTIO S a. This application must be completely filled In by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plo, t .pi.an sba. win~ I.nc.ation of lot a.nd of buildings on premises, relationship to adjoining premises or publ c streets or areas, ana g~wng a aetanea aescription of layout aT prol~rty must 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. . cl,; ,Upon. app..royal of.this al~.!ic, at, i .on, .the Bui. ldir~l. Inspector .will issue a Building Permit to the applicant. Such permit sno. De Kepi' on me premises available ?or inspection ~nroughout 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. ~ .A, ,P. PLI ~CATIO_N.!S HEREB. Y.,MA_DE to the Building Department for. the .i.ssu. an~ Building Permit pursuant to the ~una?.g. Lone. ur.amance at .m.e ,own .o,f .Southold,. Suffolk County, New Y~m¢C,, and ot136r applicable Law, rd nances or t~egular~ons, tar the construct,on of buddings, add,tions or alteratlc~s,j~"for removg//or demolition..as~l~emin described ap,,,can, r.s to comp,, w,th a,, ap,,icob,. ,... ....... ...... , /o/ ............................................................... (Acldr~s of applicant) State whether applicant is owner, lessee, age~,~, architect, engineer, general contractor, electrician, plumber or builder. "am. o' owner of prem ses.. ._.'~...~.~...'~....~.....~....'~........~:'...-:.....~.....~....,~...-~... ................................................................ If applicont iS a corporate, signature of duly outhorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ....... ~ ............... Lot No.: ..~..4~....~.. ...... ~,~,o ~' 4~'~ ~ -- 4g:>~'//~=4/' ,,5',~'~'0~"..~ Munlcipollty //~ ~,/ 2. State existing use and occupancy of premises Qnd intenc~d use and occupancy__ of i::m~cx~sed constn~ctlon: .~ · ~ ...... ~ ':~'~;~;~f~ ~- ....................... ,~ .......... 10. 11. 12. 13. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Remov~J .................. DemOlition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...................................................... ~.....Fee .......................................................................................... (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 c. ors . ............................................. 6. If business, commercial or mixed occupancy, speCify nature and extent of, each type of use ..........'-"". ................. 7. Dimensions of existing structures, if any: Front L.....~.~.~.~....,..; .... Rear .~./.~.2~1~...~... ..... Depth ...~..~.: ......... Height ..¥...,~....~. ............ Number of Stories .,..~...~...~.......~.~.d~..~. ............................... y ...................................... Dimensions of same structure with ~teration, or 'additions: Front ......... ...~...'....~'... .............. Rear ..~.....~...4....~: Depth ...... .~...~... ................ Height ...... ~ ......... ,...,Number of Stories ....~..~.... .................... · . . ~ / ~ / 8. D mens ons of ent re new construction: Front .............. ~ ................. Rear ..~.......~.¥..."~.. ~.,~Depth .....~ .......... Height ...../~e?~..~. ....... Number of Stories . ..~...~...~-'... ........................................................................ Size of lot: Front ....... .~...O.../,. .......... Rear ~0I Depth ..~..'.~..~....~,~., ../.~_?/ pete of Purchase ....... ...~...~..~e:..~..../..~..~.~... ......... N~me of Fo~me~ O~ner ..... ..../~..'~'X..'~.....~..<~C.~..e~ ZOne or use district in which premises are situated ..~'~.~-..,~...,~'.~/..~..,~-.. .--.. .................................................. Does proposed construction violate any zoning law, ordinance or regulation? ......~...~.. ................................................. Nome of O~ner of premises ~.~....¢~...~.....~.4.~.A~, ...'~...~.../..o../..~...~X. ph~, No?....~'Z.-.../.~...~, Name of' ArchiteCt ............... ~ ..............v- ............ ;.Address ............................................ Phone No..~..... ....... Name of ~tm~ct)or ..~.~....~..~.....~...~...~.-~...~...~....~.....Address .~....O~..."/"~'.¥.~...'~..?'phone No.._.~.~...~..-./..~../'~'- PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck 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. ~ ~/~,~7-~' ,~:~'90 ~- (Contractor, ~]e~t, corporate officer, of said .?n.e.r or owners, and is duly authorized to perform or have perform~:r, the/said work and to r~ake and file this apphcat~on; that all statements contained in this application are tme_~t6 theJ;~st of his knowledge,rind belief; and that the work will be performed in tl~e manner set forth in the opplicatjer~Rted-~rewith. ~, ,~ Swam to be. fore me this ~ __ // // ~ / / ' ~, · ............ ~ ~.~ .............. ~f/__/~. ........ . ....... ....../.../. ......... : .................... ./...~....'Z...T.7~ ...... Notary Public, ,~.~'...J.~c?,~.,-~cr~...,,,~,~,..~.,(~Co~.,n...t~._ ~.J.R_!O.J ~.. ~£G~] ..(.S'.lgnature of applicant) ~ ............... Term Expir~ March 30, 19~q~ Disapproved a/c ...~ ....... ~ ........................... .................................................................. ........... (Building Inspector) APPLICATION FOR BUILDING PERMIT '~ Date... .., 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 ofproperty must be drawn on the diagram which is part 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 Perm t pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York~,at~ other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or fo~emo,/ol or demolition, aD, Fi'erein described. The applicant agrees to comply with all applicable laws, ordinances, buil~g.c~od~, housing code, and,~x/egulations. ignature of applica corporation) 'L~ignature of oppIi . ....................... (Address of ~ef~cant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · . ~ ~z'~-z ~ . -× , N a me of owner of prem.ses ..... ~. ~::~.. ....... · "~"'.....~-~' ~/'~. ....................... ' .~/.~ ......... ~........./.~ ././..~..~...~...... If applicant is a corporate, signature of duly authorized officer· (Name and title of corporate officer) and on wh ch sed work w done Map N ' Lot No .../.~.. c~/ ~'~ Location of Street and Number ...~,~.~.../.w.~.o.~..k..I...~.~;.o..~.~.~. ................................... ............ ~....~z~ ..... ~/ ~ ~ 0 ~ 0 ~ Municipali~ State existing use and occupancy of premises and ~Dd~ us~and ~cu~ncy of proofed const~ction-. a Ex st ng use a~ ~cupancy ' ' '~~'~ .......... 7: ............................................................... b ntended use and ~cupancy ~C ~ ~~ -- ~ .. 3. Nature of work (check which applicable): New Bull?lng ..... ~. ........ Addition ...4T~ ........... Alteratil~J ................. Repair .................. ~moval .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..........~...~... ....................................... Fee ......................................................... ~;: ............................... ~'~-~-~,,~,~ /~4~ 4~x,x'~'4:~"~ (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 ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify na/ture and extent of each t~pe of use ......-~.........;?,.~, ...... 7. Dimensions of existing, structures, if any: Front .....~ .............. Rear ......./....?.. ................. Depth ......~.....~...i .... He ght ....../'..~...../. ........ Number of Stories ..... ~....~.....~<T... ............................... . ...... , .................................................. Dimensions of same structure with alterations pr additions: Front ......... ~.....~... ................. Rear ..../../.~...:'.../. .......... Depth .......L...'~.....~....5 .......... Height ......./..~ .......... ..I)lqmber of Stories ...~...'~'.....~:../......~ ....... 8. Dimensions of e~tire new construction: Front ..... ~.~.~. ..................... i. Rear ...... ~..~. ............. Depth ...~.' ............ Height ,~,~, Number of Stories ~,,.,'~,..~ . ................ ' ........ ......................... ...... ......... ...... 9. Size of lot: Front ...~...cff:~/..; ....... ./Rear ...... ~ ......................... Depth .L.; ............... 10. Date of Purchase ......... ~'/~'"'~"'/~"Z ........................ Name of Former ~Owner.~._~..~..~......~/.~../....~.~.x~-~'..~YJ~'... ....... 1 l. Zone or use district in which premises are situated ................. ~TL../..~ ................................................................ 13. Name of Owner of premises~./...~'....~.:/~"~ ~'X'~ ~i'~ \~'~..~-..~.:.Addres~s~..~...-~...~..~..~.....~..:~ ...... Phone No. ~..~.T ./...~../.~. Name of Architect ........... ~ ....................... ~ ......... Address ...~<:~ ................................. Phone No ..................... Name of,C-om'ra~or .~~ L~'~":.4~..r_.~'._...*.-~--a-~. ~ ~.~........~...:./... ....... Phone No..~..~.~..- ./..~'L¢~. Locate clearly and distinctly all bull lings, whether existi~!!~..' ~osed, and indicate all set-back dimensions from property lines. Give street and block tuber or descriptic~J~li.g to deed, and show street names and indicate whether interior or corner lot. STATE Of NE'9~.'"'i~K, Je {, ",~" ~ ~ COUNTY oBL,-,,~.... ....................... I°'~. / ...... : ......................................... ~.,...~.. ~ ................... g amy ~rn, d~es and says tMt he is t~e applicant (Name of individual signing application) above named. He is the: .......... 0.~.,.~.~ ...................................................... : .......... ~......~ .................................. o{ sold owner or owners, and i~ dul~ ~uthori~od to p~r{orm or h~ p~r~d th* ~i~or~and to mko ond file this opplication; that ~11 ~t~t~ment~ c~minod in ~hi~ *pplicafion ~m~~{ hi*~wl*d~e and b~li~f; tho~ Ih* work will b~ p*r{orm~d in th* m~nn*r ~*t to~h in th* Sworn to b~{or~ m~ ~his ~ '~ ~ / / ....... ............................. . ............. ............................ NOTARY PUBLIC, State 0f New ~ork [ / Residing in Suffolk CounW ~ ' No. 5Z-932t72S TOWN OF SOUTHOLD ~ ~' '~'""~" ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N.Y. ,.~'o,~ ~' ~7 Examined .................. ~../....~.~?., 1~./... Application No ................................. ~.l it No ........ ..~....'~....?.~....~.... ...... Apj:)roved ............ i .................. , 19 ........ Pem Disapproved a/c ........................................................... ~...~. ............................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ..~./...~....~... .............. ,19....~../.. .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plat plan showing location, of lot and of buildings on prer~ises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is p~rt 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, Suffolk County, New York, p~')other applicable Laws, Ordinances or · Regulations, for the construction of buildings, additions or alterations, or for~mov~l or demolition, as herein described. The appJicaat agrees to comply with all applicable Jaws, ordinances~ buildi~ .c~lousing cos:l_e~nd regulations. . (Address of ~_ licant) ._ .4/.J.Y //97,. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................. ............................................................................... :.../... ...................................... Name of owner of premises ~..../..~...`~....~..~..~.~...~.~...~...4..~....~...~./..~.~~..`~....~... .......................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of and on which,~sed work wi~C~be done Mag4~b.: ....... . .~.~.../......L .... Lot No ..../...~....~..../...~... Street and Number ..../....~...`~...~....~....~...~..~.~..~..~...~.~...z~.~....`~:~...~...~.~...~..~"~.:~..~.~///~/////..~[[~ [ [[[i[ii Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructioJ~f a Ex st ng use and OCcupancy ~.'.~.'.~..~....-Z...~J~.....~. ~(..~....,.~....~.~.~.'~....~..~ . b ntended use and occupancy ....~....'~..~'....~.. ~d"~. -- ~/~/~ ~.,~../..~., ~ ~ 11. 12. Does proposed construction vi~ zoningJo~, ordinance or ~41ation? Nome gs, whether existing ~c ;ed, a~ indicate all set~k dimensio~ from her or descripti~ a~ to d~, and sh~ street nam~ and indicate 3. Nature of work (check which applicable): New Building .....~... ......... Addition..................~ Alteration .................. Repair .................. R~v~LL-~ ................. Demolition .................. Other Work (Describe) ............ ~.[ ......................... .. '~'~"/4xx"'~ (to be pa,d on flhng this application) 5. If dwelling, number of dwelling units ..... ~..~...~-.~. ............ 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. D mens ons of ex st ng structures, f any' Front ~...~.~ ./.. Rear ../'..~..../. De th ~'./~.. .... Height ...K/.~...../. ........... Number of Stories .... ;.~...~....~'.~ ....... ' Dimensions of same structure w th a terations or ad~i;i'~::' ;;~; .......... ~"Y ................ R;~ ......... ~' .......... Depth .........~....~.. ................ Height ............. .'..~/.. ...... .~..~)~mber of Stories ..... .~..../~....~...~..,~ ....... 8. Dimensions of, entre new construct on Front ...~..~-~ . Rear ~.'."~..i D~,~, (-~ Height .~'.~.....". ......... Number of Star es ..~'....x~....~... ' . . ' ............................... ~' ........................... S,ze of lot: Front ...~.!.x..~,~/;~.:~...~.ear ..... ~'..~'.t...~'. .................. Depth ..L...~...4.~'~...~.'."~-//--~, Date of Purchase ..........~/....~....~../.~.~.. .............. Nome of Former Owner ,~..~ ...~..: ..~...~..'..~'..~ __ Zone or e ' t ' /' / ' ' ...................... us o's r c~ in which premises are situated ......................................................... Locate clearly and distinctly oil buildi property lines. Give street and block nut whether interior or corner lot. STATE 0 s.s (Name of being duly sworn, deposes and says that he is the applicant above named He s the .0.(~ ~ ~..~.. .......... ~ ............................ ...... :" of said owner or owners, and is duly authorized to perform or have perj~rmed the saicJ/~ef'lr/and to make this application; that all statements contained in this application are..~4'(i_e..'to the bes~ l's/l~nowledge and belief; ~nd t~hat the ,work will be. performed in the manner set forth in the applic_~rfott filed.J~hec~ ~ ~wom to before me this V ~ ~' / No 52.93~A 72~ ', Commission Expires March 30, 1~ t Z. .