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HomeMy WebLinkAbout5825-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi[icate O[ Occupancy No.~..766 ....... Date ........... ~lag.. 29 ........ , 19..~2 THIS CERTIFIES that the building located at 8/~..Nw¢. S. uffolk .a.~e ..... Street Map No...XX. ......... Block No .... ~ ..... Lot No... ~... Cla~;¢hogtt0 .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Aprl,~ .. 18 19.~. pursuant to which Building Permit No.. dated .............. ." ........, 19 .... 72 , 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. f.amil¥..dweLling ...................................... The certificate is issued to . H~tnn~ .Be®he ..... 01~a®I'. .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . Ii,B, .............................. UNDERWRITERS CERTIFICATE No....P?.II~ .~..g.. !:! . .~.?-.-'7 .-~-. ?..~. .................... HOUSE NUMBER... 1.~l.i0 .... Street ..... Ne~ .Suffolk. AVe .......................... Building Inspector FOEM NO. 2 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) No. 5825 Z Permission is hereby granted to: .............. g. ,~,0e~t~o~ae ........................................... Build ~n a6ditl~n on ex~sttng dwelling et premises located at ....$/$..~w.~,~',~-.i.ve .......................................................................... .................................................... ~-~t~ ...................................................................................... pursuont to opplicotion doted ........................ A.~.~.],.....I,:. ......... , 19.r'~..., ond opproYed by the Building Inspector. Pee $...~.~.., .~... ........ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ yS es JOHN STREET, NEW YORK. NEW YORK 10038 ~ly the ~t~ ~uip~nt m ~H~ ~ a~ int~a~ by t~ applic~t ~m~ on the a~ ep~ n~m~r in t~ p~ of Hann~ Beebe, ~e~ ~u~folk Ave. bet. Jackson $ Bay ~ve, gutc~ogue, ~the~ing~atlon; ~ ~emeat ~ IsgFI. ~ 2nd FL & outside ~ ~.~.mi~d o. July 17, 19 7 2 andfou~ ,o be in ~mpl~ance with the r~u~m~Zs 1 METER N OTHER A~ARATUS: Daniel A. Fogarty, Inc. 515 Orchard Street New Suffolk, L.I. 11956 Approved ~t '' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved o/c ............................................................................................ (Building Inspector) ( APPLICATION FOR BUILDING PERMIT Applicotion No. ~ April 18 72 Date ............................................... , i y ............ INSTRUCTIONS ~ a. This applicetion must be completely fitled in by typewriter or in ink and submitted in triplicete to the Building Inspector, with 3sets of plans, accurate plot plan to scale. Fee aceording to schedule. b. Plot plan showing Ioeation of lot and of buildings on premises relationship to ad oining premises or pub ¢ streets or areas, and~"~ giving a detailed description of layout of property must be drawn on 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 one, the premises 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 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. William Eeebe (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 ............ ~,~Z).~..T~.e.~ .......................................................................................................... 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.: .................... Lot No ...... ~ ................................. / ~) // D Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. .d:.?...e..Z...Z.~.~.~ .................................................................................................... 3. Natare of work (check which applicable): New Building ....................... Addition ....~ ....... A, Iterati(zn ............... Repair ............. . ............ Removal ......................... Demolition ........................ Other Work .................................. (Description) 4. Estimated Cost ............ 9~0~.._~ .................. Fee ..1..~..O..O...i[~.l~;.~;i~.;;~..~i]i;~.~i;.;~ii.~;;~;;i 5, If dwelling, number of dwelling u ,nitse~{·, ........... 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 Wpe of use ..................................... 7. Dimensions of existing structure~, if any: Front .....................Rear ........................... Depth ................................... Height ................................................ ~ .......... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions; Front .......................... Rear ......................................... Depth ......................... .~ ............... .. Height ......................................... Number of Stories ........................................ 8, Dimensions of entire new construction: Front ...... ;~ ............. ; Rear ...~,~. .................... Depth ...2,2 ......................... Height ................................................. Number of Stories ..... i ...... Q~ ....................................................................... 9. Size of 10t: Front ......... ,~.~....:....i .............. Rear ......... .1..0~..: ....................... Depth ........ )~.c~5..~...i+,~O ..................... Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase .............~;, ...................... Name of Former Owner ............................................................... 11. Zone or use district in which premises are situated ! .~.!~, ~,;[,~.t ................................ 12, Does Proposed construction violate any zoning law, ordinance or regulation: ...... z3o ................................................. 13. Will~lotberegraded_3~L~, - .......................Will excess fill be removed from premises: [ ] Ye~s ~] No 14. Name of Owner of premises ..... ~..~.~..~......~..,e.e..~..e. ........................ .(;.~D~,~,I~.....~.,t.~ ...... ;; ................................ (Address) (Phone No.) Name of Architect; ..................................................................... i~,~;~'~i ................................... i[~'~'~"~'~;i ............... Name of Contractor ...~:..Beobe ................ CLa~,h~>§~te ...................................................................................... {Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines~ Give stre,et and block number or descr ption according to deed, and show street names and indicate wheth- er interior or corner !o_t. See filed plan STATE OF NEW YORK, Sdffolk · SS COUNTY OF ...................................................... Wi~.l%. am Beebe .... being duly sworn, deposes and says that he is the applicant above named, (Name of individual signing contract/ He is the .......................................................... ~or~'t;.l~.&~.~;o.:g ........................................................................................................................... {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 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. ............................ ~l/~l....day ,o ............... Not {~ignature oJ' applicant} t -,% i ! I .... Il/!