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HomeMy WebLinkAbout6066-z· FOl~3~ NO. · TOWN OF SOUTHOLD BUILIIING DEPARTMENT Town Clerk% Office Southold, N. Y. Certificate Of Occupancy No. Z. ?.~.2.0. ...... Date ............... .J.u~..y....~.2...., 19. :~..6 THIS CERTIFIES that the building located at .R: .0.,.W.:...S./.S.. ~.a!n...Rg.~d... Street Map No.. ~ ........ Block No... ~ ..... Lot No...x~x.....E.a. '.s.t...I~..r.~.o.n....N.,.Y.: ...... conforms substantially to the Application for Building Permit heretofore filed in t. hi~ office 6066Z dated .......j..u~.eA..u.g.~..1.? .... 7~9 .... 72 pursuant to which Building Permit No..6.622Z. dated . 8./.~.8../7.2..&..~./.~. -f??..., 19 .... , 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 ...P.r.~..?a.t.e...one..f..a.m.~.l.y..(.s.e.~.olu~l,l. d~e. lling ........................ The certificate is issued to . .Kerm:tt & .L..~.1.%~..ap...~.e..a.th.e.r.1..o~ . .°,~e.~$ ......... (owner, lessee or tenant) of the aforesaid building. I~oRo Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICAT~ No....~.~.8.9.Y. ! .Y ..... .~.u~..e.. 22.. ~. 97.6. ............. HOUSE NUMBER .... ? 2.8.3.0 .... Street ... ~a.~..n..R. qa..d .... ~.a.s.t...i~..r.~.o..n ........... NOTE~ Interior to be completed by owner Building Inspectot' 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. 6066 Z Permission is hereby granted to: JO ........... ; ................................... ;~ ......... '~; ............................................................................................... ................... ~...u...,...s..~.,..~!..~. ........... ?..!~.' ......... .C~.:'.t.:..~...~: ....... ~..,w...,~..~.'..~x~...(..~..~ ~) at premises located at ............................................. ,,/~',,J,- ,~,..,/.,./~,. ......... i.,~,-.'.'~'''jk..''?''' ................................... ..................................................................... .~.~.~.Z ............. .~?..~..!)...~.£..~:. ................................. pursuant to application dated .......................... J..Z ....... ..~...~.)...,~L..., 19.7....~, and approved by the Building Inspector. Fee $ ...... !..~.. ............ Building Inspector Examined DisapprOVed a/c .. .... ...... ............... .................................. ....... ........................ (Buildin~ Application No ................... ~ ............. Date ! ~ .................. INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit.l~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. - ~ 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 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 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 beenr~ 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. I ~'t (Sig, nat,~re of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of remises... ........................ 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 ........... ~. Street and Number .......................... ~ .................................................... Municipality 2. State existing use and occupancy oft , _ ,--J----premises a,nd int?d;d u~ and occupancy of proposed construction: a. Existing use and occupancy ..... .~ ....~.~,~'~-, .. ,~r~a~=F_ __. ................................................................................. b. Intended use and occupancy ............ ..~..q~M~g,~ ................................................................................................... ~) 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction viqlat~g any z~oning law, ordir~nclt or rRgulatipn: ~...n.t,-.~ ..... n'~ ................ 13. Will lot be regraded ----2~:lrg:~......, ....... 5 ....... Will excess fiji be removed from prerpise§: J~,~.Yes [ ] 'No 14. Name of Owner of premises .z...~....~..?.....-~a......,.v..~.t~..~~.,.r~.~...~ ................. ; .......... ?. ....... (Ad,ess) (Phone No.) Name of Architect .............~ ........ , .......................................................................................................... (Address) (Phone No.) Name of Contractor ............. ~ ................................................................................................................ (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 street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. 3. Nature of work (check which applicable): New Building ....................... Addition Iteration.......~ ....... ... Repair Ramp al De pillion Othe Wp k ' ............ , ............ v . ......... ............. .. m ........................ r r ...... ~ ! Description) · 4. EStimated Cost. ...~.,.~;~...,.....[~.. .......... ,,. Fee ................................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ....f.. .........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. Dimensions of existing structures, if any: Front ....~...~. ..........Rear ....... ../...~.. ............. Depth / Height .......... ~/~.. ........................................... Number of Stories ..........~ ...................................................... Dimensions of same structure with alterations or additions: Front ...... ..~?..~. .............. Rear .......... ../...~. ............. Depth ............ t;.., .............................. Height ................. ./.~.. .................. Number of Stories ...........~ ............... 8. Dimensions of entire new construction: Front ........ ,'~...~.../. ..... Rear""' ......../~ Height ....~.../]....Pg..~...~.....~..~..L~.L.~...~..~ Number of Stories ........ ..o..~...~. .................................................................... Size of lot: Front ......./.~.~......~ ........ Rear ........... ././..~.:~ ............Depth .../...~...~..:~ STATE OF NEWyOR~I~, =// ) COUNTY OF ...~ .............................. ) ~. . '-/.- ,~ / . ~1 J- ~' ~' -- -- ~ '~ ~ · .;......~....~...~~ ........... ~ing duly s,rn, de~*s and says that he s the appli,nt above na~d ~ Na~ of ~divid~ si~ing con~, ~ ~'~ . H, ,, ............. ..................... ........ '~. ~ctor, a~nt, coyote offi~r, etc./ of said owner or owners, and is duly autgorized to~or have .~or~d the said work and to make and file this application; ~at all s~ments ~ntained in this application are true to t~ ~t ~ his kno~led~ and ~lief; and that the work will ~ ~dorm~ in the ~nner ~t forth In the apph~tlon fll~ therew th ~ ~ ......... ............. ....... ...................... ........................ (~ of applic~t} FORM NO~ 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ........... ..~....~~~ ( ul drag nspector) APPLICATION FOR BUILDING PERMIT Date .................. , ,9.Z .... INSTRUCTIONS e. This application must be completely filled m by typewriter or in ink and submitted in triplicate to th~ Budding Inspector, with 3 sets of plans, accurete plot plan to scale. Fee according to schedule. b. Pict plen showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, end g~ving a deteiled description of layout of property must be drawn on diagram whidh is part of this application. c. The work covered by this epphcation may not be commenced before issuance cif Budding Permit. d. Upon approvel of this apphcat~on, the Building Inspector will issue a BuildingI Permit to the applieent. Such permit shell be kept on the premises evailable for inspection throughout the work e. No building sh~ll be occupied or used in whole or in part for any purpose whatever until ~ Certificate of Occupancy sh~ll have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc~ of a Budding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable ,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. (Signature of applicant, or name, if a corporation) (A~dress o~' applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................· ~..~.....~. ~ ~ / ~ ........................ ; .............................. ~ ......................................................................... Name of owner of premises ~...¢-k4~.~.....~.....,~....~..~/:.../,~.,f.~~! ................................................. If applicant is a corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) 1. Location of land on w~ich proposed work, will be done. Map No.: ..................................................... Lot No ............. Street and Number ...~Q.~.....,~,~.4,,~.....I..~ .................................. , ........................ ~_~..~.,¢~....z~..~..~ ........... , Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing u se and occu pancy .....~....cZ~.. ,~.~:~,~......~..~.~-~.~ .............................................................................. b. Intended use and occupancy ......... .~.'..~.~.~ ........................................................................................................