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HomeMy WebLinkAbout7204-zNO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's ORice Southold, N. Y. Certificate Of Occupancy No. ~6521 ...... Date .... ~lax. eh .~ ............... , lg. THIS CERTIFIES that the building located at R/S .P.~I;...Rd.. ~t~l ......... Street 8outhold, N. ~ Map No. XX ......... Block No. XX ....... Lot No ..... ~X .......................... conforms substantially to the Application for Building Pemit heretofore fried in this office dated &pl'~ .~, ........... , 19. -7.~ pursuant to which Building Permit No.. dated &pr:l~..~., ............ , 19.~t~., 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 . &oO®OSOr~ .Stol~aSO. S~[~4 .... ................. *. ...................... The certificate is issued to .. ChaF~s. F., .Anas&galst~ ............................ (owner, of the aforesaid building. Suffolk County Department of Health Approval ..... N/R ........................... UNDERWRITERS CERTIFICATE No .............. N./~. ........................... HOUSE NUMBER .. 3~. ........ Street .P.~$..v.a.t.e...R..o~.d.. ~..~ ..................... ........................................ ~hO~.d~. .Ii ,. X~ ..................... Building Inspector ' TOWN OF SOUTHOLD ~/~'/~'~' BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomlned .,,~...~.~ ]9..~ ~pplicotion No. ~..~..~ .......... ~prov~ ...... Y~:~ ....... (....., 19~..~ Permit No...~.~..~..~..~ (Bui ding Inspecto/ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building a. Inspector, with 3 sete 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 oF 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 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, end 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. (Signature of appl~rporation) ' ...... (Address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... .................................................................................................................................................. Name of owner of premises ........ .~...//.,~....,~..¥C..~.J .............................. ..~.., ~..~.~ ......... ~$~ : ................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Traders License No ............................................... Location of land on which proposed work will be done. ~ap No.: ........................................Lot/~' // __~ ,N° ......................... Street and Number ....~..~./..~.'.~...~.F.~.....~...~........'~..°~...../. ............... ..~z~'.~.~.. ~,~..~..~ ................................. ~.~.~ .e./~..,......~...~..~.. Municipality/ Sto~'e existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~'~-~ /~'~"~/,./~... ~..~- ./../~.~ b. Intended use and occupancy ..... .-~.~.~..o..~...~..(..C.......-~..~..~...~:...~. ............................................................................... . Natpre of work (check which applicable): New Building , ~'/ Addition .................. Alteration ....~..~... Repair .................. Removal .................. Dem01itio~ .................... Other Work .................................................... (Description) //~) 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 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 .......O~...~.~.( ................. Depth ...~...~' .......... Height ..... ~.....o...( .......... 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 ...... .z...~..~ .......... Height ..../., ............. Number of Stories ...............~.....'ff¥..('T. ........................................................................................... 9. Size of lot: Front ............ .~...~...~...( ............................... Rear ....... .~....~....~..~..( ..................... Depth ...... ./..~...?. ................ 10. Date of Purchase ........... ../.~...z..~...q.~....~C.. ........................ Name of Former Owner ...~....~..../~....~'.~.~.~...../..~'~../.~z.~..~...Car-~- !1. Zone or use district in which premises are situated .................. % ...'~..~ .~ ................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ ...~....~.. ................................... 13. Will lot be regraded .....~.....~. ............... Will excess fill be removed from premises~,( ), Yes ( *~-}~1~o 14. Nome of Owner of premises Address ~..~..~..e~..f~..:../..~'.....~Phone No. Name of Architect .............................................................. Address ................................ Phone No ....................... Name o~ 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 whether interior or corner lot. \ \ He is the ~ (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 I~ performed i~-the .manner set forth in the application filed therewith. Sworn ~o_befor~ rl~ this / / ~* ~ ~, .... ........ ...... , Notab Public~...~.~ Coun~ .......... ~ ...... ;Z ....... ~~~ .................... ~~A~~ (Signature of applic6nt) // STATE OF NE-'~/)'pJ~, ~ ~ ~ !¢ ¢ COUNT~ ~)~~OF~.~..f~'~ ...... /_~¢~...~~.: ............................ being duly sworn, deposes and says that he is the opplicam (Name of mdw~dual s~gmng~' ~ ~" '~" ' contracf) above named. ll~RM NO. 9 BUILDING DKPARTMINT TOWN CLERK'~ OFFICE ~OUTHOLD, N~ Y. N.o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPL~qON OF THE WORK AUTHORIZED) 720~ o~ .................... a~,~...,....~ ........... ,9.~. Permission is hereby granted to: ~r~,~...~~ ..................................... .... ~r~...~II..~$.....~:£..~,..l~T~ e~.. ~4 ........ to k.~...~..d....p..t.~...e.q.~ o.~.~....( ~z~o.)...b.~l~Lf~L...' .......................................................... at premises located at .~,,~..I;:~r~..Reli~..~J~$....~8/~..~,...BB~3,Fj.w..i~e~ ................................. ............................... ~ ............. ~. g.9,.~g 3,~ .......................................................... ~ ..................................... pursuant to application dasd ................... A~l~.....~.:~ ............... , 19~..., and approved by the Buildir~ Inspector. FOItM NO. 6 TOWN OF SOUTHOLD , Bnilding Delmrtment Town Clerks Office Soufhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property showing all property lines, streets, buildings and unusual natural or topographic featurers. 2. Sworn statement of oWner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or s~fety inspection of buildings or premises, or other pertinent in- formation required to prepare~a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy ~ .00 Date '~- -~'- 7 ~" New Building J Addition Old or Pre-existing Building ................ Vacant Land Location Of Property ..... /.~..~..L~.~...~.~ ....... [i?...~....~....~../. ........ .--~....~....~....~..~.../...~.. .............................................. Owner Or Owners Of Property ....~../~..~....~-../.~/.~. .................. ..~.~....'~../...'~..?..~./.~.~.~.:. .......................................... Subdivision ................................................................ Lot No .............Block No ............. House No...~....~...~..~ Permit No...~..~..~...~....~.. Dote Of Permit..~... ........ Z.~,pphcant .... .~.../..'~'.~...~..../.~..~. ....... ~.~..~.J~..~..~..~../...:. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fin~ Certificate ............ .~.... ..................... Fee Submitted $ ........~..~..~ ............... Construction on above described building and permit meets all applicable codes and regulations. Applicant ........................................................................................... Sworn to before me this ................ day of ............................................ (stamp or seal)~ .0 Notary Public .................................... County T 193--Sub-Leaae. iiIhis ~ub-~ease made the /~r day o, J~C-' WITNESSETH, that the Lessor hereby leases to the Lessee, and the Lessee hereby hires and takes [rom the ANNUAL RENT as herelna~ter provided, pa~ahIe in equal monthl~ instaIments in advance on the / ~ day o~ each and ever~ calendar month durin~ ~aid term, except the ~r$t instalment, which shall be paid upon the execution The Lessee represents that the Lessee has read the said lease (an exact copy thereo[ is at~ached hereto). The term~, covenants, provisions and conditions oI said lease are hereb~ incorporated herein and shall be bind- i~g upon both parties hereto, those applying to the landlord therein shall apply to the Lessor herein and those applying fo the tenant therein shall appI~ fo the Lessee herein with the ]oIlowing exceptlons: a. The annual rent pa~ahIe fiere~der shall be $ b. The security, it an~, to be depoMfed hereunder ~all be ~ c. The IoIlowi~g numbered paragraphs oI ~Md lease shall not appl~ to this sub-lease: The following numbered paragraphs o, said lease are amended to read as tollows: IN WITNESS WHEREOF, the parties have executed this sub-lease in duplicate the day and year ~rst above written. . ......... ....... / STATE OF COUNTY OF On this / d~ay of /c]/~(.~ 19 ~ ~ before me perso~ul]~ came to me known and known to me to be the indivldua] described in and who executed the [oregolng instrument, and duly acknowledged that he executed the same. ~o. 52-29~95~0~ Suffolk Co STATE OF ) ss.: COUNTY O~ On tbe day of being by me duly sworn, did depose and say that he resides in · 19 , before me came that he is the of the corporation described in, and which executed, the foregoing instrument; that he knows the seal of said corpora- tion; that the seal a~xed to said instrument is such corporate seal; that it was so aB~xed by order of the board of of said corporation; and that he signed h name thereto b7 like order. GUARANTY FOR VALUE RECEIVED, and in consideration of the giving of the foregoing lease, the undersigned guarantees to the Lessor, its successors and assigns, the full performance and observance of all the covenants, conditions and agree- ments, therein provided to be performed and observed by the Lessee, including the Rules and Regulations as therein pro- vided, and hereby waives notice of non-payment, non-performance, or non-observance, or proof, notice or demand, whereby to charge the undersigned therefor, and expressly agrees that this guarantee shall not be terminated or affected by reason of the institution of any action or proceeding against the Lessee and/or the extension of time for the pay- ment of the rent reserved and/or the reduction of such rent, and the undersigned expressly consents to any such exten- sion of time or reduction in rent. WITNESS my hand and seal this day of 19 Witness: Residence ..............................................................................