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HomeMy WebLinkAbout434-zFOIR~ NO. 4 TOWN OF ~OU?HOLD ~U~LDI~G DEPARTMENT ~OWN CLER~(?~ OFF~CE SOUTHOLD, N, Y. OF' OCCUPANCY No ....... ~,'*(~'7'9 ..... Date ............ THIS CERTIFIES that the building located al Map No ........... ~._. Block No ...... ~.~ ....... Lot No ........~.~ ............................................................. conforms substantially to the Application for Build~ng Permit heretofore filed in this office date0 ................... ~O~..8 10..~8. pursuant to whleh Building Permit No ........... ~ated ......... ..."-'S~'~"~'"' 19"58' w.as issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ................................................................... VR. IVA~FE .. ONE.. ,F~tL¥..DW~LLIN6 ..................................... A1 fr~3 This certificate is issued to .................... (owner, lessee or tenant) o~ the aforesaid building. ~J Building Inspector~ FO~,M NO. e, 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.o 434 Z Date ........... ~teabe~-....t~ ................. Permission is hereby granted to: ~£~-e~..(p~.3~S~ ......................................... .......... 8eu.t.h..~ez,..~ ............................. .................. Be~the~d.¥ .....N.,.~, ........................... to ..... ~.td...aN~t~.~n~-.o~t..a~..~.x~d~n~..~well~ ...... at premises located at -/ pursuant to application dated ......................... ~'pl;g~b~l'"~ ........... 19~...., and approved Building Inspector Fee Building Inspector TOWN OF SOUTHOLD BUILDING DEPAR'rMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exom .ed ......... ...... Approved ........................................ ]9 ........ Permit ~o. Disapproved a/c ....... ..l ................... .~ ............. ,,~x ........... ;,..~ .......... z~ ............. ................................. Application No ...... ..~../~..~..~ ......... (Building Inspector) 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, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location. 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 o 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 issuanoe 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. .......... ........ .... (Sig~ure of applicant, or name, iT o corporation) ......... ............ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ....................................- · Name of owner of premises....~/'~'~.4~.~....~xT'~'' .......... '~t~..~...'~.~. .................................................................... 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. Mop No: ............................................ Lot No: .................... Street and Number ~ Municipality 2. State existing use and occupancy of premises an~ intended use and occupancy of proposed construction: a. Existing use and occupancy .......... .~....~..~(-...~....~ ........... i ............................................................................ b. Intended use ond occuponcy......~..' ........... ~..~ ....................................................................................... 3. Nature of work (check which applicable): New Budd ng .................... Add t on~ ................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ................ ...'~....~...~.....r~....,....~.. .................. Fee ........ ..~...~..z.....~.. ................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... ../. .................. Number of dwelling units on each floor .......... J. ................. If garage, number of cars ........./.....K'~,~.ce,~..~.~.~.....~....~,.~ ....... ,C..~////////~.~9~t,¢4~ .................................................... 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 ...... O~....~ ................. / Depth ........... ..~..~./. .......... Height .......... .~. ................. Number of Stories ......... Z .................... 8. Dimensions of entire new construction: Front ....... ~...'. ............. Rear ~ ~ ...... ~ ................... Depth ......~.....~.. {. ............ Height ....... /.~ ................ Number of Stories ........ /. .................. 9. Size of lot: Front ........./...~....~. ........... Rear .......... ~.'..~....' ........... Depth ...... ~..~...~. ........... 10. Date of Purchase ..... ~..~'~..~.....~.'~.?~ ................... Nome of Former Owner ...~.....~...~ 1 1. Zone or use district in which premises are situated ........ ~ .......................................................................................// 12. Does proposed construction violate any zoning law ordinance or regulation? ..,~..~...,[~..~~..~ 13. Name of Owner of premises. ~fi'f/ess .~,4~...,....~..~. ...... Phone NO. ~...'T~'.-..~-Y..?~ Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT D~AGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, end show street names and indicate whether interior or corner lot. STATE OF NEW~Y~).P,K,/, ) S S COUNTY OF ..~...tr. ...... ) ' "' ~' ' i .... ~';i~'~'i ............... being duly sworn, deposes and says that he is the applicant above named. 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 a~lication' that oil statements contained~,jn this application are true to the best of his knowledge and belief; and tl~a~t the w~rk will be performed .n the m,a~,..~f~,fc~at~ in the application filed therewith. Sworn to be, fore me this £-~ ~_~-~_C ~'~,~:I-°' ~?~o/~ Uvo~, ....... ~ ~v 4~,, of ~.¥..~....u.l . 1'~¢~ ~ ro t~gnature or applicant) .......................... . ......... ..:-t:,. ..................