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HomeMy WebLinkAbout2582-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .... l~l/~ ..... 0]Ld..l~,..RO~,d ........................... Street Map No .... ~ ........ Block No ......~,~gZ. ...... Lot No. ~ ......... S.Qll.t, ho,],~t ...... JJ~.Y~ ................ conforms substantially to the Apphcat,on for Budding Permit heretofore filed ~n th~s office dated ................................... ~,~....~Jo.v. el~lb~_~., 19~.1~.., pursuant to which Budding Permit No. 2~J~2..~. dated ............................. l~O.~.e ..... ~1,1~ ....... , 19.~.., was issued, and conforms to all of the requirements of the apphcable prowsions of the law The occupancy for which th~s certificate ~s issued ~s ........ ..... ...................................................................................... The certificate is issued to .... ~13,]~.~.~....H~tl~ ..................... ~ ............................................ (owner, lessee or tenant) of the aforesaid building H.D. Approval April R. Villa Buildin~ Inspector J FOI~M ~0, 2 TO%V~ O~ 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) N.° 2582 Z Dote ............................. ~r.e~.e~.....~,.~.., ~9....~.~ Permission is hereby granted to: ~e.+~..D~t low~L....A. ~..~t~ l.~m..J~l~!~ ......... ................. G=tehog~ ......................................... to ......... ~Bu/] a ..ne~**e~e**~a~ll:~**~w~Iit~g ............................................................................. at premises located at .... J~'.~......~.~..~JOZ'.t~..P,g~ ........................................................................ .............................................................. ~u.~h~l~ ............................................................................... pursuant to ~pplic~tion dated ................................. ~ ........ ~.XF ........]9 ..... ~ ond opproved by the Building Inspector Fee $ .....10=.00;. ...... Building Inspector s-9 SCND SUFFOLK COUNTY DEPART~NT OF HEALTH Date ~//~ /~'~ . Bldg, Permit No, ~~ ~. The sewage disposal facilities for a structure located at (Give deed location) ' have been inspected by this Department and found to be satisfactory, District Engineer TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT Date ....................... ~..o.~.e., .~.~..e,.~. ..... .~...~. ........ , '19.,.~.~..... INSTRUCTIONS a. This applicabon must be completely filled in by typewriter or m ink and submitted in duplicate to the Buildin, Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and gw~ng a detoded description of layout of propertymust be drawn on the d~agram which is part of this applicatior c. The work covered by this appl,cation may not be commenced before issuance of Building Permit. d. Upon approval of th~s application, the Building Inspector will issue a Building Permit to the applicant. Suc permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be accupmd or used in whole or in part For any purpose whatever until o Certificate of Occupanc 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 th Building Zone Ordinance af the Town af Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulat~ans, for the construction af buddings, addibans or alterations, or for removal or demolition, as herein describec The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of apphcant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde ............................................... .~.o~.~.~.~o~ ......................................................................................................................... Name of owner of premises ..1~.:~...~.~tL....~.8..~.s%l~ ............................................................................................................. If applicant ~s a co,orate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Locat,on of land on which proposed work will be done. Map No- . ............. ~ ...................... Lot No: ....~ ...... Street and Number ....... ~ ..... ~.~...~9~.~..~.~., .......... ~.~.~.~ ................................................................ Munic~pahty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex~sting use and ~cupancy .~.~...~.~ .................................................................................................... b. Intended use and occupancy ...... ~..~..~~ ......................................................................... 3. Nature of work (check which applicable): New Budding ..... .~... Addition .................. Al~raltion .................. / / Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...... ~""t' ........................ 4, Estimated Cost ...... '~..~'~.,~ ................................... Fee ............ I~..~O¥ .................................. .~.~.. ........................ (}o 5e paid on filing this application) 5 If dwelhng, 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 .......................... Depth ........................... Height ............................ Number of Stories .............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ........................................ 8. D,mens o s of e t,re new construction: Front .... ...... Rear .... ........ Depth ~ '~ Number~ of Stories -r~/~,,,,~/ Height ...~'~.~ .................. .... ~r~'~. ................ 9. Size of lot: Front .../'r,,,,~ ................ Rear-..-~".~ZCT.; .~,..~..~ ............ Depth ...-~T...'~..r..~..':'.,~. ........ 10. Date of Purchase .......................... .~4)6~1. .................... Name of Former Owner ....... ~'~[~,~'"G~I'~D~"'~'~. ..... 11. Zone or use district in which premises are situated ......... 12. Does proposed construction violate any zoning law, ordinance or regulation? .....~.?..~.,~.¢'T....~Z....~....4x..~...'~...., 13. Name of Owner of premises ~....~~.~... ...... Address ......... ~,/~%~]..~ ............... Phone No .................... Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor ..... O~"'~)Z'~¥1'l~: .................... Address ................... ~"~1~'" Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions fror property lines. Give street and block numbers or description according to deed, and show street names and mndicat whether interior or corner lot, rI STATE OF NEW YORK, ~,S.S. COUNTY OF ...... ~ ~._~.~, ........ "' .................... (Name of ~'~v~ct~ s~'i~Y~i~ation) ..................... being duly sworn, deposes and says that he is the applica above named. He is the ..................~'O~'~ ........................................................................................................... (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 f th~s apphcation; that all statements contained ~n this o~plication are~e to the best of his knowledge and beli, and that the work wdl be performed in the manner set torth m ~ a~l[cation filed thpmwitb. Sworn tobefore~ mea thiSof ~ ' (~, /-/ ~ ~ / ............. .... ....... Notary Pubhc, J, ..~:r,,,.Z....~.~Z~ ...... ~, ..... Co~.tf ......... ;";'"~ ...... ?~'"~¥~'~6~' o?"~iif~i .........................