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HomeMy WebLinkAbout2309-zFORF~ 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CEP. TIFICATE OB- OCE:LIPANCY No.,...,.......Z 2~i?? Date . .... THIS CERTIFIES that the building located at . .(1.~. '2//11. ~i.v.e ............. Street Map No... ~11/~/I.. Block No ............. Lot No... ~L ........... ~t~&tgl~h:~. ~,1~,.. conforms substantially to the Applicati. on for Building Permit hereto]~o.re filed in this office dated ......... liaX'~b..2,~ ..... , 19~4. pursuant to which Building Permit No. dated ........ ~.~h..J.7 ...... , 19~4.., was issued, and conforms to all of the require- ments .of the .applicable provisions of the law. The .occupancy ~or which this certificate is issued is ~ew O~e ~,,~y The certificate is issued to J~.~.tg. C&~i..~.'~.~ (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ...A.~?.%..l..1..4.,...1.9.~.5 .................... FON~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUiLDiNG (THIS PERMIT MUST BE KEPT ON THE PREMISES uNTIL, FULL COMPLETION OF THE WORK AUTHORIZED) 2309 z Permission is hereby granted to: Sun Valle~ Manoz'"'~no'""~/(~"i~o~e~pt~'~em,'~e~rr' ...... to....Ba:~i (t..~tew..eiie...£a~i.ty,. ~we.~.~r~ ......... ~ ................................................. ~ .............. , ........ at premises located at .~t..i~.3.j...Oa~;..~i~d.~ ~1~;'"~ .................. ~' ............. '"'"'"~ ........................ ...................................... N/t}.'~en~'"D~i l~t~tu~k ..... ~' ............ pursbant to"application dated ..............'""':J~e~t~lJ~'":Z~'"'"~ ...... ~ .... 1~;...., and~6j~pro~,~d bY the Building In~p,ctor Fee :~LO,e.QO..;...~ ...... Building' Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH Date~~ Building Permit Noo~,~5 ~ TO WNOM 1T MAY CONCERN: The sewage disposal facilities for a structure located at have been inspected by this department and found to be satisfactory. --District Engi--neer APR 1 ~ l~J s-9 SCHD FOEM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, Apphcahon No ................... 1 ......... Disapproved a/c ..,~~~... (Building Inspector) APPLICATION FOR BUILDING PERrMJT 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 bt and of buildings on premises, relationshlp to adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust 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 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 Deportment 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and r~gulations, c~4~_),/~r~,~ ............................................................................... ~,.:../... %.74 , (Address of applicant) Star__is ownil, lesse~, og.lnt, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises~ ....................................................................................................................... If applicant is o corporate, sjg~noture,of cJ~t~ authorized officer. .................... ......... ' ......... Location of land on which proposed~wor~k wil~ be done. Mop No~:~~o4~_~,(~'Lot No: ....../..,.: ........ Street and Number~ .......................... .~....~ ............................................. ;~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ........................... /,1 .......... 4 ................................ .:..~...e ................................................ Intended use and occupancy ..... ...d~......~. ................................................................................... 3. No~ure of work (check which applicable): New Building .................. Addition .................. Alteration ............. Repair ............ .~,.... Removol~,~ ................ Demolition .................... Other Work (Describe) .................................. 4. Estimated Cost ,./..~r4.~ .......................................... Fee ...................................................................................... (to be paid on filing this application) 5. If d~elling, number of dwelling units of dwelling units on each floor ........................ If g6rage, number of cars ..... 6. If b,~siness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dime,nsions of existing structures, if any: Front .......................... Rear .......................... Depth Height ............................ Number of Stories Dimepsions of same structure with alterations or additions: Front ................................ Rear Depth .............................. Height ............................... Number o.f, Stories ......................................... 8. Du~e~s~ons of entire new construction: Front .... : .... Rear .... ~.. . . Depth . . 10. Date of Purchase ...,/..~....'~...~.. ...................... : .............. Nome of Former Owner 11. Zone or use district in which premises are situated ............................................. ..... 12. Does proposed construction violate any zoning law, ordinance or regulation? 13. Nome ~f Owner of premi~,s ....... ~..,,~ ............... Address ............................. .~.1.~ ...... Phone No. .... · ............................. ,",oar ss /. ........................ t~none No. PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from property lines., Give street and block numbers or description according to deed, and show street' names and indicate whether interior or corner lot. STATE OF N W~ ~ COUN~ OF ~....f ~'~' ~~ Z being du y sw°rn, deposes and says that he s the applicant ................ ~'~'me o~ ind~L~ ~bovo n~med. He is the ..~:.~..r~..,~ ................................................................................................................ ~ ff~ (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 ~pplication filed therewith. Sworn to befo~m~ this .' . I ' . ............................... : ......... ...... : .....................................