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HomeMy WebLinkAbout2499-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ....... ~1_~ .......... Date ~,&~% Il, 6~ .R..9..a.d ~/S ~ound View Ave THIS CERTIFIES that the building located at ...~...t,.. ~ , .......................................... ~ ........... Street Map No....3133~ ......... Block No .....~ ........ Lot No. 3[3~ l~o~t~o'Id! 1~e conforms substantially to the Application for Building Permit heretofore 'filed in this office dated ~ ~.99 z .......................................... ~,1[l,~1~.t[......~,, ]9....~/... pursuant to which B~il~,ing Permit I~1o ................. dated ................................. A~t....~,~ 19....,~..., was issued, and conforr~s ,to all of the requirerhents of the applicable provisions of the law. The occupancy for which this c[ertificate is msued is ........ ..... ~.~v.a~t.e .. _-,~, .fz,.e~:~r...d.~el..!~...ng ................................................................................... The certificate is issued to l~.tldol~..h. Bernst~ Ouaer , (owner, lessee or tenant) of the aforesaid building. H.D. Approval July 8, 196 ~ by R. Villa ....................................... ; ......... ? ...... .{ ................... Building inspector FORM NO. 2 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) N? 2499 Z Permission is hereby granted to: R. 8 ~fe~4..A/G ..li~detph.. tte~n~te~ ............... ........... t~att~.t~ek ............................................... to ....btttl~ · · ~ ..~e...$sm$-~.y.. ~1~ t.~.~ ................................................................................... at premises located at .,.J~.....~..jJ.~Oj. tl~..-..~)~.f..JJ/S....J~l~..V'~'~#'-~e ...................... .................................................... 4~u.~hetd ........................................................................................... .......................... (~d:ttr- O ~']~ ;'/~'~") ....................................................................................................... pursuant to application dated ........................ &ilglt~. ...... .~, ......... 19.(~.., and approved by the Building Inspector Fee $....10.00- ....... Building Inspector{ SUFFOLK COUNTY DEPART~NT OF HEALTH Bldg. Permit No.. TO WHOM IT ~ CONCERN: The sewag~e disposal facilities for a structure located at , ~,~, ~~ ..,f.~ ,,v/~,, ~,~,~,. _ ~ / (Giv® deed locatiSn) ,~ ..~ . 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. Approved ........................................ , 19 ........ Permit No ............................ Disapproved a/c ........... ~~' ................. .................................... (Building Inspirer) , APPLICATION FOR BUILDING PERMIT INSTRUCTIONS e. 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 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 pa rt For any purpose whatever until a Certificate .of Occupancy shaJl 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, 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 and regulations, (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... Con.tr. actor. ................................................................................. Name of owner of premises ....~.'g..~.q~.~.....~.~.~..~..li~..~. .......................................................................................................... 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 .....~I'~'.~....,~,A.0.~...0~.~'..~/.~...~.O.~"J.~,,Ckft.~...~..ft ............ ~.QI~t~D.~,~...4.~.~ ~,0..A~.......... . ............ . Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... .v...a..o...a..~...t.....1., .a~,.~. ............................................................................................. b. Intended use and occupancy .................. ,q¥~..~...~.~z~.~...~W.~.i].~!lg ................................................................. 3. Nature of work (check which applicable): New Building '":lr..~ ..... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost ..... I~.~.~'O0..~/.l/l ................................. Fee ..... ~,1~1 ............................................................................... (to be paid on filing this application) 5. If dwelling, number of dweIIJng units .......... ~e ........... 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 ................................................................ v ........................... ~ ............... ,. Dimensions of same structure with alterations or additions: Front ........................ , ....... Rear ................................. Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ..... Li.~., ................. Rear ....... ~-V2 ................ Depth ........... .~.~.~l~ .... Height ............................ Number of Stories ..... O1~' ............... 9. Size of lot: Front i ....... ~.~ ............... Rear ........ ~,O0..,~. ....... Depth ................... ~ ............ 10. Date of Purchase ...........~.O~...~.c)~:~ ..................... Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ ,I.A~...¢~.t.~,. ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ................ Z~.O' ................................. 13. Name of Owner of premises ~,,,...)~'~li.~,e~. ............. Address ........................................... . Phone No ..................... Name of Architect ...................................................... Address ............................ . ................ Phone No ..................... Name of Contractor ..~/4~,¥..~"tI~'~'6 ....................... Address ....~)~t,~.~:b¢~oi¢. .................. 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 ¢Jnd block numbers or description accord%q.~o deed, and show names and indicate whether interior or corner lot. ~--"' ~ O t~ ~ V ..C v, NyC STATE O~ NEW YORK, COUNTY OF ..... 8~.~.~'o..~ .......... / S.S. ................. R~,~T~.OI'i~..'.,.~-~,I~,~.,4~ ................................... being duly sworn, deposes and says that h~e is the applicant (Name of individ~a s gn ng app cat on) abow named He IS the ..... ~..On-.~n~ ............... '~" 'x [L. on acto, g t corporate OTTIC~. ~ . f of said owner or owners 'a~d'Xis duly author,zed to perform or have per armed the said wo~l~ and to n~ke a4 file th s < pplication; that a s tements contained in this application are true.~ th~,/'b~st of hl~ knowled~'~i, cmdJ~oelief; .~!~?ot ~he~orW~rmkeWit~isbeS..~.tr.~rmed in the manner set forth in the appli/9~bn ~e..d/tthxe. r~,~ffh~. ~!~, [./~'~'?ff (' ..... :Ii: ......... .... . .' ....... .......... /........ .... Not~arv Public~)'~.4~~~.~.~.Count~7~'~L~'" ......................