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HomeMy WebLinkAbout2934-z~OR~V~ ~0. 4 TOWN OF $OUTI"IOLD BUILDING D'~-PARTM~NT SOD'TI~OLD. N. Y. OEI~TIFIOATE OF' oor!.UPANOY THIS CERTIFIES that the building located a~ ... J~/~... ~.akPJ~$~..I~0~t ..... Street Map No....'.XX. [~. ..... Block No ....... .X.X.... Lot No..X~...~. ..... .~.O~..~.h.o...1./[.t' .N.:~: ........ conforms substantially to the. Applicati~on for Building Permit heretoSore filed in this office dated ...... .I~'o.V.,...13 ......... 19.6~. pursuant to which Building Permit No. ~..3.~..Z.. dated ............... .I~.V.~ .J,~., 19..6.[, 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 . .I.~'~x.~a.t.~t. OBe. ~..~,~lly..cl~.e.].l,iY~ .......................................... The certificate is issued ~:o .. ~lli.CtO..Y~l:lJlO ........... 0lq~q:l~. ........................ (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Appcoval ...... ~;apt..8,. ~.96.6...~y..~.,..V. illa.. Building Inspector FOP,,M 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? 293 z Dote ................ .~.~O~_...~l. beF 19, ~9..~..~... Permission is hereby granted to: ~aker & ..l~cke ~ ~.~r~ .AZ.C .. ~u~do...~l~.o ............. to ....]~uild..ne.~..ol~..f-m~ l~...~e.].l~mg ................................................................................... at premises located of ...~a~;om;J~L.]ELoal~, ............................................................................................. .............................. Y~ugh~ng...~&ter. s ............ ~outhold ............................................................... pursuant to application dated ..................................... ~g~.. ....... ~L~ ....19..(~,~..., and approved by the Building Inspector Fee $~O.OO ............ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH ~EP 8 1~ Date Bldg. Permit No. TO WHOM IT MAY at CONCERN: The sewage disposal facilities fo~ a structure located (Give deed locati~ny have been inspected by this department and found to be satisfactory. District Engineer District Engineer FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ~ ~'' c/ 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 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 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. ..................... : ........................................................................................................................................ Name of owner of premises ..... .~...F.J'.../....~...~ ...... /..~/_..6...z;../../.'~.£). ............................................................................................ 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: .................... Stre~ and Number ~Z~ ~ ~ ¢~ ~ o (.~... ~..~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... use and occupancy .,.~...~.~.Z.Z~...~]~r(z.~..~, ...................................................... b. intended 3. Nature Re~ai r 4. Estimal of work (check which applicable): New Building .................. Addition .................. Alteration ............. .................... Removal .................... Demolition .................... Other Work (Describe) ........................ ....... Z...~...~.~..~ ............................... Fee ..................................................................................... ed Cost 6. If ~usi 7. Dir~ens Height Dimens Depth B. Dimens Height 9. Size of 10. Date o1 1 1. Zorie 12. Does p 13. Name ( Name Name Locate c property lines whether interi (to be paid on filing this application) If dwel ing, number of dwelling units .........../.i ................. Number of dwelling units on each flaor ........................ If garage, number of cars ...... .,.c~.,....,.~....~.Z~...,...x~...-~..~.../~....~,/X'..~.~. .............................................................................. Jess, commercial or mixed occupancy, specify nature ,and extent of each type of use ............................ OhS of existing structures, if any: Front .......................... Rear .......................... Depth .......................... ............................ Number of Stories ......................................................................................................... OhS of same structure with alterations or additions: Front ................................Rear ............................ ........................... Height ................................ Number of Stories .: ...................................... ons of entire new construction: Front ................................ Rear ............................ Depth ....................... ........................... Number of Stories .................................. lot: Front ......... /..../...~.~i ............ Rear ......... ./../..~ ......... Depth .....~'£ O x Purchase .......... ./..~.'~? ................................. Nome of Former Owner .(.-.'.../~..,....~...J..(..~....~../,'~.4~../.~. ........... use district in which premises are situated ......... ~.~...~..~i./...~....~..../,~..,~..~...'..Z./.....~;:.. ....................................... 'oposed construct on v o ate any zon ng aw, ordnance or renu at on~ ~' o, . · ~z~/~ / ~ z / 4/o' /~ ~¢,;z-~Z~. ~t/,4;f,~'/-~::;; '47"_?E~ ................................. f Owner af premises ................ ~.. ..................... Address .44J/~.~..Z'.......ff...~:...;2p..~: .~.~. Phone No ................ Architect ...................................................... Address ............................................ Phone No ................ Co,troctor Address .......... Phone PLOT DIAGRAM early and distinctly oil buildings, whether existing or proposed, and indicate oil set-back dimensions fr Give street and block numbers or description according to deed, and show street names and indic )r or corner lot. fl'5-1 STATE O~ NEW,/~'O~z~,,~ /~ ) COUNTY OF~.~ ) .............. :..~...~.h_~r.,r..M.~... .......................................................... be ng duly sworn, deposes ond soys thor he ~s the apphcc (No~e o~ individual signing ~pplicotion) above na~ed. He is the ........ ~~(~;c ............................................................................................................ i (Contractor, agent, corporate officer, etc.) of said ownerlor owners, and is duly authorized to perform or have performed the said work and to make and f this application; that all statements contained in this application are ~rue to the best of his knowledge and bell and that the ~ork will be performed in the manner set forth' ~,the~ a~li~at on filed therewith Sworr to ~efo~me this . ~ oyor ............. 19~. ,. ..... /. .........................