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HomeMy WebLinkAbout3038-zFORM 1~0. 4 TOWN OF SOUTI-IOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, I~EI~TIFII~ATE ~F EIr:.I~UPANI~Y No..~I. ~0" ' Date .............. ~aiI~Ol~.~... ~ .... 19(~. THIS CERTIFIES that the building located at . .},~t~.. '~el~l~l~&' '~l ..... Street Map No ..... ~ .... Block No. ' ';]l~ ...... Lot No. '~1t~ .... ~O~;h~'~' '~','~ ........ conforms substantially to the Applicati~on ~or Building Permit heretof~ore £iled in this office dated .......... ~p~:~. ..... ~., 19~. pu.rsuant to which Building Permit No. '~0~ '~ dated .......... ~;~ .l~ .......19.(~I~, was issued, and conforms to all of the require- ments .of the applicable provisions o£ the law. The .occupancy ~or which this certificate is issued is .. '~'~'V~,t~ ' 01~' .~1~'~~' ~']:],.'~'12§ ......................................... The certificate is issued to . .~1~. ~4. ~0~ ....... ~' o~wn~er,~' .......... lessee or :tenant) ................. of the aforesaid building. ,Suffolk County Department of Health Approval ........... ]~;...R.g ...................... Building Inspector I~OR,]VI NO..~ TOWN OF SOUTHOLD BUILDING DEPARTM[NT TOWN CL~RK'S OFFICE SOUTHOLD, N. Y. BUILDING P~RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED} N? 3038 Z Permission is hereby granted to: Rohe, r.t..L~..~.a.~t..A/~..~,...,T.,...~;~}m ......... .............. ~a~.'t. ho3~rt .............................................. to l~nJ-lfl-., an.. ad~i.~i ~.. on.. ~1!~ ..e~.~ ~,~i.~g .. d~we~:~.~.ng .......................................................... at premises located at ....~l/.8...t44~aehaha..-I~t¥.¢l ................................................................................. ........................................... · 8 o~o.~d.~... · · .~T.~ .~. .................................................................................... pursuant to application dated ............................ ~.~.....l&. ........:.., 19..~., and approved by the Building Inspector Fee $...~.,.00 ............ Building Inspector"][ FORM NO. ! TOWN OF SOUTHOLD B~U ILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .............. Approved ux 19 ........ Permit No. Disapproved a/c ..~...~..~~ .... ......... (Buildin~ I~spector) APPLICATION FOR BUILDING PERMIT ~ Date ............................... A~.?..~.~.......~.. ......... , 19..~...~.:..... INSTRUCTIONS o. 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 greas, and giving a detailed description of laybut of property must 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 per, nit 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, Ordin.ances 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. ... Ho.ber..t...L....Hy.a.tt ........................................................ (Signoture of applicant, or name, if a corporotion) ........ Slo. u.tholcl ..................................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... ............................. ............................................................................................................................. Name of owner of premises ..W~k],~LJ,~TI..~.o....T-,oh~. ............................................................................................................. If applicant is o corporate, signature of duly authorized officer. (Name ond title of corporote officer) 1. Location of land on which proposed work will be done..Map No.: .............. z::c,~ .................. Lot No.: ~ ................... Street and Number ....'.W~/.~......~tlah~i~]Lv.cl~ ....... ~o.u~holcl ................................... [ .................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~g.w.e~].±zlg ........................................................................................................ b. Intended use and occupancy ............. sme...w.i.~.h...a~t, cl.~.tfi~)D.· .......................................................................... / 3. NatUre of work (check which applicable): New Building .................. Addition ......Y~C~'.. Alteration ..... i ............ Repq~ir .................. Removal .................. Demolition .................. Other Work (Describe) ....................................... ........................................................ ee ....... (to be paid on filing this application) 4. Estir~ated Cost ].~',000 ...F .]=..O..t ................................................................ ............. 5. If d~velllng, number of dwelling units ........ g~ ............. Number of dwelling units on each floor ...... ~ ........ . ............. If g~rage, number of cars .................................................................................................... , ........................... ............. 6. If b.lusiness, commercial or mixed occupancy, specify nature and extent of each type of use ............... ............. 7. Dimbnsions of existing structures, if any: Front ............................ Rear ................................ Depth .......... i ......... Hei ht ........................ Number of Stories ................................................................................................................. Dim msions of same structure with alterations or additions: Front ....................................Rear Dep h ................................ Height ............................ Number of Stories ................................ 8. Dim ~nsions of entire new construction: Front ............. 2~ .................. Rear ........... ~.)f:. ............ Depth ..b¢~. .................. 9. Size of lot: Front ............................ Rear .................................... Depth ................................ : 10. Dat~ of Purchase ........................................................ Name of Former Owner : 11. Zon or use district in which premises are situated ....................... ~.~.A.~L..cl.:LB.t, ........................................................... 121 Doe~ proposed construction violate any zoning law, ordinance or regulation? ............. .~..t.. .......................................... 13. Nan~e of Owner of premises ..]g~.....Lohl~ .................. Address ............................................ Phone No ..................... Nan~e of Architect ...................................................... Address ............................................ Phone No ....... .............. Nan ~e of Contractor ..... ~.O.l~...~.ft.~.~ ....................... Address ............ ~'.O.~l-~f)~ ............. Phone No .......! ............. PLOT DIAGRAM Locot~ clearly and distinctly all buildings, whether existing or proposed, ond indicate oll set-back dimensions from property liy~es. Give street and block number or description according to deed and show street names and[ indicate whether in erior or corner lot. STATE OF NEW YORK, / c ¢ COUNTY DF ..... ~'1~..~'.~'1 ~ .......... ~ ""~' ...................... ,~Gbe~.~i...}l.~'a~..~, ............... ,.....:;....; ................. being duly sworn, deposes and soys that he is the ~pplicant Name of individual signing appticar,on~ ' above na~ed. He is the ........... ~.~.~.~.~.~ ....................................................................................................... ¢ .............. [ (Contractor, agent, corporate officer, etc.)] of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make~ and file this opplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the wbrk will be performed in the manner set forth in the application filed therewith. Sworn to b~fore me this ................ ........ ......................