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HomeMy WebLinkAbout3850-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTPIOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z..306.2- .... Date ....... April..30, .......... , 1968. THIS CEl~TIFIES that the building located at Rocky.Pein~.Road ........ Street Tax Map Map No. Sheet .N~ Block No ............ Lot No. Eas~. Ma~io~,.. L, .~.., . N~w. Yo~k conforms substantially to the Application for Building Permit heretofore filed in this office dated .... April..~2 ~-.~968, 19 .... pursuant to which Building Permit No.3580Z... dated ..... Apt.il. 22., ......... ,19.68., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . . s~rage .shed- - acoesso~y.but, lding- ............................... The certificate is issued to . .Ange .M,. ~amagopo~l~ .............................. (owner, lessee or tenant) of the aforesaid building. ~ [~ Suffolk County Department of Health Approval ........ ~ ...................... FOEI~I NO. ~ TOWN OF SOUTHOLD BUILDING- DEPARTMENT TOWN CLERK'S OFFIGE · SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3850 Z D~e ...... .............. Permission is hereby granted to:A, to ......... 7. ...... ; .......................... ; ...... ; at premises I~eted at ..... , ........ ~..~....}.~ ........ ................................................ pursuit to application ~ted ..................... Building Inspector. Fee $ ........................ FOR,~ NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERKJS OFFICE SOUTHOLD, N. Y. Ex mined ........................................ , 19 ........ Permff No .......................... Application No.....~......~....~...?. ......... Disapproved a/c . , ................................... ..... (Buildi~'~ In~'pector) APPLICATION FOR BUiLDiNG PEi~MIT Data .................................. , 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 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 Bud ng nspector will ssue a But dng Perm t 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to.the Building Department for the issuance of o 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 appi~ic~ble~. ~,,,-~laws' ordinal_ ,~ n,~/e~, hou. sing ~code~and regulations. / ............................................................... Name of owner of premises ....~.~[.~-C'.~.~.~.~:~.~.~:~...' ................................................................ 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.: ~./~.~.,T...,/~'.~.(.. ........ Lot No.: ........................ Street and Number ~C/~..~.~.~.(...~.~O. i~2,.~. ...~..d.'~Z~..~..~.. / ~ ~nici~lity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ......... .,/.. ~l ~...~:.. ......... s~...~.. J.. ~:~...,k).....: .............................. ; ............................... 3. Nature of work (check which applicable): New Building ....~....i ....... Addition .................. Altera.tion .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... .~...~....~..~¢) ............................ Fee ........... i~"l~'~"~i~J"~'~"~'i'l'i'~"~i~"~ii~i~'i .................. 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................ '.: ................................................... 6. if business, commercial or mixed occupancy, spe,glfy nature and extent of ~'ach type of use ............... ~ ....... 7. Dimensions of existing structures, if any: Front ..3~) .................... Rear . .~...~. ...................... Depth .'.".~..~.~'. ........ Height ..~... Number of Stories .................... ~ ............................................................................ Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ N,~mber of Stories ................. y- ............. / 8. Dimensions of entire new construction: Front ....... ~.. ........................ Rear ....... .~.. ................ Depth .......~.. ............... Height ....... ~.~.~/.... Number of Stories ........ /. ............................................................................................................ 9. Size of lot: Front ...... ~..,/~.*.~..~. ...... Rear ..... ,.~...~..:,Z2.~/ .............. Depth .....,~,, ,~,.,O ....... ~, 10. Date of Purchase ............/..~..'~...~.. ............................. Name of Former i~ ~r.Z~..~ Owner ...~....~. ........................... 1 1. Zone or use district in which premises are situated ......~....' ........................................................................................... 12. Does proposed construction viol.ate any zoning law, ordinance or regulation? ..... .K~...~ ................................................ 13. Name of Owner of premises .~...~..~ ..~./~..~D~r~f4...~2..~.Address'(..~...c,~..~.~...]~J....(ff~.q....~..,~, ........ Phone No. ~., .~..~.~.~.~.~/ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....... ~...~....~...~... .......................... Address ............................................ Phone No ..................... Locate clearly and distinctly property lines. Give street and whether interior or corner lot. PLOT DIAGRAM buildings, whether existin~or proposed, and indicate all set-back dimensions from number or description,s:cording to deed, end how street names and indicate / STATE OF NEW YORK, COUNTY OF ................................ ................................................................................................. being duly sworn, deposes end says that he is the applicant (Name of individual signing application) above named. He is the ......................................................................................................................................................... (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 b~..~s.L~f his knowledge and belief; and that the work will be performed in the manner set forth in the application filed t~rewit~~) Sworn to before me this "'~L ~I~ [,~~ , ~ Notary Public, . ........................................................... County ........ ~: ................. ~ig~ of ~ FOBM: NO, 1 ?O~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomlned .....~.-~,~ ........................ , .......... Approved .................. .r..? .................. , 19...~.!... Permit No ..... 2.~..~....~'~./..~ Disapproved o/c ............. · ~,~. ~, ,t:~.:,:::~.::.~~ ...... ~,- ..................... ................................. Applicotion No....'C..':....~....¢:! ........ APPLICATION FOR i~UILDIN; PERMIT Dote ........ ............................ , 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 areas, and giving a detailed description of layout of property must be drown on the diagram which is port 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 port 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, angL.ot4q~applicable Laws, Ordinances or Regulations for the construction of buildings, additions or alterations, or for re, m~oval or/~emolition, as herein described. Th~ applicant agrees to comply with all applicable laws, ordinance/s~ildingj~ode, h~si~g code, .and regulations. <Sign~[re Of ~icont,//~me, if o corporation) / (Address of ~pplicont) ~,~-'~ State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electricion, plumber or builder. o, o, pr m, e ........................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~"~X'/~Z/~ JO ' 1. Location of land on which proposed work will be done. Map No.: .t.,..~.~,.~...~...-..~T..~.. ........ Lot No.: ....., .................. Street and Number ..~.fl~.~/.....l~.~.P.~...~.~..~/.~,~/~/~JJ?,/..~..).~O.~'.7././~..~....~.~' ................... -- -- ~ / / / ../ Municipality 2. State existing use .and occupancy of premises and intended use and occupancy of proposed construction: a. J~xisting use and occupancy .: ................................................................................................................................. b. I ,tended use and occupancY.. ~......,~:.~.Z./...~..?~.. ...................................................................................... 3. Nature of work (check which applicable): New Building ....~ Addition .................. Alteration .................. Repair .................. ,~P~emoval .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...~.....~'.~....~..~%.~ .......................... Fee .................................................. : ....................................... · -~r (to be paid on filing this application) 5. If dwelling, 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 ea~'h type of use ................. ~.. ...... 7. Dimensions of existing structures, i,f any: Front ......~.~ ................ Rear ....c~......~. .................... Depth ..(~...~... ........ Height ........................ Number of Stories ............... ~...~.~...'M~....: ................................................................................ Dimensions of same structure with a.l~or additions: Front ..................... , .............. Rear ......,-~...: ................. Depth ................................ Height ....~¢......f. Number of Stories ............... 8. Dimension,s of er~tire new construction: Front ...... ~ ........................... Rear ...... ~. .................. Depth ...... ~ ............... Height ....1~.2t~ ......Number of, Stories .........../'. ......... ./ ................................ ; ......... /'.. ................................................... 9. Size of lot: Fro/n~r ..... ~../'.~:1..~../.... Rear ....~.4~...O..,'/.~ ............... Depth ..../(.~..Q. ................. 10. Date of Purchase ....... ~..i~..~...~... ............................... Name of Former Owner .~..........1~.O./,~.~... ................... 11. Zone or use district in which premises are situated ............. ~,~.:. ................................................................................ 12. Does proposed construct,on v,olate any zom~ng law, ordi,nance or regulation? ....~.~..~..: ........................................... 13. Name of Owner of premises ./~.~..~.~/~'./~...~.r3. P~..o....~....Address ~c7.~,~..~.l~/~..~'....~...~..~..... Phone No...~...~..~....~..~'~, Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of 'Contractor ..... ~'...~..~...~.~. ............................ Address ............................................ Phone No ..................... Locate clearly and distinctly property lines. Give street and whether interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and indicate all set-back dimensions from number or description according to deed, and how street names and indicate STATE OF NEW YORI(, 1, c ¢ COUNTY OF ................................ ~ .... ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ......................................................................................................................................................... (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 be~s~t of his knowledge and belief; and ?atrth'e w' °-r)" wil/~e~'p'-erf°rmed.~wo nzo ~erore me~n~s in the manner set forth in the application filed th~)h.~, Notary Public,. ........................................................... County .......... ~~~;~"'~ ..............