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HomeMy WebLinkAbout4522-zFORM NO. 4 TOWN OF SOUTHOI.D BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No. Z 3~46 Date THIS CERTIFIES that the building located at Map No. XX Block No.. XX' Lot No. Rocky Po2zlt Road Street East gario~ conforms substantially to the Application for Building Permit heretofore filed in this office dated 00t 2?' , 19. ~ pursuant to which Building Permit No. I+~ 22 g dated 00t; '27 , 19 69' was ~ssued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is l~i~t~' ~ne fe~i~ .dwetlitlg The certificate is issued to of the aforesaid building. Suffolk County Department o£ Health Approval (owner, lessee or tenant) Building Inspector 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) Permission is hereby granted to: ............ /..~........L~~....~...~ ........... .............. ~....~...~...~ ................ ........ ff~.~ ....... ~~.~ .......................................................................................... .~..~.~...~.. ~, ,.m,~. ,~,e~ ~, ...... ~ ...... ................................. .~.~ ....... ~..~ .......... .~...~-- ........................................ pursuc~q~' to application dated ............................................., 19... and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ^ppro,,ed ........................................ , ........ Pe it ........... =7.7.=..."':: .............................................. 7:::.::...: .... '..:.: ...... ........... , ...... ................................ APPLICATION FOR BUILDING PERMIT ~ INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plat plan showin.g, location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detaded description of layout of property must be drawn 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 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, housing 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 .....~..:...~..~..~..~..~..~'..~..e.~ ............................................................................................................... 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.: ..;~r3~ ................. Street and Number .~...~....~'...O....~J~..~D.~,Y~...~.Q~nJ;..-I~c~ .........~',..~b~z'.;Lo~ ................................................... Municipality State existing use and occupancy of premises and intended use end occupancy of proposed construction: a. Existing use and occupancy ....... .~...~..e..]_..~..~.§ ......................................................................................................... b. Intended use and occupancy .......... 5 n m e...~=L'l;~., eao.'l.o&ed....p&~.o ....(~ ~ ........: .............. ,::~i'::. .... 10. 11. 12. 13. 3. Nature of work (check which applicable): New Bu!ldir.:j .................. Addition ..~r.3~ ........Alteration .................. Repair .................. Removal .................. Demo t on ...... Other Work (Describe) ........................................ 4. Estimated Cost ...... ..2..~.~..0..~....+.. .................................... Fee '.~..t...0~... ....................... (to be paid on filing this application) : . 5:; f dwelling, number of dwelling units ....~...~i...;;'. ........ ;.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 .........2.~ .............. Rear ........... 2~ ................ Depth ......... .bt6 ...... Height ........................ Number of Stories ...... .o.~. ................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .............. .2..~.. ................. Rear ....... 2.~ ................ Depth ...... .1..~ ............. Height .................... Number of Stories ..oZle ........................................................ Size of lot: Front ~ ....... .I..~..Q. ............ Rear .....1.0Q ........................ Depth ........ 2.10 ................. Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated ...... .I.IA!!..~-~; ............................................................................ Does proposed construction violate any zoning law, ordinance or regulation.;> ............... ~10 ........................................ Name of Owner of premises ~..~.t'~.l..q~11~..c[e,s ...... Address ......~t...~a.l~.~.o~. ............... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... ~lome of Contractor ..~.~ ........................................ Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, ond indicote all set-back dimensions from property lines. Give street and block number or description occording to deed, and show street homes and indicote whether interior or corner lot. STATE OF NEW YORK, tee COUNTY OF ..... .~'~.£O.].~. ......... ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ..;; ....... ~L~e~l;..o~'...o~ae~. ........................................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke ~d file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fodh in the application filed therewith. Swam to before me ~is ~OT~y PUBLt~, State of ~ew York No. 52-8125850, Suffo k Co~y Term Exp res March 30, 19~ !!