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HomeMy WebLinkAbout4549-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~78~ Date THIS CERTIFIES that the building located at Map No. ~ ... Block No..~ Lot No~x~ April 8. ,19 ?0 Middle Road Street Mattituc~ ~.¥, conforms substantially to the Application for Building Permit heretofore filed in this office dated " No'g' l0 , 19 (~ pursuant to which Building Permit No. dated .... }lo~r · lO , 19 69, 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 Farm. bulldog The certificate is issued to of the aforesaid building. -.potato. storage ............... ~tanley Tuthil~ Owner ....... (owner, lessee ortenant) Suffolk County Department of Health Approval ...... N..R, ............... Building Inspector TO~N OF $OUTHOLD 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: ....... ~ ~ ,.~,e.~.v.~...,&...~.~.~L~.=~..~..4~...,,~..~te~r ~t~t~l, ................. .~.~a.~~ ....................................... ]:ee $[ ....................... pursuc~t to application dated .~ ............................ ~Q.IE. .......... '[~1 ........ , 19..i~., and approved by the , L Building Inspector. ~ FOR.1~ lqO. ! I'~:~/N OF SOUTHOLD BUILDIHG DEPARTMENT TOWH CLERK'S OFFICE SOUTHOLD, H. Y, Approved .................... [..: ................ , 19..:.:... Permit No. q~ 7~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This opphcation must be completely filled in by typewriter or in ink and submitted tn duphcote to the Inspector. b Plot plan showing Iocohon of lot and of buddings on premises, relahonship to adjoining premises or pubhc streets. areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatio c. The work covered by this application may not be commenced before issuence of Building Permit. d Upon approval of this application, the Building Inspector will ~ssue a Building Permit to the applicant. Such pen-r 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 o Certificate of Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to t} Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances . Regulations, for the construction of buildings, odd~tions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable lows, ordinances, buildm9 code, housing code, and regulations. ..... (Signature of applicant, or nome, if a corporation) T,... ........................... (Address of applicant) State whether applicant is owner, lessee, agent, archttect, engineer, general contractor, electrician, plumber or budde ................................................. ..... Name of owner of premises .....~.M~k.J~.~.~. ..... LI~..~'I~.I...~...~,. .............. ~. ~.'.~..~.'..: ............... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1 Location of land on which proposed work wdl be done Mop No ..................................... Lot No.: ...................... Street and Number ....... ~,~,~......~..~,~.-~...~t..'..~...'..'~Dt~,~.....~t-..'. .............. '..~.J~.~'..l..l.~.~J.~l~. ................................ ,/~ / - / ~ ~ ~_~' ~ Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy .............. L~...~.J~.I~/~.J,Z.~.J~..~.I~......~...~.[~.|). ............................................... b. Intended use and occupancy ............. .~..~...q:~..~"t~.~..(~....~.'[.~J:~l~......~...~.l..l~.~.l/)~J.~ ........................ property lines G,ve street and bl~jc_k j~j~_l~r descriphon whether inten or corner lot. ,' I 3 Nature of work (check which applicable)' New BuHd:ng .~¢.~,, ...... Addition ................. Alteration ............. Repair ................. Removal .................Demolmon ............... Other Work (Describe) .................................... 4 Estimated Cost ..........J ~y .~..(~..O..~....~.. ............. Fee ................................................................................. (to be po~d on filing this application) 5 If dwelhng, number of dwelhng units .......................... Number of dwelhng umts 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 ex~st~ng structures, if any. Front ...................... Rear ............................... Depth .................. Height ........................ Number of Stories ....................................................................................................... D,mensions of same structure with alterations or edd,tions Front .................................. Rear .................... Depth ................................ Height ......................... Number of Stones ............................. 8. Dimensions of entire new construction: Front ...... -- °.~.'. .................. Rear ...... -- *.~l.t~..: ............ Depth .....~...~..I...~ He,ght ..../~,.~.! ....... Number of Stories .......... l ........................................................................ 0. S~ze of lot: Front .......................... Rear ................. Depth .................. 10. Date of Purchase ............................................... Nome of Former Owner ................................................. 1 1 Zone or use district in which premises are situated .......................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulat~on~ ......................................... 13. Name of Owner of premises . NI,~.? I~t~lll~,. Address ..... 1.1.~.~,.~.~, ........ Phone No ." ' -- Name of Architect ..................~ ............ Address ...... ~ Phone No. Name of Contractor ~'~O~.h~}.. ~.,.~l~.~ll~.Address '~. ~.~l~.~?~.~,l~Phone Na~...~...~.~.~ PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether exmting or proposed, and red,cate oil set-back d~mens~ons fro, recording to deed, and show street names and ind~cal N STATE Of NEW YO~.K., COUNTY OF ~.L'..~.I;~,~, ........... · l~'~~....~.,..~~'....~.~., ...... be,ng duly sworn, deposes and says that he ,s the applica~ (Name of ~nd~vidual s~gning ap~cat~on) above named. He is the .............. ~ ~~..~..~J.~I~Q~ ............................................. (Contractor, agent, corporate officer, otc ) of sa~d owner or owners, and is du~y authorized to perform or have performed the sa~d work and to make and fd this application; lhat all stetements contained m thru apphc~t~on are true to the best of his knowledge and behef; a~ that the work wdl be performed m the manner set forth m the apphcat~on filed therewith. Sworn to before me this ........ ~... d~y of ..~~~ .............. , 19~ Noto. Pub c~' ~ ..........