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HomeMy WebLinkAbout4553-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17923 Date APRIL 3~ 1989 THIS CERTIFIES that the building. Location of Property 34715 MAIN ROAD House No. County Tax Map No. 1000 Section 19 Subdivision ADDITION & ALTERATION TO ACCESSORY ORIENT~ NEW YORK Street Hamlet Block 2 Filed Map No. Lot 5 & 6 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 13r 1969 pursuant to which Building Permit No. 4553-Z dated NOVEMBER I3r 1969 was issued, ~d conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITION & ALTERATION TO EXISTING ACCESSORY BUILDING The certificate is issued to KATB~i~INE HEINS (owner) of the aforesaid building. S~'~'OLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1553 Z Permission is hereby granted to: to ............ *~~_.~..m~ll..ea~le.~ls~-e~ee~,e~.i~j.~ttal. .................... at premises located at ............. JJt~tJ~-JlJ~,tJJJ--I~j~J--JJk~j~B~r~--JllJil~ .................................................. ......................................................... em~.e~dl ........... 11.~ ........................ : .......................................... pursuc~n~' to application dated .................... , .............. :~Jl~ ...... /~j~ ..... , 19..]~Jt., and approved by the Building Inspector. Fee $...~ ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NEW YORK 765 - 1802 1197 i ,~ FF~ 2 3 BLDG ~-_ , TOWN ? S~~ APPLICATION FOR CERTIFICATE OF OCCUPANCY NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUIL~ING,.h~...VACANT LAND ........ Location of Property /~/}~[~ ~Z ~/~ ~ ~7 ~OUSE NO. STREET HAMLET O~ner or Owners of ~ropert7 ................................................. County Tax Map No. I000 Section . ~.. Block ~ Lot ~m ~. Subdivision ....................... Filed Map ........ Lot .......... Permit No ........... Date of Permit .......... Applicant ................... Health Dept. Approval .................. Underwriters Approval .............. Planning Board Approval ................ Request for Temporary Certificate ....... Final Certificate ................ Fee Submitted: $ .... 1_0. ~. _C~ ........... rev. 10/14/88 ,FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE /~ /~ ~ SOUTHOLD. N.Y. Examined ............~., ........ 19.. '.. ]-/ _~ ~'3 2--- Appr, aved .................... ,19 .... Permit No .................... Disapproved a/c (Building Inspee~ar) Application No ................. APPLICATIO2~I FOR BUILDING PERMIT Date ............ ~./t.~ ....... 1~.~. INSTRUCTIONS a. This applicati.on must be completely filled in by typexvriter or in ink and .submitted in duplicate to the Building Inspector. b. Plot plan showing 1.ocation of ~o¢ and of buildings o n premises, relationship to adj,oining premises or public streets ,ar areas, and giving a detailed description of lay out of property must be drawn on the diagram which is part of this application. c. The work covered by this applicatkm may not be commenced before issuance of Building Permit. d. Upon approval of this applicati.qn, the Building In spector will issue a Building Permit to the applicant. Such permit shall be kept ~ma the premises available for inspectio~n throughout the progress of the work. e. No building shall be occupied or used in whole o~ in part for any purpose whatever until a Certificate Occupancy shall l~ave been granted by the Building Inspects'. APPLICATION IS HER.FAY MADE to the Building Department for the issuance of a Building Permit pursuant t.o the Building ~5one Ordinance of the Town of S(~atho ld, Suffolk C~ounty, New York, and other applicable Law.s. Ordinances .or Regulations, for the construction .cfi build ~ngs, additions or alterations, crt f. or removal or demo litton, as herein described. The applicant agrees to cam ply with all apphcable laws, .ordinances, building code h.~using code, an, d regulations. ................................. (S~gnature of applicant, o_r name if a corporation) · .................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber o~ builder .................. ~ .] ~ ~ .... ................................................. Name.of owner of premises ... ~...l~ .............................................. If applicant is a carporate, signature of duly authorize d <yfficer. (Name and title of corporate officer) 1. Location ,of land on w ie prcrpose war will be done. Map o ......... ~ ....... Lot No ............. Street and Number ..... .~ ~ ./?. ~ ~.d4 .~./q~..~.4 .... ~ .......... Municipality 2. State existing use and .occupancy .of p~?~.Lanj~oin,~ie~?ded use and .occupancy of proposed constructior a. Existing use and occupancy ...... ~ '~ .... ~"~-';/ .... M' ' ' Ff' ~ ............... b. Intended use and occupancy ......... .~.~ ..... .~/./.~..4 ..~..k..~ ..... .cT/.....Y~...~ .... 3. Nature of work (check which applicable): New Building ........ Additi,on ..~.. .... Alteration ..~ ..... Repair .... Removals, ...... Demolition ..... Other Work (Describe) ...................... 4. Estimated Cost ....... '"~. ~ .............. Fee . ..-~. ........................................ (to be paid ,~n filing this application) 5. If ,dwelling, number of d~velling units . /..~..~.. Number .of dwelling units on each floor ............. If garage, number .of cars ........................................................................ 6. If busincss, commercial aT mixed occupancy, specify nature and extent of each type of use .............. 7. Dimens$ons of existing structures, if any: Front ........... Rear ............. Depth ............. Height ................ Number of Stories ....................................................... Dimensions .of same structure with alterations or additions: Front .............. Rear ............... Depth ................ Height ............... Nu~b~ of St~o¢ies ..................... 8. Dimensions .of entire new construction: Front .... ~'Y'~' ...... Rear . ..~././.~-.. ..... Depth . .~..~. ....... Height ............ Number ,cfi Stories ............................................................. 9. Size of Lot: Front .............. Rear ............ Depth ............... 10. Date of Purch. ase .............. ./. ~..~..~. ....... Name <~f Former Owner . .-~/..~.~. ~ ....... 11. Zone or use district in which premises are situated .... .~. '. ........................................... 12. l~oes proposed construction violate any zvning law, .ordinance or regulati~m · 13. Name of Owner of premises . .~:.~:..w~ .......... Address .................... Phmqe No .......... Name of Architect .. Name .of Contractor ~.}~.~r~~iiiil;i" Address~. ............ Ph, one No ............ J' ~-~' PLOT DIAGRAM ~ ............ Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimension~ from pro.perry lines. Give st~'eet and block number ,~r description aceording to deed, and show street names and indicate whether interior ,or corner 1,or. STATt5 OF NEW YORK, ) S.S. COUNTY OF .............. ) ........ f~....~.~.: ~ ~. ........................ being duly sworn, ,deposes and says that he is the appli ....... (Name .o~[~ s'qgning application) cant above named. I~e is the .......................................................................... F.o~rC~_r~.. ~ ~ , (©ontraet.or, agent, corporate officer, etc.) of said owner .or ,owners, and is'el~/ly-authorize.d t.o perform or have performed the said work and to make an, fde this application; that all statements contained in this apphcati, on are true to the best of his knowledge an, belief; and that the w~rk will be performed in the mann er set fortlY in the application filed therewith. Sworn t.o before me this ........ t. ..z .... day of. !>,. '::. . . ...... ~ (Signture of applicant) ELIZABETH ANN NEVILLE NOTARY PUBLIC, St,~te of N~w Yor,k No 52.8125850, Suffo'k ~? Term Expires March 30, 0 ' DO0; I" 6G .ON P ~QP EE F2.1'¥. Dur~VEY E D LMILL. tAM ~'IF. ATNEI'21NE I-tEINS r OI;~1ENT TOWN'.~F 3, CONTOUrZ r2EFer2¢ TO ~E^~4 SE& LEVEL,