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HomeMy WebLinkAbout4294-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..F~29~ .... Date ............... J~...~6...., 19~.~.. THIS CERTIFIES that the building located at .... O&~l~er8 · I~ ......... Street Map No. F&-i. lWl~. PkBl°ck No ........... Lot No...~ ...... M~ltlaOl&.. · I~,¥, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~4~ .... 16 ...., 19.69 pursuant to which Building Permit No.. dated .......... l~lr'' 'l&' "" 19. f~), 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 .... l~te' ~®' f~ly '~l~e~'l:l.n[ .................................... The certificate is issued to . J~ · 8p~i~a~'$~ ..... 0~t' ........................ :. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ,~l~'~l' ' ~8. ~7(}' · bT .I~..V~Li~ .- - ! ........... ........ B'~din~ i~l~r' FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4294 Permission is hereby granted to: "/) "~ I ~' ' ¢~ ' ............. ?../.~ ...... ~ ......... .cj........c...c~ ...... ............... ............. ~.y,.,.,~.~.~- -- ....... .~.,,~z~. .......................................... to ot premises l~ted ot ............... ] ......... ; ...... ~ .............................. ,, ............................... ~ ......... ; ..................................... ~~~ ................................................ ..... .~..~.~....~....2.~..~...~..~.~:. ..................................................................... Building Inspector. ~.. ~...../.~.~. .... Building Inspector TOWN OF SOtrI-~'IOLD ,~?,/.-f~ {-~/~,~.~d' ~ BUILDING ~AR~T' :' c rs ~ 7 SO--OLD, N. Y. Application No, ./~, .- 'ned ................ g .... 19.~; -/.~--~"~U ~ '/~]71 ~'~% ~ ~ ....... ................... .... ......... ....................... ....... ~S~U~O~$ a. This applieat~n must be e~mpletely fill~ in by tTpe~iter or in ~k and ~ubmi~ in duplicate Building Inspect. b. P}~ plan showing location of 1~ and ~ buildings o n prem[s~, relati~ip ~ a~oin~ng p~mi~ s~ets ~ m~, ,~d givlng a d~led description of lay out of P~OP~7 must bo drawn on the d~8~m wh~ pa~ of thi~ appl~eati~n. e. ~o work ~ve~ by ~ applieat[~ ma7 ~ be commenced befo~ ~ssu.nee of ~ild~n~ Pemit. d. U~ ap~v~ of ~[s applieat[~, the Build[n~ Inspee~r will ~sue a Buil~ Pm~t ~ Su~ ~mlt sh~ ~ kept ~ ~e p~mi~s available for ins~cfi~ throug~ut ~e pm~ of ~e work. e. No building sh~l be occupied or us~ in whole o~ ~ p~ ~ ~y pu~e whateve~ until a Oc~cy ~ ~ve b~n gr~t~ by the Building ~sp~. ~ICA~ON IS ~.~Y M~E to ~e Building D ep~tment f~ the issuan~ 0f a Building P~it pu~uant to the ~ilding ~ne O~in~ of the ~wn of ~athold, S~folk ~nty, New Y~k, ~d o~er a~H~ble La~, Ord~nces or ~lat~ons, for the ~ion ~ build ings, ad~iti~s ~ alt~ations, ~ f~ ~v~ or dem~ lition, as h~in des~d. The applicant agr~s ~ corn ply with all applicable ~, o~i~nces, building ~sing c~e, ~ regulat}ons. ................... ~ a~plic~t~ or nme ff a (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber builder ....................................................................................... Name ,of ,owner of premises .............. ~(~ .... I . ~ .~ l .~ ................................ If applicant is a corporate, signature of duly authorize d ,~fficer. (Name and title of corporate officer) 1. Location of land on which proposed work will b e doue. Map No .... ,-~.~.~.~. .... Lo~ No....~....~.. .... Street and Numar ........ ~]~i~it~ ................... J2. State.existing use and occup~cy of premiss ~d iniend~ use ~d oc~p~cy of p~ed ~eti0n. Existing use and occupancy Intended use .and oceupalley / 3. Nature of work (check which applicable): New Building . ~ Addition Alteration Repair ......... Removal,~,__ ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost .... .-~.~ .4~..~ .................. Fee ................................................. (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 each type of use 7. Dimensions of existing structures, if any: Front .............. Rear ............. Depth ............. Height ................ Number of ~Stories ......................... ~ .............................. Dimensions of same structure with alterations or additions: Front .............. Reax ............... Depth ................ Height ................ Number of Stories 8. Dimensions ~of entire new construction: F~wat ....~'..4/..¢..~ ..... Rear .'.'.'~.~!~./ 'I~ ,.'.'.' . ,/ Height............--~-- ...... Numbe~--of Stories .... ' / ' 9. Size of ~ot: F~o~t ...].~.~,.0.~.... ~ Rear .... ]~ff.,,~... Depth .]~.~..~.~..O. .... 10. Date of Purchase ....~ .~....~. ~..~.~.~q. ........ Name of Former Owner ...~.. mt..~.~.~.~.~t~ ....... 11. Zolie or use district in which premises are situated ......... ./~..~./.~..~'. ?.~..V~....~..~.~.~. ................. ' .... 12. Does proposed construction ~.la~e apy. ,2~min~ law, ordinance or regulation? .......................... i3. Name of Owner<ofp.re_,,mis_es.-....,.~..%~:k~ R ~.% .~'..~ddress . ~(~'.~__~..~.T...~.~ .~. Phone No./~.:~t~ Name of Architect: ~ ~.. ~l ~.'[.ff .~ ~.... ~ ~.~,. -~ddress . ~t~. ~,.~.'~o.~'~_%~ Plmone No ............ Name of Contractor .~..~l~{.j~%~. Address e~.~ ......................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali set-back dimensions from In. petty lines. Give s ~treet and block number or de scriptlon according to deed, and show street names and indicate whether interior or coener lot. <. · STATE OF NEW YORK, )S.S. q~ ~ L~- OF ............ ) aa4_ being duly swo~, ~e~s~ ~d ~ys ~at he is ~e appli. e~t a~ve n~ed. He is ~e ............................................................................ (~on~a~r, a~t, ~ate ~fi~r, etc.) of ~id own~ ~ owne~, and ~ duly auth~M ~ p~rm er have perm me ~id ~k file ~ application; ~at ~ statemen~'~ntalnM in ~is applicatDn belief; and ~.at ~e ~k will be p~ in ~e manner set fo~ ~ ~e applicuti~ filed ~e~wi~. Sworn to ~fo~ me ................ .......... .... N~ ~blic, ~ff~--n ........ f ....... ~' '~ .....~ ...................... '~f~ I'_~ ~ :' '~'~n~, ~/ (Si~t~ of applic~t), ~ ~pires March ~, S-9 S~IFFOLK OO~NT~ DEPA~MENT OF HEALTH Bldg. Pen~.% No. 42~f Z__ TO ~0~ IT ~t~! The sewage disposal facilities for a structure located at (Oi~e deed location) hav~ been inspected by this Depar~aent and found to be satisfactory. Dlstriot ~El~eer Distrio% Eng~ee~ FOR REVERSAL of the house design, th~se plans are reprinted (in reverse) on the back of each page. To fadlltate use of the reverse plan, take the main dimensions from the front of each. sheet / ,221.0" / / 4zL Z." J ~OLO'1 II .[ ~EE~E::EDOM J IFLOOI . Pt_Arq DRAWN BV~'[~'T'y~ ~'r~ APPROVED BY ~ UNEX, IILo" 4 qL 4" LJN~X · sL 4" I ILG'" rolo~ .AI~..AVqALL~ .AI2~. OAt.V, /W~TAL, PLAM DRAWN BY;~'~'''~ 7'~/-~'J~ '1 APPROVED BY ciesign number Ish~no. ;t ,I .1::2. ~A I:2--.. I DRAWN BY ~'~ APPROVED BY I- ,I LEFT SlOE -00,~ MC.C.. EL. EVATIONS~ GF_.CTI©bJ DRAWN BY APPROVED BY /~., design number Isheet no.I 4 PLL.JMDING DIAGRAM L DETAIL _"-----:Li DETAI L~ IDRAWN BY ~"' A¢~ '~///.~'~ APPROVED BY ~