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HomeMy WebLinkAbout4396-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy I ,,ap ~o. ,~.~.t~.~.y... ~-~..0...~,:..,.ot ~o.. ~~ .~O..~.T... ~ .... conforms substantially to the Application for Build~g Permit heretofore filed ~ this office dated ........ ~ ~. ~..~..., 19 .~ ~. pursuit to which Building Permit No. dated ...... ~ ~.~ ~. ~.~ ..... , 19 ].~ was issued, ~d conforms to all of the requir~ ments of the applicable pro~sions of the law. The occupancy for which this certificate is issued is. ~.~ ~AT~. ~.~. C~.~.'. ~.~...~.~ .~.~).~.6.. ~9.~'~ The certificate is issued to ~1 ~ ~ ~ ~ ~.. ~C (owner, lessee or tenant) of the ~oresaid building. Suffolk Co~ty Department of Health Approval ~. ~.[. UNDErWRiTERS CE~TIFICATE No...~.O/.~ ~ .................................. ~OVSE NW~ER.../.~ ~ .... Str~t. CO~ ~.. ~/~ ?.~ ....................... FOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~-3~)~ ....... Date ............ Alagg, mt... 2.~ ·., 19~).. THIS CERTIFIES that the building located at , t~gt- ~. off. ~//e41 · 6. et. Street Map No. Amhb~.01~ · Block No ........... Lot No ..... Gl'ee~lpo~.t ... I~,Y. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~'~...~ ..... , 19~9.. pursuant to which Building Permit No..l~3~. dated ......... J~'..L~ ..... , 1969.., 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 .. P~.l~m$~ -9~ .falet. ly. d~ll~[[ ...................................... The certificate is issued to&~lexallder. 5eo~;t .&. W.~.fe .... ~®r8 .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Ma~,..$l~i· ~0.. try. R... '~'~.'1' '1~ ...... ..... .......... 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? 4396 Z Permission is hereby granted to: ~3~..&..Ja..m~l~%..~tt ................. .......... IJB6.....~.~..A.~ ......................................... .............. .~1~ t,l~m.~.... Jl.,,~.~ ............................... to ............ Itu~ld..~a~.. ~a~..lJat~..d~l~...ia~..ap ~w~..l~..~..~£..~l~&l~ ) at premises located at ............... pursuaJ~t to application dated ............................ ~.lll~J.....~ ............... , 19..~9., and approved by the Building Inspector. Fee $...l.(J~.(~J ......... Building Inspector $-9 SCHD SUFFOLK COUNTY DEPARTMENT OFHEALTH ~a~ 0=/4'-?O. TO WHOM IT MAY CONCERN: at __ ,The sene disposal facilities fo~ a structure 1.o~ted (Give dee~[ location) have been inspected by this department and found to be satisfactory. Distric~ Engineer District Engineer ~FORM ,NO. I TOWN OF SOUTHOLD BUILDING DI~ABTM~.NT TOWN CL3;RW"S OFFICE SOU'~'~tOLD, N. Y. isapp oved.a . ............... ... ..... [ u~ d~g APPLICATION FOR BUILDING PERMIT Date .................. INSTRU~.-riONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Pl~t plan showing location of lot and of buildings' o n premises, relatignship to adjoining pr~mises or public streets o~ a~eas, and giving a detailed description of lay out of property must be drawn on the diagrm~ 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 Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspect.io~ throughout the progress of the work. e. No building shall be occupied or used in whole c~I in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspectce. APPLICATION IS I-~-~.~Y MADE to the Building Department for the issuance of a Building perniit pursuant to the Building Z~ne Ordinance of the Town of Southold, Suffolk Oounty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo- wi_th.,alJ~applicable laws, ~flinances, building code, lition, as herein described. The applicant agrees to com housing cede, arid regulations. · ' t (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................................................................................. Name of owner of premises ,t~...ff~..t~A~..~ ..~. ....................................... If applicant is a corporate, signature of duly authorize d officer. (Name and title of corporate officer) ~--,~-~,0~_~ 1. ~a~n of l~d ~ which p~ work will b e done· ~.~ N~ ................. ~t No .............. ~.~/~/~..~ ~ ~ ~. ~¢~<~ .............. Strut and Num ...... / Municm~tv 2. State exist~g u~ and ~p~cy ~ premiss ~ d intend~ ~e ~ ~p~ of pm~ ~lon. a. ~ist~g use a~~ .~.~ ........ · .................................................. ,. ~.~~~. z.~..~.~ ...... ~ ............................... 3. Nature of work (check which applicable): New Building ........ Addition ........ Alteration ........ Repair ......... l~oval ........ Demolitfon ........ Other Work' (Describe) ...................... 4. Estimated C~st~,-/4"~'~' .~.... i.. i ...... Fee .... i~ '~ '1~ '~1~ '~ii~' ~ '~ii~i~i ....... 5. If dwelling, number of dwelling units .......... Number of dwelling units on each floor .............. If garage, number of cars ............................................................. ~ ............. 6. If busine~S, commercial or mixed occupancy, specify na. ture 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 al~eratk}ns.0I' additions: Front .............. Rear ............... Depth ................ Height ................ Number of Stories ..................... ~ t · ...~.-?./. ...... Depth ~...~. ....... 8. Dimensions of entire new construction: Front .... ~ ....... Rear He~gh~ . ../o~. ..... Number of S~ries ........ ; ....................... .~ ........ :/ .................. 9. Size of l~t: Front . ./...~0. ....... R.ear :::./:~..o. ..... Depth ~.. 10. Date of Purchase ~/~...~P. f.,~../. ~. ,.~.''- ......... Name of"Former Own~..~.~. '~"..~.~??..~....,~...~..r .... 11. Zone or use district in which premised'are situated..~..~. ............................................. 12. Does proposed con~amctiolLyioli~e~l~.~zo~ng law' °rdinance °r regulati!~'~"~'""/~~_//~/~z. .............. 13. Nanle of Owner.of premlses~-/~g~,.~ .~¢o.Z]~'. A~ldres~zo..~.~.:~.c7..~ .......... Name of Architect ............ .~. ............... .~ddress ......... ~. ............ Phone No.. ff. ........ Name of Contractor .......... .a ..... ~.. ........... Address ........ ? ............. Phone No...e: ........ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property line6. Give street and block number or description according to deed, and show 'street n~znes and STATE OF NEI/7 YOI:LK, )S.S. COUNTY · .~.~~... ~. being duly sworn, deposes and says that he is the appli- (Name of individual signing !tl~cation) cant above named. He is the ..... ~..~J~t~..o'-. ~.-~. (Clontractor, agent, corporate officer, etC.) of said owner or ~wners 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 best of his knowledge and belief; .and th'at the work will be performed in the mann er set fortli in the application filed therewith. Sworn to before me this (~gntuPe of applicant) ,:~CO ; ,'7"