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HomeMy WebLinkAbout4195-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY No..~.....3...~.~..6. ............. Date ................... Ma~, ......... 2, ............... , 196.SL.. THIS CERTIFIES that the building located at ..G~,~,cJ:i,D,e~'J~,.:ballet~ ................................. Street Map No....3...3..8..~. .......... Block No ....................... Lot No..1 ....... S.ol~.~,jlc:~l.~l.,...lee~...y~~. ............... Fairvie~ Pa~k conform~ substantially to the Application for Building Permit heretofore filed in this office dated ...................... k~.~..~.~.. ............ .5.~ ............... , 19..6..~... pursuant to which Building Permit No. daced ............ .~.~.q..~ ............ .5..., .............. , t9...6..~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .... .p~..t..v..~ ~..e....o...n..e.... ~..m...t..Z. ~.....~....e..Z...Z..t...n.~ .......................................................................................... The certificate is issued to .......~.~.~..J~.~,~. ....................................................................................... (owner, lessee or tenant) of the aforesa.id building. ~ouse ~ 305 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? 4195 Z Permission is hereby granted to: .f~e~.~..~e~.~.....~/~..~T~m..2~pp ........... ............... ~ f~,c~."L~ ............................................. to ........ ~,~.~lct...~...~,~,,lit:Le~...o~..a~x..~,,~;~xg...~t~t~.~ ............................................... ot premises located at ......... ...~...~..~..../. ......... .~-.e'-*~.~-~..~-~-..~i'..~.~.~ ...................................................... ............................................. .Qe~z~d:tz.,e.~,~...~..&..Ct~..A~e ...................................................... ................................................ ~o~th~d. ...... ~.~., ............................................................................ pursuan.t to opplicotJon dated .......................... ~i~,~ ........ ~. ................ , 19~.., and approved by the Building Inspector. Fee $.....,,~.,,.QO ......... Building InspectoI IFORM ,NO. TOWN OF SOUTHOLD BUILDING DEI~ARTMENT TOWN, CL~'RI('S OFFICE SOUTHOLD. N. Y. Examined .... ~.a~..~. ....19.. ¢ Approved ........... ~.(. .......19..'.~. Permit No.. ]/. ~...7.J~. '.~. ..... Application No... W Disapp~,oved a/c .................................................... .............. : r:~7 .~.~. ~ .............................................. APPLICATI(1N FOIl IIUILDING P~IlMIT Date ....... .... INSTRUCTIONS a. This application must be completely filled in by typewriter or ]n ink and ,submitted in duplicate to the Building Inspecf0rrr. b. Pl. ot plan showing location of ~*t and :o{ buildings o n premises, relationship ~o adjoining premises or public streets ~m' areas, .and giving a detailed description of layout of property must be drawn ,on the diagram which is part of this application. c. The work covered by this applicatkm may not b e commenced before issu.ance of Building Permit. .d. Upon approval ,of this applicati,m~, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept ~n the premises available for inspection throughout the progress ,of the w, ork. e. N,o building shall be occupied or used in whole o~ in p~rt for any purpose whatever until a Certificate ~*f Occupancy shall have been granted by the Building Inspec3~r. APPLICATION IS HEREJ3Y MADE to the Building Department for the issuance of a Building Permit pursuant ~o the Building Zone Ordinance or the ~own of Soathold, Suffolk ©~mnty, New Y,~rk, and other applicable Laws, Ordinances .or Regulati,ons, for the construction .~f build trigs, ad,dittoes or alterations, ,m' f, or removal or demo- litton, as herein described. The applicant agrees t,o cam ply with all applicable laws, (ordinances, building code, h.ousing code, an,d regulati.ons. (Signature .of applicant, or~gne if a corporation) · .... (Address of applicant) State whether applicant is owner, lessee, agent, architecf, engineer, general contract.~r, electrician, plumber or builder ........... :, .~..Z~';<' .~. ~..~/.~-. ........................................................................ Name ,of ,owner of premises ....... ..~..~.~..~/./. ..................................................... If applicant is a corporate, signature of duly authorize d .qfficer. (Name and title of corporate officer) 1. Location ~of land o.n which propased w,ork will be done. Map No ................. Lot No .............. Street and Number... ~.~..~..~../.~..<~.4....~..~./?.~. ~ ..... J;~ ~r//~/. ~'.~'- .................. ~ / - ~,~ ~5 Municipality 2. ,State existing use and ,~ccupancy ~of premises and intended use and ,occupancy of p~,osed const~ction. a. ~xisting use and occupancy ....... ~/~C ~ ~ ............................................ l/ b. Intended use and oc~pancy ................................................................... / 3. Nature of xvork (check which applicable): New Building ........ Additi,on . ~.. .... Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Co.st .'~.~ ~2.~2 ~ .................... Fee ................................................. (to be paid qn filing this application) 5. If ,dwelling, number of dwelling units .... ./ ..... Number .of dwelling units on each floor ..../ .......... If garage, number ,o{ cars .......................................................................... 6. If busine.ss, commexcial ,~r mixed occupancy, specify nature and extent ~)f each type of use .............. 7. Dimensions of existing structures, if any Front . ...~....~. ..... Rear .fr/~.'~f. ..... Depth ,~F.~/. ...... Height .... /.'-~.. f ...... Number of Stories . .~;)~4~..~- ............................................... Dimension.s ,of same structure with alterati,ons or additions: Fr. ont ....~.?~. ....... Rear . .~..~. ...... Depth . ...~..~. f. ....... Height . .../..~.. ~. ....... Number of S~eries ...~?...~..~Z .......... 8. Dimensions ~of entire new construction: F~nt ................. Rear .............. Depth ............ Height ............ Number ,~f Stories ............................................................. 9. Size of I~ot: Front ../...~,~.%~.~. f .... Rear .../.'.~.~-~ f ..... Depth .~/.~.¢~...z ..... 10. Date of Purch.ase ............................... Name qf Former Owner ............................. 11. Zone .or use district in which premises are situated .................................................... 12. Does proposed con,stxuction violate any~,z,~ning law, ,ordinance or regulati,~n? .................. . ......... 13. Name .of Owner,of premises .~.~./~...~....~..e~./.~.... A, ddre~s .~.~ ~-~<~.,~.~ Ph,~ne No.7~..-. Name of Architect ............................ A'ddress ...................... Phone No ........... - Name .of Contractor . .6~.~'~.~.~-..~. ~...~.~.y... Address . .~. ~.~..,~-,,f~../~.... Phone No.~.~Z.. ~/0~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensi,ons from prg.perty lines. Give street and block number .~r de scripti, on according to deed, and sh.ow street names and indicate wheiher interior ,or corner 1,et. STAT* OF NC-U4 ¥9R19 )S.S. ..................... being duly sworn, ,deposes and says that he is the appli- (N~-rne-~f individu.al signing a_pplicatiol~=~ cant above named. He is the .... /f..~.~,,,~.,~ . ,~:.-,,...~.'~ ............................................ (©ontractor, agent, o~rpoxate .officer, etc.) of said owner ,ox ,owners, and i.s duly autherized 6o perf.~rm o1' have perf, ormed the said w, ark and to, make and file this fipplicati.on; that all statements contained in this applieati,on axe true to the best of his knowledge and belief; and that the ~rk will be perf~)rmed in the mann er set forth! in the application filed therewith. Sworn to before me this NOTARY PUBLIC, State o~ New York No 52-8125850, Suffolk ~ Term Expires March 30,