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HomeMy WebLinkAbout4199-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi[icate O[ Occupancy THIS CERTIFIES that the building located at . ]~/tS.. Ma$~. ~ ......... Street Map No... ~ ....... Block No..~ ...... Lot No..w,~ .... Ma.~,t~tuM[.. lq..I, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~a~' ..... lC- ·., 19. ~:;~ pursuant to which Building Permit No..t~l~)~.. dated ........... Ma~... 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 . .P.~.J,¥.a.t.e...o.a.e..~..a.~.y..~.~.~..~.~.~'. ,J~ ...................................... The certificate is issued to .. AnYone. ${~.le.~l~a ............ 0~w, er ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... ~I,R. ......................... i~ou~e ~ l(~tl'~ Building Inspector ~ FORM NO. 2 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? 199 Z Permission is hereby granted to: to pursuan¢ to application dated ID /~¢/¢ /~' 19,..~.C.?. and approved by the Building Inspector. Fee $....~ ................... Building Inspector ~F,ORM ,NO, I TOWN OF SOUTHOLD BUILDING DI~-PART~F.~T TOWN CL~RK'S OFFIC~ SOUTHOLD. N. Y. Examined ........ ./..~...~...~..., 19 .... ~ ~ Approved ......... ?..~...~..~..., 19 ?.~. Permit No..~../.~..~.. ~ .... Disapproved a/c .................. ~,,~ .......................... (Building Inspeet~) APPLICATI(~N FOR BUILDING PERMIT Date ................... /..~...../~...~..~... 1O..~. INSTRUCI'iONS a. This application must be completely filled in by typewriter or in ink and ,submitted in duplicate to the Building Inspector. b. Pl, ot i~lan showing location of l(~t and .of buildings o n premises, relationship to adjoining premises or public streets or areas, .and giving a detailed descripti.on of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may n~t b e commenced before issuance of Building Permit. d. Upon approval of this applicati<m, the Building In specter will issue a Building Permit to the applicant. Such permit 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS I-I~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S~athold, Suff~oIk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction ~f build ings, additi(ms or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all .applicable laws, ordinances, building code, h.mising code, a~d regulations. ...... (S~gnatu~e ~,f applicant, or name ff a corporation) (Address of applieant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber er builder ~ ~ .Y~ e ~'~ Name ,of ~wner of premises ............................................................................. If applicant is a oorporate, signature of duly authorize d c~ffleer. (Name and title of corporate officer) 1. Location of land on which proposed work will b e done. Map No ................. Lot No .............. Street and Number ..~. [...Z'~-....]..~..~..~..~/.....~]..~../../~. .... .~..0.~...~. ...........~?.~., .-~...[. ~ .~...C..~... Municipality 2. State existing use and occupancy ~f premises an d intended use and occupancy of proposed construction. a. Existing use and occupancy ........... /..../~..~. ~ !..1.~....~. ...... . .'~...~...~./...~..~.~.. ~.~-. ......... b. Intended use .and occupancy .~/q P4 ~ ~/ tT/"t ~.b.1.)l"l'-I fl ~ 3. Nature of work (check which applicable): New Building ........ Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ O];her Work (Describe) ...................... 4. Estimated ©ost .... ~,~./)0 _T-- Fee ff' ~. ................ (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: F~nt ...... .~....~... Rear ...~....5.~. .... Depth . Height ...... .~..o.'.? ....Number of Stories ....... ~ ............................................ Dimensions ,of same structure with alterations or additions: Front 3 ~ Rear . .~..5.'~.. Depth ...... ?'../. ......Height ........ ./..-:~. .... Number of S/~des ..... .~...'~..~.'~ ........ 8. Dimensions of entire new construction: Front ................. Rear .............. Depth ............ Height ............ Number, of Stories ............................................................ 9. Size of iot: Front ....... .~.?. [ .... Rear .... ?..~../. ..... Depth ........ .~..~..~..' 10. Date of Purch,ase ~7Y~c7'- /~/A~ .~.,Name of Former Owner ~C/DI~.~. /'~o~/ ~-~ ............................................. 11. Zone o~ use district in which premises are situated ......... ?..' ........................................ 12. Does proposed construction violate any ze~ning law, ordinance or regulatkm? ...... ~.o. ................ 13. Name of Owner.of premises....~....P~./.~../77.~. (.~.~... A, ddress .Af.~../~?.~/...,~.~?-....~.~.9~f~ne No. Name of A~ehiteet ............................. ~ddress ...................... Phone No ............ Name ,of ~on~rac~or ............... -~.~P.~-~, .... Address ...................... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or .proposed, and indicate all set-back dimensions from property lines. Give s~eet and block number or de scription according to deed and show street names and indicate whether interior or corner lot. STATIg OF COUNTY OF .............. ) (Name of individual signing application) a ove named. He is the ...................... ......................................... (Oontraetor, agent, cx.,~-t.~orate officer, ete.) of ~ald owner or owne~, and is duly authorized to perf<~rm or have pe~ormed the maid w~k and to make and file th~s application; that all statements oontalned in this application are true to the best of hi~ knowledge and belief; .and that the w~k will be performed in the mann er set fortl~ in tho application filed therewith. Sworn to before me this .......... of ...... N~t ary Public, .................... (,~unty (Signture of applicant) ' ~ ~'~LIZABETH ANN NEVILLE ~{OTAR¥ PUBLIC, ~ate of Ngw Yo~