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HomeMy WebLinkAbout4226-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE: OF OCCUPANCY No.....~.....3..4..?..4. .......... Date ................. JJ~!l~'. .............. g., ............. , 19~.~J... THIS CERTIFIES that the building located at ....... ~.~.~..:~JII.~..W~Y .................................. Street Map No....2...]:.4..~ .......... Block No ....................... Lot No....4~, ....... .8.~.~..t~...~..~...~...q~.....~.O.~..Jl[ ............. 8out~oo~ conform~ substantially to the Application for Building Permit heretofore filed in this office dated ...................... ?..e...~..~...~..~..J'.,~. ......... ..~..4 .......... , 19..~...~... pursuant to which Building Permit No...4..2...2..~.....~.. dated .............. .~'..J~'....~.-~.. .............. .4.~ ......... , 19...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 ........ .......... ~.~..t..v..~.e....g..a.~..a.g.e..... ( .~ .e...e..e..e.e..q~.y...~.~ ~ 1.~,~tng.) ................................................................... The certificate is issued to ........~...~...e~........~.:~..~.~.~ .............................................................................. (owner, lessee or tenant) of the aforesaid building. Building Ir~pector 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) 4226 Z Permission is hereby granted to: .......... G~X4 ~..~;h.. ~d~..A~t¢..&~e~E.. lllllfllE. at premises located at .............. ~'~'""i]01~¥*o01], ............................................................................... ............................. ~.. .~.'D .......... llee4.. ®nd...v~y .........~a%~m.3A ............................................... pursuan.t to application dated .......................... ~.~ ......... .1 ............... , 19...~9, and approved by the Building Inspector. Fee $....~[.,00 ........... . ~ v Building '-I'hspector ~ rFORM ,NO. I . ~ TOWN OF SOUTHOLD BUILDING D~PAR~T TOWN CL~RK'S OFFIC~ SOUTHOLD, N, Y. Approved ~ ., 19 '~ Permit No .~. ~- ~- ~ ~'- Disapproved a/e ...... ....~,.--r~r~"'"~.. APPLICATIQN FOR BUILDING P~BMIT Application No...~./...~f. -~- .~. ..... INSTRU(Ji'iONS a. This application must be completely filled in by typewriter or in ink and .submitted in duplicate to the Building Inspec'~w. b. Plot plan showing location of l~t and o~ buildings o n premises, relative,hip ~o adjoining premises or public streets ~r 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 application may not b e commenced before issuance of Building Permit. d. Ulx~n aplyroval of this application, the Building In spector will issue a Building Permit to the applicant· Such permit shall be kept ~n the premises available for inspectic~n throughout the progress of the work. e. No building shall be occupied or used in whole on in part f~r any purpose whatever until a Certificate .~f Occupancy shall have been granted by the Building Inspeglgpr. APPLICATION IS l-kl!~-~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, Suffolk C~unty, New Y~rk, and other applicable Laws, Ordinances or Regulations, for the construction ~f build ings, additions ov alteeations, or for removal or demo- lition, as herein desCribed. The applicant agkees to corn ply with all applicable laws, ordinances, building eode, h.wasing code, arid regulations. . ................ · '~' (Signatuee of applicant, or name if a corporation) ~ ~ ] (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pinmber or builder . .~. p.q?.~.~.A-o~ ................................................................................ Name ,of ,owner of premises ...~k~-~ ..... .~-Y~I).t~ ......... ~. 0 g ] ~ N PA .............. If applic~t is a earporate, signature of ~uly authorize d ~ficer. ......,, ......... ~ame ~d title of cor~ate off' ) i. L~ation of 1and on which pried work will b e dohe. .' ............. ~t No ........... II ... 2. S~te existing use and ~cupancy of premi~ ~ d intend~ ~e ~d oc~p~cy of p~ ~t~ction. a. ~isting use and ~cup~cy ..... ~0~ ........................................................ ' b. ln~ded ~ and ~c~p,~c~ ...... ~ ............. ~.~ .~ ............................. 3. Nature of work (check which applicable): New Building ........ Addition ........ Alteration ..... ~.. Repair ......... Removal ........ Demolition ........ Other Work (Describe) .~.t~C_~T. .......... 4. Estimated ©est .... .~. ~T.~O..o__° .............. Fee~.ff,.,.o.o. .......................................... (to be paid on filing this application) 5. If ,dwelling, number of dwelling units .......... Number of dwelling unit~ on each floor .............. If garage, number of cars .......................................................................... 6. If business, commercial or mixed occupancy, spec fly nature and extent of each type of use'. ............. 7. Dimensions of existing structures, ff any: Fro~t .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front .............. Rear ............... Depth ................ Height ................ Number of S/~des ..................... 8. Dimensions of entire new construction: Frcmt ..... .2..~ ........ Rear .....z:~.; ....... Depth ..~.-~! ....... Height ... [G..~/:~ ... Number of Stories ...... 9. Size of iot: Front ................ Rear .... ~ ~ ......... Depth ............... 10. Date of Purchase ............................... Name of Former Owner ............................. 11. Zone or use district in which premises are situated..~ ~i;~-~ ~(. ................................... 12. Does proposed construction violate any zoning law, ordinance or regulatkm? . p0..,. ..................... 13. Name of. Owner-of premises ~... ~..c~..~.~bl. 19~'~ ..... -~ddress . .~...o~q~... ~t/OtSO. .......Phone No ............ Name of Architect ............................. -~ddress ...................... Phone No ............ Name of Contractor ~m~.o~m~....~U~-. Ca~-~. Address . .~O'~D .,N:~,... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or descriptk)n according to deed, and show street names and indicate whether interior ,or co~ner lot. STATE OF NEW YORK, )S.S. COUNTY OF .............. ) ..... ~t.~'g.~... ~-_ .... ~c~3:;~m t~ ............. being duly sworn, ~lepos~ 'and saYS that he is the appli- (Name of ir/dividual signing application) cant above named. He is the . .C~ ~.. O.~. ............................. ' ................... (Oontractor, agent, eo~,perate officer, etc.) of said owner/rc owners,~ and'i~ duly autl~ori~ed to per~o, rra Or have per,Craned the~said work and to make and file thi~ application; that all statements contained in th iS' application are true to the best of his knowledge and belief; .and that the work will be p~ed in the mann er set fort2/in the application filed therewith. Sworn to before me this N~rtary Public, ... ~ ..... County . (Signture of applicant) ELIZABETH ~%NN NI~ILLE NOTARY PUBLI~, ~tate of New York No. 52-8125850, Suffolk ~erm ~pires Ma~h 30,