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HomeMy WebLinkAbout4242-zFO~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at ~,~alie~ .l~l. & .Ca~$1~- - .DS* Street Map N~t;.l.S~;~... Block No.. ~: ...... Lot No.]6. .... ~t~;i~k. · .N,Y, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~i]....] ~., 19 ~9. pursuant to which Building Permit No.. ~,2. ~ dated ......... ~X,l~l'' '~" ', 19.6~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . 'P'~i~/a~;~' 'O~®' i~z~il7 '~W~ '~ing ...................................... The certificate is issued to . .~? ~lVilx 'lt~nZO~ (owner,O~es~see or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~,~. ~ .. ]~. · by .R,..~$].l& ...... .... ...... Building Inspector FOP~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERN~I'T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~3~2 Z Permission is hereby granted to: ............... A,..~el.vl~.~.e~ ......................... ............. ~,e~.....~ ................................................ .................... ~.t,t~.'~u,~ .......... ~.~,.-, ................... to ............... ~u~..~w..-o~:~...~;~.~..~,'~ll~g. .................................................................... · ~ at premises located at .......... ~ot~.....].~ ....... ~J~.~.T¢~,.~)~C~q.....~.~.~.~.~ ................................................. .. ~-~....o°.~,5....~.r.d.~.~.~L.2).r.,i~.e~. . pursuon¢ to application dated ........................... ~l**~:]k ........ ~J'~ ......... , 19.~¢).., and approved by the Building Inspector. Fee $.....10,~t0 ........ Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit'S. / TO WHOM IT MAY CONCERN: at The sewage disposal facilities for (Give ~deed location a structure located have been inspected by this department and found to be satisfactory. D[strio~ ~ngineer District Engineer ~FORM ,NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CI~ERK'S OFFICE SOUTHOLD. N. Y. Disapproved a/c · .... Application No. ~;.~ .gT/..~ .~.. APPLICATIO,~ FOR BUILDI~IG P~RMIT INSTRUCTION.S a. This application must be completely filled in by type~vriter or in ink and submitted in duplicate to the Building Inspec~0er. b. Plot plan showing 1.ocation of R~t and of buildings o n premises, relati,onship ~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 applicath~n may ~ot be commenced before issu.ance of Building Permit· .d. Upon approval ,of this applicati,3n, 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 work. e. 1~o building shall be occupied or used in whole o~ in part ~or any purgose whatever until a Certificate ~of Occupancy shall b~ave been granIed by the Building Inspector. APPLICATION IS HEREBY MAI~E to the Building Department fo~' the issuance of a Buil,ding Permit pursuant ~o the Building Zone Ordinance of the Town of S,*athold', Suffolk ©ounty, New ~*rk, and o~ther applicable Laws, Ordinances ,or Regulati,ons, for the construction .of buildings, additions m' alterations, or ~or removal or demo- lition, as herein described. The applicant agrees ?ye com ply with all applicable laws, ordirmnces, building code, housing code, and regulati~ons. · ....... (Signature .of .apphcant, or name ff a corporaB. ) .. (Address of applicantY State whether applicant is Q~wner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ......................................................................................... Name ~of .owner of premises ...... ~.~.~.,. - -'~ - ~. u- ' If applicant is a corporate, signature of duly authorized ,officer. (Name and title of corporate officer) 1. Location r0f land o'n which prop.o.sed work will be done. Map No..//.~. ff.~. ...... Lot No....//.~.. ...... Municipality 2. State existing use and .occupancy of premises an d in'tended use and .occupancy of proposed construction. a. Existing use and occupancy ...../~..~..~../.~..~./..~....../,..o. ~.~.. ..................................... b. Intended nsc .an,d occupancy ........ /.~/.q~..~.ZY.~ ................................................ / ~d 3. Nature of w.ork (check which applicable): .New Building ... dirt,on ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. F-stimated Co.st ..... ~.~,(.~.~..~..~. (,..0 ........ Fee ................................................. (to be paid ~n filing this application) 5. ff qweiling, number ,of dwelling units . .~.4/4-~ .... Number ,of dwelling units on each floor .............. If garage, number .of cars .......................................................................... 6. 'fl business, co,mme~cial ,~r mixed occupancy, specify nature and extent of each type of use .............. 7. Dimensl,ons of existing strttctures, if any: Fro,nt .............. Rear ............. Depth ............. iEIeight ................ Number of Stories ........................................................ Dimensions ,of same structure with alterations or additions: F~ont .............. Rear ............... Depth ................ Height ................ Number of Stoeies ....................... 8. Dimensions of entire new construct,o.n: Front .~ 2~-.. ........ Rear ...~. ~. ....... Depth .~. ...... ~.. iEIeight ../. ~.~: .... Number .o~f S~ories ..... .~.~'zz ................................................... 9. Size of ~o¢: Front ../~.~.( ...... Rear ../~..~.~. ..... Depth . .~. ~.~. ~ ..... 2-.. 10. :Date of Purchase . ././/.~.~...~ :'. ............ Name <~f Former Owner ./-'.'? 11. Zone ,or use district in which premises are situated .................................................... ~2. Does proposed con,struction violate any ~ning law, ordinance or regulation? ........ /Y.~. ................ 33. Name ,of Owner.o.f premises/Y,e~,/~./..iz2/.~[~.u~.. A, ddress ./3.e.y.]~:/./.'~/4~.5/?c,q'.4'g/~'h,(~ne No. ~.~.~...~.2. Name of Architect /~lflf../~ ~ c~d~..l'/.~..~ ........ 2~ddre~s Y/2 ~/e'//'.,F .... ,f../,./ ....Ph,3ne No. ~.~.~..-./.~.J. Name .of Contractor ............................ Address ...................... Ph,(me No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing ,or 'proposed, and indicate all set-back dimensions from pr~,perty lines. Give street and block number ,~r descripti,on according to deed, and show street names .and indicate whe(her interior ~or corner l. ot. ,Lo,/" Z STA]q~ OF NEW YORK, )S.S. COUNTY OF ~2. .~:,?. %,//~ ..... ) .... ~-[... 2.~.. ..:.:~..~.~.'?.-..z~..: ............. being (Name ,~f individual signing applicati, on) duly sworn, ,deposes and says that he is the appli- cant above named. He is the ............................................................................ (Contractor, agect, em~poeate .officer, etc.) of said owner ,or ,owners, and is duly authorized to perfi~rm or have per~armed the said w,ovk and to, make and file th~s application; that all statements contained in this application are true to the best of his knowledge and belief; .and that the w~rk will be per~rmed in the mann er set forth! in the application filed therewith. Sworn to before me this (Signture of applicant) ELIZABETit ANN NEVIILI~ NOTARY pUBLIC, state of New York No. 52-8125850, Suffolk Cou~.ty ]crm ~xpires Ma~ch 80,