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HomeMy WebLinkAbout3461-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE nF nP.I~.UPANCY THIS CERTIFIES that the building located at .I~./S...1~..~.V~..t.e..R~...1~. ........ Street Map No. ~,!.~*~,. mock ~o ............. Lot No. ~ ..... ~r~. l.~ ........ conforms substan~4ally to the Application for Building Permit heretofore filed in this office dated ......... l}*~..~. , 19.6~. p~suant to which Building. Permit No..~ .~ dated .......... ~ .... g .... ,1~.., 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 ~_~g .po~.~i~. e~ . ~r. ~[. ~8e.,. ~te~. ~ .&. aeey . ~ ~ ~bb~s The certificate is ~sued to ..................................... ~ (owner, lessee or tenant) of the aforesaid b~lding. Suffolk Coun[y Department of Health Approv~ . N.~f ............................. Building Inspector ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UN~'IL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3461 z Permission is hereby granted to: ..... ~ ' ..... ! , .!~..~.,e...~, · ~.~ ~.,..e.~,~ ~. ~..~ ........... ~....~..~ .................. ~ .......... .................... , ............. ,~, ........................... ~ ........ ,o ..~..~t..m...~.~i..~...:,~..~.~ ........................................... pursuan¢ to application d~ed ~. ..~ ,~ ~.]~.'.:.~, 1~..., and approv~ by the Building Inspector_ d TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permtt No ...... ~.~......~...... Application No...~ ...... /. ....... APPLIGATION FOR BUILDING PERMIT INSTRUCTIONS Q, This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building inspector. b, Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust be drawn on the diagram 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 o Building Permi,t 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 Ear any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. Ao John Ga~a Drawer B, Fishers Island, New York (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... .~.el~m~.~...~,~.~g.to~ ................................................................................................................................ Nome of owner of premises ~o~].t~m~,..,IT~J~Lrl~. ................................................................. ~ ................................... ~ .......... If applicant is ~ corporate, signature of duly authorized officer. iN, me and ~itle o~ corporate officer) 1. Location o¢ land on which proposed work will be done. Map No: ............................................ Lot No: .................... Stre~ and Number ....... ~..~.~ .......................................................................................................................... Municipality 2. State existing use and occupancy of premises end intended use and occupancy o~ proposed construction: Existing use end occupancy ................................................................................................................................... Intended use and occupancy ................................................................................................................................. 3. Nature of work (check which appucuu,=,. ,~ ......... - Repair ................... Removal .................... Demolition .................... Other Work (Desch~ 4, Estirnated Cost . ..0.0. ..................................... Fee ..,.~1~.~0 ....................................... (to be paid on filing this applic~, 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: Front .......................... Rear ..........................Depth ............................ Height ............................Number of Stories ............................................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ,.~.~,~...,~.?. ............ Rear ...J.82...D.." ........... Depth .~...0.¥ ................ Height ...[..~..,~1,~. ........... Number of Stories .,J, ........................ 9. Size of Jot: Front ............................ Rear ............................ Depth ................................ 10. Date of Purchase ........................................................Name of Former Owner ........................................................ J 1. Zone or use district in which premises ore situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ...................................................... ,~re ises l{Ot~l&ad ...J~.....J~.~i Address ~.~J3~6. ;[~l.J,~l. ....... Phone No...3.?.5 ........... 13. Name of Owner of ~. m ................................... Nome of Architect ...... ,..J~.....i~....~..~.....G,.~....C.,~...~.~. ............. Address ]~.~¢~,..l~.Q~l,13,t;.~...~,~:t1313,~. Phone No ..................... Nome of Contractor ....~...E~I~O...(3~ .................. Address ~.,t~lle~i...3;eS,~,~1%.~'. Phone No...~,~, ........... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ S.S. COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the (Contractor, agent, corporate officer, etc,) of said owner or owners and is duly authorized to perform or hove per~ormed the said work and to make and file this application; that a statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before2./ me this A[31:'~L.J. 1~.. .......................... day of~,: ....... .. fz : . ......................... ...... ---- , ~'7~:~C7-'",~''"'";, ......