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HomeMy WebLinkAbout3514-zFORM ~0. 4 TOWN OF SOUT~IOLD EU~LDING DEPARTMENT TOWN CLERK'5 OFFICE SOUTHOLD. N. ¥. ~ERTI~I{~ATE ElF E}I~E:UPANP. Y THIS'CERTIFIES that the building located at . .~/I~...S.fl;illwa.t;¢~. AVe ..... Street Map N~'8'I~alld. ............ Block Bio ............. Lot No.l.0.~....~..?.0.~.....~..R.~.~..~.O..g~. ?....1~.¶~..~. conforms substantially to the Applicati, on for Building Permit heretofore filed in this office dated ......... .~..L~..~....~.1~. ...... 19.~.~. pursuant to which Building Permit No..~..~.~.~...~. dated ......... .~..1~..~....~. ......19.~.~.., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .o.ccupancy for which this certificate is issued is ... P~.~Vg$~..0~..f~i~.. ¢t~l~,il~g ............................... , ......... The certificate is issued t,o (o;vner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health App,roval ............. ~..~.R.~. ....................... FORM NO. 2 TOWN O1~ ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. 'Y. BUILDING pERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES 0NTIL FULL COMPLETION OF THE WORK 'AUTHORIZED) Permission is hereby granted to: at premises located at .~(~.~..~©..~O~,...~[~.~,~[~.~L~ ...................................... i ............................... ......................................... .~//[.. ~t~,~,~' ,~a~ ~...Ave ........ ~ C~*,c~-~ ............................................ pursuaqt to application dated ................................ ,~:~1~.~....~+. ........, ~9../~..; cnd approved by the Building Inspector. Fee $.. [[e,i~J~) ............. ........ /...~_,.~,.~...L ,/...'...,, .... Building Inspector / FORM NO. 1 TOWN OF SOUTHOLD BUlL. DING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined Approved -/ ........................................ ,,, ........ Perm,t No. '. : (Building ~ INSTRUCTIONS a. 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 property must 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 a Building Permit to the applicant. Such permit shall be kept on the p,remises 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 gra6ted by the Building Inspector. APPLICATION. IS HEREBY MADE to the Building Department for the issuance of'a Building Permit pursuant to the Building Zon~ Ordnance 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, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. ...... .. i ......................... . . (S~gnatur~of opphcant, or name, ff a corporahon) ........................................................... : .~...~<.,.....I..../~.~ .~,. ......... (Address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................... ........................................................................................................................ Name of owner of premises '~J ~ ~ ¥ ~ }~'~cs ~< ~ ¢~ ( If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ./.~.!.:...~.!..~..~.~..d....~. ............ Lot ' Street ond Number ...... ~...I..I..,..Lm£;.~.~.'r:......L:.Y...~. ........... ~..~...~...e~..%~..~..%.~.: .............................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....~..¥..M~]~.~.~.~ .........~...k?..~.!.!.l].~...~. ........................................................................ b. Intended use and occupancy ~7 t' I 'Va ~ J~2~o e,J J 4. 5. 6. 10. 13. Na] Na~ Local property I whether i'n STATE OI COUNT' above na of said m this appli, that the ~ Sworn to NatUre of work (check which applicable): New Building .................. Addition ..... ..~... ....... Alteration Repair .................. zRjemoval .................. Demolition .................. Other Work (Describe) Estibated Cost ...... Z. ~.'~.., l~..~....g ................................. Fee ................................ j (to be paid on filing this application) If dj'welling, number of dwelling units ..... ~,..~',~.,..Y.~.?...~..Number of dwelling units on eoch floor If g?rage, number of cars If I~usiness, commercial or mixed occupancy, ~,cify nature and extent of each type of use Dirt ensions of existing structures, if any: Front ......... ~.. ................. Rear ......... ~,~,..'~..Z/{. .............. Depth ..2./, ............ He!iht ......:~.~..'~... ....... Number of Stories ....... / Din-ensions of same structure with a.lterations or additions: Front Dep :h ..... ,~...~....~,..! ........... Height .......... /....?... ......... Number of Stories ..../. ........................... Dirt ensions of entire new construction: Front ......... ]...~. ..................... Rear .....,/..~.. ................. Depth ............... Hei!lht ...... /....~..../. .... Number of Stories ...... /. Siz. of lot: Front ....,~....°....O. ............. Rear ......~....~....O.. .................... Depth ................................ Dat~ of Purchase ...... ,/..~..~....~... .............................. Name of Former Owner ..~..:....~'../../.~.~...~.~ Zor~e or use district in which premises are situated ......... /~.~..$..!.¢)..c...~i~.~z..~ ................... Doc s proposed construction violate any zoning law, ordinance or regulation? .....J...~. Na ne of Owner of premises ...~...~-~.~...t..~......~.~..W.~!i.~.W..Address ...~...7~..(.J.J.~....~.~.~...J~.v..e..-.... Phone No,~.~..~:7,..~.,~. ne of Architect ............................ ne of Contractor ......~....~...°.~..~...~.,....',~.R.~.'~..I.~.~ ........ Address ..~..i .~.../?..~...~.~..e.~.~.....~.u.~. ..... Phone No. PLOT DIAGRAM e clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions nes. Give street and block number or description according to deed,, and show street names and indi~ ~erior or corner lot. .................. [..~.. day of ._.......~-v:~(._,.~ ................. , Notary PLJblic, ~~~-.~ ..... : NEW YORK, OF .... ~....~...~.v..~ ..................... being duly sworn, deposes and says that he is the applk (Name of individual ' ~ed. He is the ...... (Contractor, agent, corporate officer, etc.) ,nar or owners, and is duly authorized to perform or have performed the said work and to make and :orion; that all statements contained in this application are true to the best of his knowledge and belief; ark will be performed in the manner set forth in the application filed therewith. efore me this ~ature of applicant)