Loading...
HomeMy WebLinkAbout3569-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .... lqZS .gain .Road ........ Street Map No. ~ ......... Block No. ~ ........ Lot No.. ~c~ ...[~iel~t.. 11.,.5, conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Attg' 'lbrTM 196~' ' pursuant to which Building Permit No.. dated ............ .A~lg...~1+.., 19.67, 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 ...PriMate. a.ccess.Qry, b.u~ldtng ....................................... The certificate is issued to .. ;4illia. m. Sclu~leve:r .... .Omaa: ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....N.:.R: ............................ UNDERWRITERS CERTIFICATE No .... i~l"O~..~ltl~tt, llg ................................ ttOUSE NUMBER...P02.~ .... Street ......I'4&::I.D..Ro~td, ................................ Building lnspeclor FOP, M NO. 2 ',TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~ BUILDING pERMIT (THIS PERMIT MUST BE KEI:q' ~ON-THE PREMISES UNTIL FULL COMPLETION OF THE WORK AuTHORIzED) N? 3569 Z Permission is hereby granted to: to at premises located at ~ ~ ............................................. ...~,~.~ ..~,~,.L ..~ ............................ :~ ................ ~ ............ : ........ ~..~ ...... ~,~ '" ~ k .... ,. ~.. pursu~ to application ..... ................. ; ....................... -.~,. ·., 9.,-._ and,.~pP¢°V~:by tho Building Inspector. ........................................ , 1c) ........ Permit No ............................ ^pplication No. ~..J....~....~...?..i ...... ~ Disapproved a/c APPLICATION FOR BUILDING PERMIT Date Auzust 1L~ 19.....6.~..... ~q 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 bp 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 premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shall have 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 bui dings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinance~lb~d~4ing code and regulations. ......... ~./. ~,.wr~. ~ .-~ ~..._,,~.. F.~T...".~ ..................... (Signature of applicant, or name, if a corporation) Main Road, Orient, N.Y. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 0~-ner Name of owner of premises .....~.~..1.~..e:..~....~.~...z..e.~.e.?. ........................................................................................................ 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. ]V~ap No.: .......................................Lot No.: ........................ Street and KI,,,~I~. N/S Main Road, Orient, N.Y. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ..D~. ellin[ &Access. oT.~. Bld a. E~$sting use end occupancy .................................................. b. ~ntended use and occuponcM addition to accews.o..r..y..b..umld.1..n.g 3. Nature of work (check which applicable): New Building .................. Addition ...... ~... ...... ... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...~.~.Q.Q.Q..~.}~ ................................... Fee ......... ~.~.Q.Q. ........................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .~...o..n....e .............. Number of dwelling units on each floor ............................ If garage, number of cars stroage & shop 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ..........3.~. ............. 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 ........ ;~.~. ............... Depth ..... 5..©. .............. Height .................... Number of Stories .....o.B.e. ........................................................................................................... 9. Size of lot: Front ...... 25.0 ............... Rear ......... 2.~9.~9 ............ Depth .~.0.~.* ./.2.br..8..,.0. ........ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated "A" dist 12. Does proposed construction violate any zoning law, ordinance or regulation> nO 13. Nome of Owner of premises ....... .~...~..,....~g..~..r..J:.e..~...e..r...Address .....0...~.~e...~..~.. ......................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....s.~.e. ........................................ 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 street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~OEK, ,, ~ ~ ~ COUNTY OF ..... .~...~..z..z..'.o.~..~. .......... $ P.D. William Schrie~/er being duly sworn, deposes and soys that he is the applicant (Name of individual signing application) above named. He is the Owzzer - builder (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all 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 before me this ................... day of .............. ._. ........ / ~ommis'sio '