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HomeMy WebLinkAbout4954-zFOR~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y, CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at W~.ll.~ ~[0&(~ ..................... Street Map No. XX Block No. ~rX Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ......................................... ~e~,,l; ........ 1..~..., 19...~.0. pursuant to which Building Permit No..~kg~:~ .... dated ........................... ~;D.]~)~. ......... .'1..~....., 19....~.Q, 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 ........ ........ ~.i .~.~ .%~... ~.~ .C.C. ~ ~.r.~ ~'~Y_..(.~..¢.~ ~ ~.e. )....~ 1~ :[~; ................................................................... The certificate is issued to .....~..9...~.....~.~.~.~..~ ............ ~..~..e.~....~ ............................................................ (owner, lessee or tenant) of the aforesaid building. House # 3330 Building Inspec([or FO~ NO. ~ TOWN OF S~OUTHOLD BUILDING DEPARTMEH'I~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO, ~195~1 Z O~e .......... i ................. : ........... ~....., Permission is hereby granted to: ............... ................. to ......................................................... ; .................................... ~. ........... .~ .......................................... at premises I~ated at '~J ~ '~ ~ t'q ~ ' i9-~-~., and approved by the Build,no Inspector. ,Fee $..;...;.% .............. FORM NO. I // 1"OWN OF soUTHOLD. BUILDING DEPARTMENY TOWN CLERK'S OFFICE SOUTNOLD, N. Y. Examined ............................ ~,1 g....'~...~.) , ............................ .............................. .......... (Buildin~ In~p~ntor) APPLICATION FOR BUILDING :PERMIT Date ...... ~m.p~.e~o.~ ~,... 1.4 .......................... 19..7.0 ...... INSTRUCTIONS a. This application must' be completely filled in by typewriter or in ink and submitted in duplicate to the BuildingV1 Inspector, b. Plot plan showing location of lot and of buildings on premises, relaiionship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawr(on the diagram which is part of thie applicotion~.t c, The work covered by th~s apphcotlon may not be commenced befqre ~ssuance of Building Permit. d, Upon approval of this application, the Building Inspector will issui, o Building Permit to the applicant. Such permitAb 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 for any p~rpose 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 ReguJations for the construction of buildings, additions or alterations or!ilar removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinance ~uil?~ilg cod~, housing code, and regulations, me, if (3 corporation) ~.e. ~.~- ~.e~.~,...~.a n. x~ ~.o.,... ~.~. ...................................... (Address of applicant) State whether applicant is owner, lessee., agent, architect, engineer, general contractor, electrician, plumber or builder. Norne of owner of premises ...~t~'~,.,/Lg~,;I, fi ............................................ , ............................................................................ If applicant is a corporate, signature of duly authorized officer. ~.~,) (Name and title 'of corporate officer) I Location of land on which proposed work will be done Map No,: .,~ ..................................... Lot No.: ...................... rq / Street and Number ....... .W.q.~.~,~...~P.P,.~ ...................................... ~.l~.l;.[~.q],i~,)...~t.,~. ............................................ ,., ~'~ i ~ D% ~ '/ Municipality 2. State existing use and occupancy of premises and intended use a~d occupancy of proposed construction: a. Existing use and occupancy ...................................................... i'"'. ........................................................................ b. intended use and occupan:, . ............... .,s.~p~,~[~,,.~...~.~,~e~..1~,o.a~La. ......................................................... 3, Nature of wot-k (check which applicable): New Building ,.,:~ ............ Addition ................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................. 4. Estimated Cost ........~.,~f).~.~.0. ...... .-.~.?..~. ..................... Fee ....~,~.o.Q0 ....................................................................... (to be paid on fi'.ing this application) 5. If dwe[llng, number of dwelling umts ........................... Number of dwelling units on each floor .......................... If garag'e, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensien~ r,f existing st'ructures, if any: Front ,..(~;!./', ~.... .......... Rear ...~.'!~:,.,~.'~'.... ............... Depth .~ ~;. ~ ..... Height .....,,~..~.'q.,~ ..... Number o~: Stories ........~, ...................................................................................... Dimensions of some structure with alterations or additions: Front ....................................Rear ........................... Depth ................................ Height ........................... Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. DQte of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in ~hich premises ore situated ..................................................................................................... 12. Does proposed construct;on ~iol~te any zoning law, ordinance or regul~ation? ...................................... ,,~ ................... 13. Name of Owner of premise~ J I)HKJ AC~IA Address ~/IcLL$ 'jE'l)/'r~ ,~. ~ b ~'~ I..~ ......................................................... ¢-~L~'EOlVt'~ ....... mane ~o ..................... Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor ................... ..'~...~.~..~. ................... 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 ,vhether interior or corner Jot. STA'i=E OF NEW YORK, ~ ~ c COUNTY OF ................................ ~' .... ~J~//~l . ./~.. ~'/~! "~ being duly sworn, deposes end says that he is the applicant (Name of individual signing application) above named. He is the ...................... .~....l~../~...~.'~...~ .............................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ond~is duly authorized to perform or have performed the said work and to make and file this application; that all staternent~ contained in this application are true to the best of his knowledge and belief; and that 'the work will be performed in the rnanner set forth in the application filed therewith. Sworn to before me this ~ No,a,-, ................. of .......................... ' ,con,,, ..................