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HomeMy WebLinkAbout5041-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No..Z. ~.1,98 .... " Date .............. &P.I'..~!....~....., 19.~.~.. THIS CP, RTIFIES that the building located at . .D~m~l. & .X~S .8~ ..... Street Map No...~ .~. ....... Block No..~ ....... Lot No....~. ..... 0~.~..~ .... N ~.~.*. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... NeV ...~ .... , 19. ~ pursuant to which Building Permit No.. ~..1~.. dated ............. 1~' ..... ~, 19..70, 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 ...Pl'~.V&~e. e~®. £mil~. dvetlAnl ..................................... The certificate is issued to .. RSeh&~l. P&saanaa~ ..... Ounel' ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval lieuae d~ 2b'70 FORI~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ' SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTNORIZED) N? 5041 Z Permission is hereby granted ......... tO pursuon* to application dated ............................................................ , ....... , and a__roYedoo b_v Building Inspector. Fee ,i.J.e...,.~ ......... S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH Date Bldg. P~rmit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give, deed lo~atio~ have been inspected by this department and found to be satisfactory. Chief of Genez.al Eng. ineez, i~f 0 Examined ........................ ~ ........... , ....... ........................................ , 19 ........ Permit No .......................... TOWN CLERK'~ OFFICE ~OUTHOi. D, No ¥o Application No. Diwpproveda/c ............................................................. ...: ............ ~.. " APPLI~ATION FOR BUILDING pIIrRMI~/~~ 19..'~..c~..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in d~pllcate to the Buildir~g Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premieel areas, and giving o detailed description of layout of property mustbe drawn on the diagram which II tmrt of ~le 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 appllea~,t, 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 for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS ItEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold; Suffolk County, New York, and other applicable Lava, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or.demolition, al heroin described. The applicant agrees to comply with all applicable laws, ordinances, building code, ho_~ing code,,,and regulations. (Slgr~ure cf applicant, or nome, if a corporation) ~aaress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~...~ ............................ ; .................................... (Name and title'of corporate officer) . 1. Location of land on which be done. Map No.: ............... ~ ............... Lot No.: ...'....~.. ............. proposed..~lvork will 2. State existing use and occupancy of p.remises and intended use and occupancy of prapaeed comtructlon: a. Existing u, and occupancy .....Y.~ ................................................................... i ........................... b. Intended use and occupon? ...~..~.. .............................................................................................. property lines. Give street whether interior Or. 3, Nature of walk (check which applicable): New Building .................. Addition Alteration ............. Repair .................. Removal .................. Demolition ........ : ......... ,at_her Work (Descr be) ..................................... Estimated Cost ...........Z. ~".~ ........................... Fee ..,Z*..~.. .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ · .~..,~umber 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 sarne structure with alterations or additions: Front ....................................Rear .......................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ..~...1~. .................. Rear ...,~'...~. ................. Depth .~ ............... Height ../..~ ........... Number of Stories ...... ~ .................................................................................................. 9. Size of lot: Front ...... ~..~...~.. ......... Rear ..... .~....~.r.~..~ .............. Depth .~...~.~...'~.. ............... 10. Date of Purchase ....... ? ................................................ ~_e. o.f Former Owner ........................................................ 11. Zone or use district in which premises are situated ...~-~-~....~.~ ................. ~.~. ................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .. ~..~....~.. ................................................. 13. Name of premise~.r...~/.~ ...... Address .~.)'J..~. ........ Phone No ..................... of Owner Nome of Architect ..................................................... Address ......~ .................................... Phone No ..................... Name of Contracto~..'.~...',~...~:~:~.... .......... AddreSs ~ ............ Phone N .o~..~.. ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from block number or description according to deed, and show street names and indicate i / STATE OF NEW YpRK~ J~e · ........................ ~,-.~6~-,,F~-....~ ....... ~being duly sworn, deposes and says that he is the applicant above named. He is the ........ I~..m/7...~..~'l~l~......~... ................................................. '~ ....................................................... (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 alt statements contained in this application are true to the best of his knowledge and belief; and Swamthat the to work before willmebethis performed ,,~ in the ....... ..... o, ............... . $~,, ~,,~-~ ! I J' I · I/l ..... ~......~~..'..~ ............. Notar'! Public,~2~-'/,~...[~. ~.~..~ Countv~.~ (Signature_ of applicant) ~ ELIZ_.~B~E~H aNN ND/ILLj~[~I~ YOrk ' NOTARY ~U~LIC StBte of · u folk Co No. ~2,8125850, S