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HomeMy WebLinkAbout4615-zNO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..Z3f~.~ ............... Date ............................. S.e:p.t,. ..... ~2 ..... , ~9..20. THIS CERTIFIES that the building located at ...JJt[.~.te~..])~ ........................................... Street Map No gg,:V~,..~li~l,~r Block No..~1~.~.~ ......... Lot No ..... ~)3~)Jt- ...... ~.-.J~:V.:[4)II-.-..J~,T~.~, ........ conforms substantially to the Apphcohon for Budding Permit heretofore filed in this office dated .................................... ~e~ ........ '1~ ....... , 19,~Q.. pursuant to which Building Permit No...~.~.~.... dated ..................... ~ ...........1.~. .......... , 19. ~., was issued, and conforms to ~11 of the requirements of the applicable prowsions of the law. The occupancy for which this certificate ~s issued is ........ ·..P. :l:'J,'4~ f,~ · · o~e...£a~ ~-.. ~l,~e .~ &;Jz~ ........................................................................................... The certificate is ~ssued to ..~.~..~_l~j[~t~, ......... .O.~l?te~ ................................................................ (owner, lessee or ter~t~t) of the aforesaid building· 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 AUTHORIZED) N? 4615 Z Permission is hereby granted to: to ................. ................................... '.. at premises located at ................... ...~,..t;....~....~.... -~........~.~.¢[t~..IL...~...~.t~..ILCH~...X~. ............... ............................................. ~..~?..*.~ ......... .~..,.~..t ....~.~m,...~.,~,. ........................... pursuan¢ to application dated ....... ' ....... : ........... ...~...~. .......... ~.~ ............ , 19...~1~, and approved by the Building Inspector. Fee $ ........................ Bu,ldmg Inspec' to~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE Sm)THOU), N. Y. 'Iy)WN OF SOUTHOLD (~ . ..~/~,,,,,~ Application No. 9~' ~' ~-' ~ · .:... .................................. ,, ......... Permit .............................. Disapproved q/c ---'-'-k__.,~ -- ~ ~ APPLICATION FOR BUILDING PERMrr ........................... INSTRUCTIONS a. This application must be completely filled in by t~/pewriter 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 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. ^PPLIC~TION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of So~thold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the cOnstruction of buildings, additions or alterajio, ns, or for removal or demolition, as herein descr bed The applicant agrees ~o comply with all applicable laws, ordi~arJc~, buildihg ced~e, h9,usirl~q c~ 9nd regu at ons · ' (Sig68tur~ ~ applicant,~or ~n~e, if a corporation).,~ t , State whether applicant is owne~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name~ ~f owner' of pre ,rnise~~..l~ ......... ~:'.~ ;Y:~...~..~.~ ................................................................... 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 dane. Map No.: Lot No.:~.,~.... Street and Number . . ...~.. ~.~...~ ~.~.~ .~.~...(~....i ~....i~.~ '7'L~/ - ._,~'L/5 ~>A- ~' ///A-'-I~ . Z)/~>l I/'~'~ Munici~'l'i~": .......................... 2. State existi.ng use and occupancy of g.r~ises and intend[ed use and occupancy of proposed construction: a. Existing use and occapancy ...........~.~S...I....~....~..~)~ ...~ .............................................. : ....................... b. Intended use and ~::Cupo"cy ..... ~.~.j~.~.~l..~.~......~.~._~ ................. ;.... 3. Nature of work (check which applicable): New Building .................. Addition ....~.. Alteration .l ...... Repair .......... :~.. Removal .................. Demolition ............ ~.~ Other Work (Describe) ......................................... 4. Est at ~ '! ~' (~ 'm ed Cost ..... ..~.:)..~..(.,~.., .......... ~ ...........Fee ;...: .............. :...(~ ................................................................ (to be paid on filing this application) 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, speci__i.~ nature and extent of each tvDe of use ............................ 7. Dimensions of ex~sting structures, if any: Front ...... ....~...~.~.~...." Rear~ ....... ~..~....~ ...... Depth .~...~:~. ......... Height ....... !.~.. ........... Number of Stories ......... ! ............................................... .! ........ ; ....................... ~--~u~'"'"~" ......... ~,ame structure with alterations or additions: Front ....... ...~......~.. .................. Rear ....~ .............. Dimensions. o~< Depth .........~.~... .............. Height ......... ~.~.~'~' .............. Number of Stories ..... Z ........................ 8. Dimensions of e~)tire new construction: Front ...~.....~..~, ................. Rear ......./'~...~. .............. Depth ......~....~... ........... · . ................... · ........... I. ........... ,..,..~ ....... ~ .............. , ........... i ................................................ 9. SHii:~g hotf lot: F;~t ...... ! .N~ .~.r...°. ~..S. ~°~;:r ................................... - 'Depth ....... ( ...~..~1......?.... ~..~- ~-- ! 10. Date of Purchase ....................................................... ,,t~me of Form.er Owner ........................................................ 11. Zone or use d str ct n wh ch prem ses are s tuated ....... .~,.....~:...~...(..r~.~.....~...l~c~. .................................... 12. Does proposed constructi6n violate any Zoning law, ordinance or regulation? .......... .~...~.:. ....................................... 13. Name of Owner of premises~'.......Iri~l....:...~')...J.~l~..---'Z~.....Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ................... · ........................ Phone No ..................... Name of ContraCto~..~'C~,~ ................... Address ....c~.....~.~........~.....~.. ........... Phone N~6~..-.L.~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all .set-back dimensions from properb~, lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF N ~D~---'~)~I~/~.~ Icc COUN** ...................... ' ................ ~...~....T ............................................... being duly sworn, d~oses and says t~t he is the applicant (~ of i~diyiduql;signing applicat~l- · ~ . : · a~ve named. He is the ...,....~..~..~.~. ~ ~. . ......................... ............................. (~ntractor, agent, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or h~e performed the said work and to ~ke ~d file this application; that all ~otements contained, in this application are tm~ to the best of h~knowl~ge and bel el; and that the work will be performed in the manner set fo~h in themapplicati~ fll~ ther~ith. Swam to before me this ~ ~ .