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HomeMy WebLinkAbout4848-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .. ~y~k®. PaX'k. ~ ....... Map No.. ~-~ ........ Block No..~:~ ..... Lot No.. X~... ~a~.~..M~X*:~I~.. ~.o.Y~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 3ult.... 8., 19 .~0. pursuant to which Building Permit No..~.~,~. dated ........... J~" 9 .... , 19. ~0, 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 .. P.~.$¥~.~..o~..e..~.~..~.~.y .~.~0~. ~. ~ ..................................... The certificate is issued to .... .D.~.o~*.o.I~. K~.~,b ..... .~0~. ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... !1.~I!, ............................ UNDERWRITERS CERTIFICATE No ...... ~. ?.R.,. ....................................... HOUSE NUMBER .... $..~'.~.. .... Street.......~....*.~..P.~..t~. .............................. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? Z Permission is hereby granted to: ........... =~er~l~ze ~...z~,e ~.~ ..................................... ........ ............. ~B.~ ..]~';t.,~ ....... 1.,~ ........................... to ......... ~t~.~,..~.~,~ee, i~e;.:y. -u~;~.,~l~t ..(e:l~OZ;~je..~l~) ................. at premises located at .................. ,~/~.~'~. ~'~.~...(.l~....:[~...~§.~.~.....s~...). ........................ ................................................. ~&t,....~.~ ......... I~oX., ................................................................. pursuan¢ to application dated .............e~lll-..$..~=..~T~ ....... ~,....., 19..~0., and approved by the Building Inspector. Fee $...~e,(;IG ........... ~ ~ I [ ~ O~ ~ UTH OLD ,,*~. /~'~*~_...~**~ BUILDING DEPARTMENT ~ ~1~ ~.~ .--7 ,. Town CLERK'S OFFICE .. ........... .......... ........ .......... .............. Dis~ppraved a/c ............ ~.~~. ................. .................... ........................ ~ I--~'.~//~V ~Building Inspector)) /~ ~-/~(/'~' ~l': ;~ ~6~¢~u'~ APPLI~TION FOR BUILDING INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildim Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjo n ng prem ses or pub c 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 opp cant. Such permit shall be kept o~Jthe premises available for inspection throughout the progress of the work. . e. No buildiing-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 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 buildings, additior~s or alterations or for remova or demo t on, as herein descr bed. The~apPlicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature cf applicont, or name, if a corporofion) (Address of applic<~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... Q.~..~..e~ ....................... ~...~.~..~..~.:......~;..~...~..~.~.~.... ~:. ~ z~.~..: .................................. Name of owner of premises '~l~J..~.~..~. A: Kr~P-~..~. .......................................................... if applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) · +i 1. Location of land on Which proposed work will be done. Map No.: ........................................Lot No.: ~t;~..:.;....~ ......... Street and Number ...~Lg... '~,...~.J.~....~......~.~d......j...~.~.~...~..ff...~/]..~...~..d...~.,..~: ................ 't~ .~./-- //'~ c~~) "/'/~ U/~ ~ A/''~ '~r~ Municipality ~ 2. State existing use a,nd occupancy of Premises and intended use and occupancy of proposed construction: a. Existing use and occupancy e/L,',~.~...~.. ~ ~ b., ntended use and occupanc,' .g~..~...... ~../..~.~....,E...)~..r .~.~,.....,~.~....~/.. ................................................... 3. Nature of wink (check which applicable): New Building'.....~... ........ Addition Alteration .................. Repair .................. Remora . .. Demolition ............... ~Z Oth,er Work (Describe) ........... 4. Estimated Cost ....~.~.~..~..,.O...~. ...................................... Fee ...... ~.!...~...~. ........................................................ (to be paid on fi',ing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on e~ch floor ............................ If garage, number of cars ............................................................................................................. ~ ............................... 6. If business, commercial or mixed occupcmcy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ......... .,~...~ ..... Rear ..... ~..~....~...~ ............. Depth .~.~O...~..'~.. .... Height ........................ Number of Stories ....... ~...~..~,. ....... ~ .............................................. ~ ....................................... Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ 8. Dimensions of,entire new construction: Front .......... I~.,..~T.. ......... ,... Rear .......~..:~..'~.. ........... Depth ...... I~....~..~.. ...... Height ..... .~....~...~..... Nurnber of Stories ......~...~..~. .................................................................................. 9. Size of lot: Front ......... /.~..~...~4¢...~.., Rear ......... .~.L.....~.. ............. Depth ..... L~.~.,..~..;.....J~-~Y.,...~ o~ ~Tb ~ 10. Date of Purchase ....... ~.....-..~.~. ................................. Nome of Former Owner ......~..~..,.~./'~/.../~..~-....~T.....~. .................. ! 1. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction viol6te any zo.ning law, ordinance or regulation? .................................................. ]3. Nome of Owner of premises ..b.,..~.~¢J..~. ............. Address Jl~.~'~.,.~a.~.~.~.~l. ............ Phone No. ~7...7......~..~.e~'/ Nome of Architect ...................................................... Address ............................................ Phone No ..................... Nome 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. whether interio Give street and block number or descripti~ ~n according to deed, and show street names and indicate STATE OF NEW' 'YORK, JS.S COUNTY OF .,~2....,~.. ........ ,f ' ........... ~.~...(~.:J-~,~ ................................. being duly sworn, deposes and soys that he is the applicant (Name of individual signing application) above named. He is the ............. ~...~ ...................................................... .~ ....................................................... (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 end file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this , ......... o_o, ...................... . g, , ......... ....... ..... NotoW Public, ......~...~..~i~s~,i~,?~? oe¥~' ................ County ~ ~ .,~,_= (Signature of oppli;;~;f ............................