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HomeMy WebLinkAbout5558-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~L~-I~ ... Date .. MaY ],6 .... , THIS CERTIFIES that the building located at Ca~t!_~_a~ Dt~ Street Map No. M~t~; ~S~$~ck No ..... Lot No. ~6 . . lt~t~t~tC~k, X,~, conforms substantially to the Application for Building Permit heretofore filed in this office dated 0e.~ 8 ... , 19 ~r~. pursuant to which Building Permit No. dated ........ 0C~..~ , 19.~., 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 · l~i~'at;~ .~® .faml~]~ .d¥~!ling ....................... (owner, lessee or tenant) The certificate is issued to Edwal~t of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICAT~ NoN ItOUSF~ NUMBi'R $200 Street Btuldmg Inspector F~RM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOI. D, N. Y. BUILDING PERMIT CfHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5558 Z Dote ......................................................... ]9 ........ / Permission ....... is hereby granted c~t premises located at ........... ~...-c..,r. ~.~.....~ z ........... . .T.~ ~ ~ ................. ~..,,..r.....~ ........................ -,.~u~ to ~,~ t,on 'at ' ~ Z -! p app' a' a ec~ ........... : ................................................ , 19 ........ , and approved by the Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at ~¢/ ~ - (Give deed location) / // ., have been inspected by this department and found to be satisfactory. Chief of General Engineering MAY 1_ l.. 1972 /~.J~r~ ,., w~'/r~v~. '~/' BUILDING DEPARTMENT_ ' ~v/~ Y~ ~Y~ ~/' "' '~., /V~K4~/' ' ~J~- ~'~ TOWN CLERK'S OFFICE ~. - O/~ , -,~ Examined ........................................ , 1 .~../. _ App ication No ................................. ..................................... , ...... · ................................... APPLICATION FOR BUILDING PERMIT ate ........................... I ZI ..... 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 ofproperty must be drawn on the diagram which is port 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. ~. 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, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, build,~g~code, housing code, and regulatlons~ ( 'g of applicant, or ~me, if a corporation) Trj '7 c (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner of prem ses ,~' . A -'~ ! T~ Name of ...................................................... ;7, ........................................................................................... applicant is a corporate, signature of duly authoriZed officer. If (Name and title of corporate officer) ~' L/~ ~'_~ "% 1. Location of land on which proposed work will be done. M~p No.: ........................................ Lot No ......................... Street and :Numar .................................................................................................. Munici~li~ 2. State existi~ use ~nd ~cupo~y of premiss and infended use and ~cu~ncy of pr~s~ c~struct~: o. ~isiting u,' o~ ~c~oncy . ~ ~ 4 ~ ~. ........................................... b. Intended use and ~cupa~y ................ ~ ........... .~.~./.~.~ ............ ~.~.~.~.~.~..~ ................... 3. Nature of work (check which applicable): New Building / Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other We~- (Describe) ........................................ 4. Estimated Cost .,~.....~'../..O...0...~. .......... 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 ................................. ,.~.....2~,. .......... 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 same 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........ ...... II Z......................- ,3 o o Depth ...../..3..?..-.....5.....e. .......... 10. Date of Purchase ............................................ .7.../.....Nome of Former Owner .............................................. ~...~... 11. Zone or use district in which premises are situated ..~....~..~'/Z~ 12. Does proposed construction violate any zoning law, ordinance or regulation.> /1/O 13. Name of Owner of premises .....~... ........ ..~....~.../...-~.....Z~.......Address ............................. ~)'~'"'"~;'~;~' ..... ..........P one No ..................... 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-hock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, ,~'//?~'- COUNTY OF ................................ .................... · . .................. , ..................................................... oe~ng auw sworn, deposes and says that he is the applicon! (Name of individual signina application) above named ,.~1'1~ i~. the z~/~ ~.,{,/~-/-~ ~'1/- Z~-~ (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. Swam to before me this .................. · ~-.. y of ............................... ~ 19..~./.... Notary Publi ' .~ ' ....'..~'&~n~¥~~ .........................