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HomeMy WebLinkAbout5268-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town CJerk's Ol~ice Southold, N. Y. Certificnte Of Occupnncy No...Z.~.35.~ ..... Date ...J..u~v...2.~. ................. , 1973.. THIS CERTIFIES that the building located at . ~ 800. S~d. Avenu~ ...... Street Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Pemit heretofore filed in this office dated ...~.~Y..3 ............. , 19.7J.. pursuant to which Building Permit No.. ~.2.~..8.Z. dated ... ~4ay '3 .............. , 19..72, 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 .... A~leu~tn~a,], .Bu~ .......................................... The certificate is issued to . ]/.&. ~l .(}atz .......................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... .N.,.R.: ..................... lloRo UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER 1800 Street ~oUn~ ~V~U~ ~ Ma~tituck~ N.Y.... Building Inspector FORM 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 AUTHORIZED) 5268 Z Permission is hereby granted to: , / -- -- -- at premises ............................... ; ................................................................................................... .............................................................................................. ~..~( ................. pursu~ to application doted ......................... ~.....~..~.~, .......... , 19.~.~, and approv~ by the Building Ins~ctor. F~ $ ..................... Building Inspector isopproved ................ .......... ................................ ...... IC- o, (Building Inspector) TOWN OF SOUYHOLD BUILDING DEPARTMENT M.~ TOWN CLERK'S OFFICE ~. ', SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink end 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 o detailed description of layout ofproperty must be drown 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 r~ 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/V~ADE to the Building Department for the issuance ora 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 buildin{~s, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordi nan. ces~lding code, housing code, and regulations. - - ~ 'tSign6'ture of applicant, or name, ff a corporation) AOle. icu L 'r ~ P---A ~. '~ u/~b/~ ' ' .............................. '~'X~i;;;;';F;~;~ii;;;';'~i ............................... ~Stote whether applicant is owner, lessee, agent, arc_~t.eCt,v engineer, general contractor, electrician, plumber or builder. .................... ...... ...... ........... 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 done. Map No.: ........................................Lot No ......................... Street and Number .....~...~.. ................ /~....~.~........~.....0...(/...~....~... .......... ..~...~..~... ................... : ...... ~ ................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use aod occupancy ...... ./.....F..~..../~'....i...-~.....J~... ....... .~... ........ ..'~.....'~..~...~.....~...~....~'... ........ ..-~....~....~....~... .......................... 3. Nature of work (check which applicable): Now Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolitior .................. Other Work (Describe) ........................................ 4. Estimated Cost / ~/ OOO , .~"~ . (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, 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 now construction: Front ................. ~...~..~. ......... Rear ......~...~...'~. ............ Depth Height ....... ..~.....~.. .... Number of Stories ...................... ..~..~...~. ......................................... ¥ ....... ;4"Z'""i ..................... 9. Size of at Front ~ Rear ~. ............... Depth ................................ 10. Date of Purchase ...................../.~...~../......-~... .............. Nome of Former Owner .~...~. ...... ..~..~..~..-V~,..~...~. .................. 11. Zone or use district in which premises are situated .......... ' 'Z~. * ...~...~..-~'~ ~Z~-~¢71,,~ L 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... 13. Name of Owner of premises ~ ~ ~4~ ~/~7'7 Address -~//~'D ~¢--~-...... ~...._.~ ~--_,~/~)_.phon.-~.,~_......oc~._.7..7 ......................................................................... ~ ......... e ~o ................... Nome of Architect ....... : ................ ~ ....................... Address ............................................ Phone No ..................... Name of Contractor ..~....~....1~....~..~. ................... Address ~..I I//+E'TT /9 E~) Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed and show street names and indicate whether interior or corner lot. ........................ ....... du,y swo . Z£; and so,s (Nome of individual signing application) % that he is the above named. He ~s the .............................. ~.~.~-..~.7. ............................. ~. ....................................................................... (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 oil 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 therowith. Sworn to before me this .................. of .............................. . _ ,/3 .orary ~'uo,,c. ~.~~~ ..... County ' ' '(Signature of applicant) ..............