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HomeMy WebLinkAbout5429-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at Ho~t~, ~. & J4e.~o~s. Pa.t,h Street Map No..~ ......... Block No .... ~ ..... Lot No.. ~ .8~ ... N.*~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ~...~.., 19 .~. pursuant to which Building Permit No...~2~ dated .......... .~...~..., 1~.., 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 .~..~. ~ .~ ....................................... The certificate is issued to . .~o~-O~b~ ..... ~ ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~...~,..~9~...b~. R,.~ll~ ..... ....... ........... Buildin~ 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) N9 5 29 Z Permission is hereby granted to: . ~e m, .. Ah~,e;r.~....5.~;~.~,~.e.~,...~.~..~ ~'.~..-..... ~.e..e...eph Cat,~,bbe to . ~.t~...~ew,.~a~,.-f. aa~l'~..~we~;L~'~ ........................ ~ ......................................................... at premises located ot ...l~.~...i~l.l,t~...tm...&..~,/~../~.~e~!.~e~h .............................................. pursuor~t to opplicotion doted .............................. t~'~&~r.~'""~'"";'"", 19..~.~.., ond opproved by the Building Inspector, : .Fee $...~.~.e,~. ......... · ' Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH DEC ©'~ :.,, 1971 Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ~-Give deed locatto~ have been inspected by this department and found to be satisfactory. · row,,, oF soUT.oLD BUILDING DEPARTMENT Disapproved a/c ................................................... APPLICATION FOR BUILDING FERMIT ,NST.UC ,ONS a. This ppplicotion mus~ b~ c6mpletely filled in by typewriter or in ink und submitted in duplicate to the Buildin~ Inspector. b. Plat plan showinG location of lot and of buildings on premises, relationship to adjoining premlMs or _l~bli¢ streets areas, and Giving a detoilecl description of layout o( property must be drawn an the diagram wh)ch Is I~rt of 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 port for any purpose whatever until o Certificate of OcCupancy shall have been Granted by the BuildinG Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 I.awl, OKIInances or Regulations, for the construction of buildings, additions ar alterations, or for removal or demolition, os herein diecrlbed. The applicant c~rees to comply with oil applicable laws, ordinances, buildinG code, hou~ncl~ (Address of applicant) State whether applicant !s owner, lessee, agent, orch~ General contractor, electrician, plumber or builder. Nome of owner of premises ................ ~ '~ (Name and title'of corporate officer) .~/_~ .. ~ 0 1. Location of land on which proposed work will be done. Map No.: ................................ ; ...... ~Lot I~o,: .......... ~ .......... ! L 2. State existing use and occupency of premises and intended use and occupancy of proposed construction: ntended use and occur an-', ...~..~ ......................................... 3. Nature of walk (check which applicable): New Building ~ Addition Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost (to be paid on filing this application) .5. If dwelling, number of dwelling units .............. ~. ........... Number of dwelling units on each floor ...... i .................. If garage, number of cars . J. ................................................................................... 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 ............. 2 ...... Number of Stories ..................... ./....~.. .......................................................................................... 9. Size of lot: Front ...... /..~..~. ............. Rear ......... ./..~.~..~.. ................. Depth ........ /..2/. .................. 10. Date of Purchase ..... ~'4~l~.~,h/.......6Z.../.~.,I/..~/ ................... Name of 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 Owner of premises .,~/t~.....C~./t/.~j~ .......... Address /.~.~ .~'..~..e/nt.e~.~...5.~.....~.'..e'.~...~°. ~one No.../~.....~..../...z~.....~... Name of Architect ........................................... ~ ......... Address ............................................ Phone No ..................... Name of Contractor ....~....~Z..~.~/L/C.(~......~..~.4I.~..e£. ....... Address ...?'..~..~'.~.4.....X..~.....~...~..:.... Phone No..~..~..~...~.~?... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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. STATE OF NEW Y~.,I~' ................. ~.~ ........ (Name of ~dividual signing applicati~) ~~~.~ above named. He is the ..................J ....................................................................... ;'j ........................................................ (Contractor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke ~d 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 fo~h in the applicati~ filed therewith. Swo~t~me me this Notaet Public~~~~ou,,'~'"'-~;; :, applic;~;~ ...........................