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HomeMy WebLinkAbout5445-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z.~. ~]1~1 ....... Date ........... THIS CERTIFIES that the building located at .. l~r~. I~.. E/S. 8h~9~ .~reet Map No... ~ ...... Block No.~ ....... Lot No. ~... E.a~t. ~0~ ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Aug...6 .... , 19..7~ pursuant to which Building Permit No...~t~Z. dated ........... ~g .... 6 .... , 19.7~., 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 ... ~riYl.~. On~ .f~X. 9~;;~g ..................................... The certificate is issued to . .g0~ .~h.~ ...... ~ ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ~p.~...1.8 .... 1.973 ............. UNDERWRITERS CERTIFICATE No.. P~. ~g ...................................... IlOUSl( NUMBFR .... 1'.90 ...... Street .... P~l~a~..~Oa~ ~.?.. ~a~. ~o~ .......... Building Inspector FO~I~ NO. ~ TOWN OF SOUTHOLD EUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. EUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ' N? 5445 Z Permission is hereby granted to: to ...~d3~L.atm..mm..gtm~...4am~.la&....La~h~le..~/..J~A~la~ ................................... at premises located at .........L~ell~.....l:,~..~l~t&~...~ ...................................................... .................................................. ~1~..~.~ ......... ~ ................................................................ pursuon~c to application dated ............................. ~ ............ ~ ......... , 19...~, and approved by the Building Inspector. ~:ee $..~.Of.(~L .......... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date APR 1 8 1973 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Gt~e deed l~ca~ton) ~ f ~ have been inspected by this department and found to be satisfactory. Chief of General Engineering Services APR ! 8 1973 ~ t ~ y~.~- ° /D'~/~5-/~ ~ TOWN OF $OUTHOLD r~,~ ~ ~ ~ ~ BUILDING DEPARTMENT SOUTHOLD, H. Y. ........,, ~proved ........................................ , 19 ........ Pemit No ..................................... Disapproved a/c ....................... ................................................ ........................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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 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 perm 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, building cede, housing code, and regulations. (~nature of applicant, or name, if a corporation) ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. ............ ..................................................................................... iii~ ::;:r:fc:::~;~: ::g~t[;~'~f"~ul;';~~r-~'' .............................................................................. .................. ......... "7-.2 - 1. Location of land on whicb proposed work wilbbe done. ;~ap No' '~' '/-t No /~ . ' -~ Street and Number ..... ~..., .................... ..~.~. ~ ~' ~ ~ ti/ Municipality ~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ,I a. Exisiting use and occupancy ........ ..~....~..~.......~...~....~. ....................................................................... b. Intended use and occupancy .~,.P:..,.,-. ,E.,.~....~..!...~../. ~. I~..~,~. i d~-~ 3. Nature of work (check which applicable): New Building ...... addition .................. Alteration .................. Repair ................... Removal .................. Demolitio~ .................. Other Work (Describe) ........................................ 4. Estimated Cos,t., :...~.:...: ........................... Fee I.~. ~ ....................................................................... - (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 ............ ~...~... ......... ~umber of Stories ...........~ .............. 0 8. Dimensions of entire new c°nstructioq: Front ..... ~....~.i.....~,...~....~ ....... Rear ......~.. :~..--~ ................ Depth ...~'~..'. ............... Height ...... .~....~.. ..... Number of Stories .........../ ............................. ./~../.[.7'J-/ ...... ~.~.~../..~.....3.......17.~..p..~.~....~.~.~.~...[/....~ 9. Size of lot: Front ...... /.~...d. .............. Rear ...... /.J~..~..~ .................. Depth ..... .~...-~...~...~ .............. 10. Date of Purchase ......... ~...~..-..~....~.. ................................ Name of Former Owner-~T~'~.~..~/......~...~./~...~..~.....l.~L~ ...... 11. ZOne or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or recjulation? ..... ..~..~ 13. Name of Owner of premises~ -~ '- .~..~.~....~..s...~.~..~.~.~...~.~ress .~..~./..~.~...~...~.~.'.~./..~'"'"'"'""'"'"Y" '"'"'""~-'"'--'"'-- ..~.;'.~.6...~..~. f~e'N°'~'.~.~..~../..~...~...~' Name of Architect .............. .~.....'~.~'Z .~..~.,~ '-~ ..................... 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-back 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 NE"~L.YO~I~/, J. ! S S ' COUNTY OF ~-~;/'~lt~J~....^....~" , ~ , ,, ,, .... ................... ~/....~.;....L .......... ~,ng duly sworn, deposes and sa~'S ,hot he is the applicant (Name. oF. in.di~lal signing application) ebove 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 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 applicatio~ filed therewith. Swam to before me this ..................... t, ............ , ,6 Yl.\ _/~//~/ /,,,_';/I L.-////. ......... :,,-..,~_.Z...~'/(.~ ..~.. ,otor Pub,'c. Coun, , ,gnoture o' opp,,can,, .......