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HomeMy WebLinkAbout6197-zFORM NO. 4 TOWN OF $OUTHOLD BUILI~ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No. ~;~73 ...... Date ...... 0~tob~..18t ......... , 19.7.3 THIS CERTIFIES that the building located at .. ~&ss&u. Point. Road ..... Street Map No. I[&SS~ti. P~, Block No .... XX ..... Lot No. . ~..of. 1~9~. ~0... Clli;aho~le .... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 0etob~. 20f .... , 19.. 7~' pursuant to which Building Permit No...6].9.7Z ~,,~d~t~d .... Ootobe~,.2~! ..... , 19.72., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... P~$vate .ae~essol~y .bu&..ld~ug..(.batl~ &. be&eh, hour&) ............ The certificate is issued to ~FS,. J,. D, .liO~l,:~S ................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval -llsR., ............................... UNDERWRITERS CERTIFICATE No..il,l~ ...................................... HOUSE NUMBER . .~1~80 ........ Street ....... Nassau .l~o~l~t .Road .............. ................................................... Cuteho~u® .................. .... ............ Building Inspecto~ I~ORM NO. ~ 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? 6197 Z Permission is hereby granted to: ED $~v~ ~Cg ~ at premises l~ated at .......................................... ~.-~.~.~. ......... .~..L~.~. ....... ~.~.~ ...... ........ .C ~..~..c..~..o.~..u..~ ............................. ~ ~ ~..~... ~A ss~u ~,~ ~ ............... pursuant to application dated .................................. ~.~....~., 19~.~ and approv~ by the Building Inspector. Fee $ ........................ Building Inspector ~.,. ~o. ~ .shJ~ ~,~ ~/.( 9',,, ~ TOWN OF SOUTHOLD ~ ~'~ ~ ,~/.~/t s BUILDING DEP.~,RTMENTo,~.~/.~'~/ - ~' 0/~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. om,n ............... ........................................ , 19 ........ Pemit No .................................... Disapproved o/c ............................. ~ ................................................... (Building Inspector) Application No. ~'/~ 7 APPLICATION FOR BUILDING PERMIT ...................................... , 19 ....... ; .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit 3 sets of plans, accurate plot plan to scale. Fee according to schedule. 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 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 permit shall be kept o the premises available for inspection throughout 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 ~z-~Td. inance of the Town of Southold, Suffoik Count-Ir, NeWYo~k~ and otller applicable Laws, O~dlnahc~s Ol; Regulations~ ~0r 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 code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~-~L ~ ~, 0~_0~ ~~' j~~licant, or na.~me, ~ (Address of applicant) r ................. .............................................................................................. Name of owner of premises~~~~ .......................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which propo,d wo~ill ~,~d.o~ne..~p No.: .~.....~.......~... ..... LotNo .......?.~....~....~o~.. ~ ........... Street and N u m her .~~/o~d. -~...'.....~/.~.~ ............................ ~ .,~.~ .......... 2.State existing use and occupancy o~ntended use and occupancy of proposed construction: a. Existing use and occupancy ....~:~~.....~........~._...~ ...................................... b. intended use and occupancy ....le~wa~:...~..:~ ~ ~:;'I~L ~-z~--~'-~/r*'~'/ //~ ~--~ ........ ,4..~......~ ........... ~.flt:~.T.....~..~.:.L..~ ........... 3. Natur~ of work (check which applicable): New Building ...................... Addition ..................... Alteration ............... Repair ..................... Removal Demolition Other Work ............................ { Description 4. Estimated Cost ........................ ~ ................... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units....o..~-'.......... 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 ........--'~ ............................ I 7. D~mens~ons of ex~st~ng structures, if any: Front ...~ .......... Rear ...~... .................... Depth ...~....O. .......................... He ght ............ .~..?.. ........................................ Number of Stories ........~ ............................................................... Dimensions of same structure with alterations or additions: Front ...... ~ .............Rear ........ .'. ............................... Depth ............................................. Height ............. ~ ........................... Number of Stories ....~ ............................. 8. Dimensions of entir~ new construction: Front...~.~ Rear ........ /~O/ Depth /'~- He ght -- ~.. ................. Number of Stories ......... ./. .............................................................................. t ! Rear ....... /..~....CZ. ....................... Depth .................................................. 9. Size of lot: Front ........ /.,~..c.). ................... ~,5-~O Height .................... /..¢.....i ....................... Number of Stories ...... (. .............................................................................. 10. Date of Purchase ............... ~ ................. 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. Will lot be regraded ...... ~ ..................... ....~...W/il~ ,.~Nil ex_cessfill be~;emoved from premises: [ ] Yes 14. Name of Owner of premises~..:....~..> ..~.'.-....~ ..................................................... ~ --....~ ........ ^ '/J /2 ~ / %/~ // /,/ (Address} (Phone No.) Name of Architect ....~...~...~. ........... c~...¢'~... ......... ~ ............................ , ............................ (/,., [ ~ I1 I J ~(A~ldress) (PhoneNo.) Name of Contractor ...-~...~....,.....~~'~' ........... ~...~.~.....-....~...¢...~....~.. .............................. (Address} (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street end block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK; t~P He is the ....~.~.~.~ .......... ~...~~.~.%/ ............................................................................................................................. { Co~tracto~, ~t, coyote o[~cer, ctc. J of said owner or owners, and is duly authorized to ~rform or have ~rformed the said work and to make and file this application; that statements contained in this application are true to t~ ~st of hal kn~led~ and beliaf; and that the work ~ ~ormed in the ~r set forth in the application filed therewith. · ..~.:..~...:....~....:,day of ....~ .......................... H~.5~=6~ .Z..~. ~_ // // // ~ % , . m 'on pire~ ...................