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HomeMy WebLinkAbout5634-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~ ...... Date ............ ~'lal~... 2 ...... , 19. THIS CERTIFIES that the building located at . 1~1t. 14aSa. Roa~l ........... Street Map No.. ~ Block No., -~t ....... Lot No .... 11~ ....... Ma.tt~,~tctk.. N,,¥ o... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Nov ..... '16..., 19-71. pursuant to which Building Permit dated ........... 1~ ..... 18., 19. ?.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 .. ,q'e~eOB'Ol*y' b~ld~g' (ptBap. houae. &. ~ater. -oe~f~oll. bldg.) ....... The certificate is issued to . .J4a.~;t:LtucR.. Azsoe~stom. Ine ........ Owner ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · .N.I~ ............................. UND[RWRIT[RS C[RTIFICAT~ No... ]~303 .................... ~ .................... HOUSE ~UMBI~R.. 90~[ ..... $~cc~ ..... btaLn-Road .... 14att$'tuek ................... Building hlspcctor FOI~M 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? 5634 Z Permission is hereby granted to: ..... 330 .... ~eter...Pk~n/ ..................................... to .. ~...~..~e.. 2.. ~a~e n..s~a..~.. (~eel~o~l.. f~r.. ~..~%llage ........ · ~~..e~te~ ................................................................................................................... at premises I~ated at ........ 'N~'"'~a'i~"~O~ ................................................................................. ....................................................................... ~~..~..~!..!~ ................................. pursuan¢ to application .............. ~ll.~. ......... ].6 .... , 19....'~..., and approved by the dated Building Inspector. Fee $...10000 ......... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Examined ................ L.~.. , 19...~.../. ',.~ ........................................ , ........ Pemit No ..................................... Approved INSTRUCTIONS Application No ............. .~.. ................ 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 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 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 Ragu at OhS, for the construct on of bu Idings, additionS~ alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicab e laws; .0rd nances, building code, housing code, and regulations. WHEELER ASSOCIATES, ~NC. (Signature of applicant, or name, if a corporation) .13.3.8..Mo.'coz...~ar k~a.y. ~.. ttat~pp~ug.e .,...N.....Y.....&12 8 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................. . ....... O~n~ ........................................................................................................................ Name of owner of premises ..................MaI.ti.tuck..As$.Qciat~.s.,...Izm ...................................................................... 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 n/s Main Dr. f~Rte. 2..5.) ...... ~i3,.'f.laJ,.lz. ll~.k ......................................... ........................................ Municipality 2. Store existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy under constrM..gtign retail store b. [ntended use and occupancy ........................... $.ame ............................................................................................ 3. Nature of work (check which applicable): New Building ............... Add }ion .......... Altera.tion ..... ~'ddit iona 1'"'~'~ ..... Repair .................. Removal .................. Demolitior .................. Other Work (Describe)ll)..O..u..$..e.....~....w..a...t..~...r...~..a..n. k 4. Estimated Cost ................. $$.~.~).00...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 ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............ 2.ff2 ......... Rear ....2.92 ..................... Depth ..].5,~.~/.J..0.~.. 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 ..... $.1.4.! .............. Rear ........... St).0.! ................ Depth ......... 2.l. 2.! .............. 10. Date of Purchase ........................................................ No;me of Former Owner ........................................................ 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate ~vhether interior or corner lot. Plot ~ram (as per attached plan). (J? ~r.~ ~.o. ~ 6,j~-~a,~-~~ ' ~ '~'0 '"' STATE OF NEW YORK, COUNTY OF ................................ fo"~ ........................ ~e~ne.th...C ..... iv~;$~.].l ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ............................. l/J. ce...~.r.e$.j, rlez~: ...................................................................... (Contractor, agent, corporate officer, ;~t~i ............... 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. Sworn 5worn tn before me this _ ........ l..7 ....... ~y~ ;... ,~of ..~~........~......~..~..., , 9~..~ Notary Public, -~-.,~ ~ ~.~,,~.. · ................. County (Signature of applicant) ..............