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HomeMy WebLinkAbout6839-zFORUM NO. 4 TOWN OF SOUTHOLD BUHJDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate 'Of Occupancy No..Z6.51,1 ..... Date ........... June...20 ....... , lg..7-5 THIS CERTIFIES that the building located at ... No~th. ~oad. & .I~,OoW,. · Street Map No.. xx ........ Block No.. xx ..... Lot No, .~ .... SoutholO...N.,][, ......... conforms substantially to the Application for Building Permit heretofore fried in this office dated ............ Eept. · .b~., 19..73 pursuant to which Building Pemit No.. 6~39Z' dated ........ S~pt;. I,..., 19.7.3., was issued, and conforms to ~11 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P.x'lvate. aacessoz*y. (~tor~e..) .bt~ldinl$ ......................... The certificate is issued to .. Edlla. Koebl~... Da, Ilex' ............................. (owner, lessee or tenant) of the aforesaid b,,ilding. Suffolk County Department of Health Approval .. ~,R, ........................... UNDERWRITERS CERTIFICATE No.. I~oR, ...................................... HOUSE NUMBER .... .%90 ...... Street .... Richmond .Road.~as, t ................ ~ B,,ilding Inspector [ FO~ NO. ~ TOWN OF SOfT,OLD BUILDING DEPARTMENT TOWN CrLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6839 Z Permission is hereby granted to: ...... ~id...Nox~h..~qo~.. &.. S'.g~..P~ ............. to .....e.?..e..~.....a~...d.....m...a...~...~.a..~.n.....n..e.~..~.~.a.,.C..e,. ~.g~.~.o..'2f....(~.~'.ag~....al'~e.~.)...b.u~i0A~g at premises located at ....O..],f]...~9.~..[~Cl,...~..~..y:.t..~[ ................................................................. ................................................... 8oi~,f, ho;LO, ......... :~¥,, ....................................................................... pursuant to application dated ............................ J~.~.~.....~ ........... , 19.~.,~.., and approved by the Building Inspector. " / ~- Building Inspector Approved ............~..~. .......... ~ ........... , iFOBM NO. i ~ TOWN OF SOUTHOLD '/' . / ' // ,_./ ~ BUILDING DEPARTMENT ~ ~~~-- TOWN CLERK'S OFFICE ~ SOUTHOLD, N. Y. Disapproved a/c ........................................................................ __ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter oK in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of b~,lJldJngs an premises, relationsh~ip to adjoining premises or public streets 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 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 o 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 code, housing code, and regulations, and to~ admit authorized inspectors on premises: and in buildings for necessary inspections. (Signature of Plal~licant, or name, if a corporation) ................ (Address State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buJlder. Name of owner of premises ...:.~.~ ......... ~ .................................................................... If applicant is a corporate, signature of duly authorized offJcer. (Name end title of corporate officer) Builder's License No ..................................................... Plumber's License No ............ ~.. .............................. Electrician's License No ........... ,,,,~.,, .......................... Other Trade's License No ............................................... ~ ~ 1. Location of land on whi.9~/jj~ '77~-~./..~/~ ~ ~/ ~ ~/prgp°sgd wo_r_k will J~e~kianp. /V~ap,hlo.: .....~......~...~.~..~..r..~..:....:; Lot No....:...~- ............. Street and Number ~ '~/-""/~L'3' "~'"~"~' '~'~7"'"'~'"~/":' 'Z/z~'/"'/"/'"C/ Municipality 2. State existing use and occupancy of premises and intended us)l~d ~:cupancy of proposed construction: a. Exisiting use and occupancy .....~....~.........~ '~.~..~.~'"~...~.~.. ................................................................... b. Intended use and occupancy ............ ~-~...~ ......... ~...'~..~...; ................................................................ ¢ 3. Nature of work (check which applicable): New Bui ding ..,...;,.;, ...... ~u~clition .................. Alterat~on ................. Repair .................. Removal .................. Demolition ........... i~.~.i... Other WOrk .................................................... ' ','~/'/~ ~ ,' , ~/,6 / i .~....~.. ~ (Description) " 4. Estimated Co~t ........................................................... 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, sl~ecify 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 c~f 'Stories 8. Dimensions of entire new construction: Front. .................................. Rear ............................ Depth ........................ Height ....:..: ............ Number ~of Stories ....... · ............................................................................................................ 9. Size Of lot: Front .:..~..~...~i..~:, ...... i ..... Rear ,.~&~.. ,,~.~Depth ..~. ..... : ................. 10. Date of Purchase ....... L,,....~..~....~;..,..,,,........~ ............ '.Name of Former Owner ..~...~......~.~ 11. Zone or use district in which premises are s tuated 12. Does proposed construction violate any zoning lawf ordinance or regulation: ........................................................ 13. Will ]¢>t be regraded ..~.~..~ ..... WjlLexces~fill be removed from premisesL( ( No 14. Name of Owner of premises ..:~..~ ~..~ .~ Add~" ~f~'* ~'~ _ · ...................... . ..................................................................... NO: ............. ~m® of ArChitect ....~..~.~ ...................................... Address ................................ Phone No. ...'Cl. ~me of Contractor · : .=~., ....................................................... ... .. Address ................................ Phone No. ...................... PLOT DIAGRAM : .: Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from ;"( Property lines. Give street and b ack number or desc~ pt on accord ng tO deed, and show street names and indicate ::. whether Interior or comer lot. STATE OF NEW Y.,ORI~,///~ I c ~ ~' f. ~,~/~ '~-~ .,' ~ , , ........... ./...:.,,, ...... .z~.-~.~..~..,..N~. ...... ~','~'~',',~"-.-...~~, ~'~ys t~t he is the opplic~m . (Name of 3~i~bl' Si~ing ~r0c~ .... a - - x . ~bove ~am~. ~ ~He s the ~ ~ :~ ....: '~ ...... ~ "~' ........ 2'~? ....... *~ .................. ~ ............................................. (Co~~Te offlcer,~C.) of said owner or owners, and is duly author{z~ t~r~rm~ h~e ,performed the said work and to ~ke and file this application; that all statements contai~ ih ~ ~Pl~otion ar~,tme to the best o~his knowle~e and b~f' ~-~ ~ at the vo~k wdl ~.performed m the mann~t fo~h i~he application filed therewith. ~/-~ ~' ~'~,~ ~wom to betore me this ~ /~ x~ ~ / ~ J~ ,~ (Sionotur~ o{ opplicant) .......