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HomeMy WebLinkAbout6502-zFOItM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificate Of Occupancy No..Z~8.7.0. ..... Date ............. APr,..1.....2.2...., 19..?+.. THIS CERTIFIES that the building located at ... 0rc. hard..St ............. Street Map No.. ~ ........ Block No... ~ ..... Lot No...x~x.. ....0,.i.e.n.~;...N. :.Y: ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Afar. il...1.? 19.73. pursuant to which Building Pemit No...6%.0.2.Z.. dated .......... A.l?.r.i.!.. 2.0..., 19..7.3., 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 . A.c.c.e. .s .s.o..fy .B.u.i. 1. d ~.n.g...(.s.t..o.r~ g.e..e..to.) ................................ The certificate is issued to ...~.i.l. 1. !.a.m..;il.Y.S.°.c.k..i...J..r ....... . .OUCh..e.l,' .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No. h.':.H.. ........................................ HOUSE NUMBER .... ...... Street .... .0~..c.h.a.r..d..S.t. .......................... Building Inspector FORM NO. 2 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°. 6502 Z Permission is hereby granted to: William .......... ~.~f.....o.~,.~.~.~,.~.¢...s...t. .................................. ................... g.~i.e~.~ .............................................. ,:a ~.z..~..~....a..e...e..e..:..s..o..~...~.t..z.~.%~f~ ........................................................................................... at premises located at ....~. ....... Qr. Ct~l,~L..~.t~ ................................................................................. ......................................................... D~le~t ....... ~¢,~, ........................................................................ pursuant to application dated ............................. ..~.~..~..~.~......~.~......, 19.~,,~ .... and approved by the Building Inspector. Fee $..1..0..:...0~... ........... Building Inspectq TOWN OF Sou'rHOLD ~ ~ BUILDING pEPARTMENT ~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....~.....~.., 19..~. ........................................ , 1 . Pemit No. Disapproved a/c ............................................................................................ Application No. ......................... ...~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~~.'~ a. This application muat be' completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi 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, end giving a detailed description of layout of property must be 'drawn on diagram which is pert of this application. c. The work covered by this applicction 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 aveil~ble for inspection throughout the work. e. No building shall be ocoupled or used in whole or in pert for any purpose whatever until a Ce.rflficete of OccupencV shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department fo~the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold~ Suffolk County, New York, and other applicable Law~, 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 necasterv inspections. ............................................... ................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................................... .................................................................................................................... Name of owner of premims .......... ~.......~..~.~.../~. ................... ~'..~ ....... X~.¢ ......... (~....~. .................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trada's License No ................................................... I. Location of land on which proposed work will be done. Map No .............................................. Lot No ......................... .s' : ' Street and Number ........... ~..~:.. ......... ~....'.~...<~.{;~ .......... ~ ........................... : ...................... ~..'./C/...~ ............ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex~st~ng use and occupancy .............. ,~. .............. ..~.~, ................................... ~ ................................................. b. Intended use and occupancy ...... . ././~...."~.....A~.......,~. _...~.. .......... ...~....~:,~. ,..:~. ....... ~ ........................................ Alterat om~...,.~ ........ 3. N. at~re of work (check which applicable): New Building ....................... Add, ,on ......, .............. Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ...~...~...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 tVbe 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 .................. ./Z~.../. ....................... Number of Stories .............. 9. Size of lot: Front .......... ~'~7.../. ................... Rear .............. an[. ........................ 2/ Depth .................... ~'oO ~. ............................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in ~hich promises are situated ......... 12, Does proposed construction ~n'olate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded .............~..~.....; ........... Will excess fill be ramp.veal from premises: [ ] Yes ~ No (Address) (Phone No.} Name of Architect ...................................................................... (Address) (Phone No.} Name of Contractor . . . (Address) (Phone No.) PLOT DIAGRAM Locate clearly and diStinctly ell buildings, whether existing or proposed, and indicate all set*back dimensiom from property lines. Give street end block number or description according to deed, and show street names and indicate wfiefll, er interior or corner lot. STATE OF NEW YORK~~. Jj t~,~ ) co .T O ............. .......... I ~.....~~....- being duly sworn, deposes and says that he is the applicant above named. (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 statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mlftl~r set forth in the application filed tberewlth. .o,aryp h,ic ........................................................... County ................................ · ..................................