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HomeMy WebLinkAbout6555-zTOWN OF $OUTHOLD BI.m.F~INC, DEPARTMENT Tow~ Clerk's Oltice $outhold, N. Y. Certificate Of Occupancy No. ZA! ....... Date ............. .~'l~...16 ..... , 19~.. THIS CERTIFIES that the building located at~/S..Me..~.r;~..~ ............Street Map No....x~.. ....... Block No..x~.. ....... Lot No...Xl~... 8..o~..~. 9..~..: .N.o.Y.,. ........... conforms substantially to the Application for Building Permit heretofore filed in thiR office dated ............~lay.... 9.., 1~.3.. pursuant to which Building Permit No.6~.. dated ............~.~ .... ~ .... , 1973.., was issued, and conforms to all of the require- ments of the applicable provisionsJof the law. The occupancy for which ~ certificate is The certificate is issued to . .~.l'.a.~4..CKet$$~ ..... . .0w. Ol#le ............................. (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE N~I~, / HOUSE NUMBER . 3.1.~ ......... Street..L~ .I)ir;l,v.~ ............................. FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6555 Z Permission is hereby granted to: .... ~.,...~.e.~......*./.c....~..e.r.~.Z.~....c..~..~....s...e. ......... ................... {~.~.~.¢~9].¢t ...................................... to ..~..~],~...~...~,~-.t,~.~,~...~a..~.l~,g...~l.~e2~l~g ........................................................... at premises located ot ...... ~.~....~l~e..~Z'. ......... (.g..~.~.~...~.....~..O..~...~..). ........................................ .... · ~ .................................................. ~ .............. ~o~oi~ ...................................................................... pursuant to application dated ...~ .................~t,~ ........... 9 ............. , 19~.~..., and approved by the Building Inspector. Fee $.1.~*Q0 ............ APPLICATION FOR BUILDING FEI~IT Y ]r 9 Date. ............................................... , $ 9..?.~ ...... INSTRUCTIONS application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Impector, wit~ This 3 mU of plm~, accurate plot plan to scale. Fee ece~ording to schedule. b. Plot plan showing location of lot end of building* on premises, relationship to adjoining premises or poblie itreets or areas, and giving e detailed description of layout of Ixopert¥ must be drawn on diagram which is pert of this application. ¢. The work covered by this application may not he eomrnencad before issuance of Building Permit· d. Upon approval of' this epplioation, the Building, Inapeetor will i~sue e Building Permit to the applicant. Such permit,shell he kept on the ~rerrfises available for imbection throughout the work. e. No building shell be occupied or used in whole or in pert for any purpose whatever until a ~e.rtifieate of Occupancy ~hall have been gsanted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department ~ the issuenee of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as heroin described. The applicant agrees to comply with ell applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inlpectigfl~ $outhold N.Y. (A~clre~ o~ egplicantl State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Contraotor Name o~ owner o~ premises ....~.1~.~...~.~ ................................................................................................................ If applicant is a corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) Builder's License No ........ Plumber's License tu,~ G. Berry Electrician's License No....~.~...~;~,~,~.~1 ......................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No .................... ~ ...................... Lot No ......~ .............. Street and Number ................ ~Z'.~ ....... ~,~1~;fl..]~'~I.1~1~ .............. RD~l.~hc~d. ................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed constnJction: · dwell~n Ex st ng use and occu anc ........... ~ ..................... b. Intended use and occupancy ................... ~.~..~W~....&~[([~.I~I .................................................................. 3...Mature of work (check which applicable): New Building ....................... Addition ..... ~ ...... Alteration....'....'......', Repair ......... Removal ......... Demolition Other Work ....................... (Description) 9~000 + 4. Estimated Cost ...................... ,,~ ................... Fee ...!1.~..~...0~.. ................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .,....o.~9. ..... Number of dwelling units on each floor ......................................... If garage, number of cars ............................................................................. 6. If business, commemial or mixed occuoancy, specify nature and extent of each type of usa ..................................... 7. Dimensions of existing structures, if any: Front ..................... Rear ........................... Depth ................................... Height ............................. .... ....... .. ............ ..... Number of Stories ............................................................................. Dimensions of same structur~with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ........~. ............. Rear ..... .1.~. ................. Depth ...... ~,, ...................... Height ................................................. Number of Stories .......... __n~__~ ......................................................................... .................................... Rear ............ 1D~ ....................... Depth ........ $~Q~...2,.3. 0 ........................ 9. Size of lot: Front 100+,. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or usa district in which premises are situated ....... ~...~.~..~..~. ........................................................................... 12. Does proposed construction v'olate any zon'ng law, ordinance or regulation: ...... ~.~,g ............................................... 13. Will lot be re~'aded ......... 33,0 ..................... Will exCess fill be removed frompremisas: [ ] Yes [ ] No 14. Name of Owner of premises ....C-..;....C...~.....s..e. ............................................................................................................... (Address) (Phone No.) Name of Architect .............................................................................. (Address) (Phone No.) Name of Contractor ........ G',..]~,lze: ............... , ........................................................................................................ (Address) (Phone No.) PLOT DIAG RAM Locate clearly and distinctly ell bulldlng~, whether existing or proposed, and indicate all sat-back dimensions from pro. party lines. Give street and block nu~be2'~ or d_,e~Aptlo~n eccor, d[ng to deed, and show street names and indicate wheth- er interior or corner lot. L~tC~ ~ ¢)/~1 , STATE OF NEW YORK, ~11~o'~ ) COUNTY OF .................. .:.....--...-...-..'~... ................ ) SS Geo Bauer .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the ................................................ ..q..O.~.~..?..a...~...~...O.~ ..................................................................................................................................... (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 ~!~$et forth in the application filed therewith. ............................. k.~......day of .'~I~.¥~l~w,,.~l~..o*.m~..¥~l~.., 10 .~.,,~ ....... .............. ....................................