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HomeMy WebLinkAbout6775-zFORM NO. 4 TOWN OF SOUTHOLD Bu~,r~NG DEPAHTMI~-T Town Clerk's Southol~ N. Y. Certificate Of Occupancy of the aforesaid building. Suffolk County Department of Health Approval No.. Z~3~ .... Date .............. ~pt..¶0 .... , 19. ~,~ THIS CERTIFIES that the building located at . ]~.. ~/~. ~d .......... Street Map No... x~ ....... Block No.. ~x ...... Lot No... ~'~ .... 8o~fl~hold...N,~.~ ....... conforms substantially to the Application for Building Permit heretofore fried in this office dated .......... &tl~.. 3 .... , 19..?~ pursuant to which Building Permit No. 677~ · dated .............. A~...~.., 19.. 73 was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is issued is . .. l~va~a .alia .fam.~ly. d~ll~ .................................... ..... Th~ certificate is issued to .0ll~a .0VelttolL., .01enel' .............................. (owner, lessee or tenant) UNDERWRITERS CERTIFICATE No...Pezldl~ .................................. HOUSE NUMBER ..... ~[6~9~. · · Street ...... ~ .Ibrd ......................... · ............ FO~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? 6775 Z Permission is hereby granted to: ... R ... H~&t.t .. ~n¢.. ~.. ~llt&.. I~.e~.t~ll .... .................. .s..q..u. ~o. k4 ......................................... to ...k.u,~3,.ct...~....~.cL4.~.t,~u...~...ez,,t.~.'t;,,~..li..~.~.~l&,~ ............................................................. at premises located at ....N./..~........~.....~........I~....~_... ....................................................................................... ........................................... ~u~ho~d ....... ~!.~. ................................................................................ pursuant to application dated ............................ &.~ ....... .~ ........... , 19..~.,I~.., and approved by the Building Inspector. Fee $..'J.~.a.~ .......... Approved ........................................ , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN a. ERK'S OFFICE ~SOUTHOLD, N. Y. 19...'?.~...'~ 192..~.. Permit No. ~...ZZ..~...~ ......... App,icat,on ............. Disapproved a/c .......................... ~ ................ -- ..................... ............................ (Building InspeCtor) [ ~" APPLICATION FOR BUILDING PERMIT '~ Date ...................... ..A..~..1~....S..~...... ~...., 19...~.~.....U'l INSTRUCTIONS g~ o. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Buildin Inspector, with 3 sets of plans, accurate plat 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 al areas, and giving a detailed description of layout ofproperty must be drawn on the diagram wb ch is part of th s.ppplication. 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 PerrhJt 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 shaft 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 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 applicant, or name, if a corporation) Southold (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. e ontrac tor Name of owner of premises .....0..~]: .l..e.....0..v...e..~...~..o..~.. ................................................................................................................ 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 Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ......... Street and Number ........... ~[~'~.....~.-~..~.Q~,~ ...... J~Q.U..~Q~, ............................................................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... .~...w..e..Z.~.../.D..F= ...................................................................................................... " with an addition b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .................. Addition ..;~lcz~ ...... Alteration .................. Repair .................. Removal .................. Demoliti~ .................... Other Work ................................................ . .... (Description) 4. Estimated Cost .........~.QQ.Q....~+ ............................... Fee ...]J~.,O~J ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... .o.b.e. ............ 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 ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ...................................................................... Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..~LO**.~ ......................... Rear ........ ].Q ................ Depth .....1.~. ............... Height .................... Number of Stories ..... g~.. .. ................................................... 9~ .Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated "A" dist 12. Does proposed construction violate any zoning law, ordinance or regulation: nO 13. Will lot be regraded ....... ~.O. ................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ...~.,~,~,~..e.....~..~..~.o.~ .... Address .,...J~.l~.~.~.~ ....... Phone No ....................... Name of Architect .............................................................. Address ................................ phone No ....................... Name of Contractor ...~..~[.y~, ..................................... Address................................Sol/t;~o'lc~ 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 whether interior or corner lot. . \b tO STATE OF NEW YORK. J¢c COUNTY OF ...... J~lZ~..f D__'I_~. ........ .... ..................... '~0~..~¥~:~. .......................................... being duly Sworn, depos.es and says that he is the applicam (Nome o{ individual signing contract0 above named. Bull~er He is the ................................................................................................................................................................................. (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 thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this Notary Public,. ................................................... County .... ..?... .....~... .. (Signature o{~licant) .......