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HomeMy WebLinkAbout6346-zFORM NO. 4 TOWN OF $OUTHOLD BU~DING DEPARTI~NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . ?~)..~.&~.~.~re~.~ .~.~ ..... S~reet Map No. ~+682 Block No. . .Lot No. 39 conforms subst~ti&ly to the Application for B~d~g Pe~t heretofore filed ~ t~ office dated . ~. ~ ........ , 19. ~ ~u~t to which B~d~g Pemit No. ~ ~.qJ.. dated J~ua~ ~ 19. 73, was ~sued, ~d confo~s to ~ of ~e req~ ments of ~e applicable pro~sions of the Iaw. The occup~cy for wMch ~sued is .....- ~?~. e~ ........... .................................. The certificate ~ ~su~ to ~* ~ ~* George a (owner, lessee or ten,t) of ~e ~ores~d buil~g. S~olk County Deps~ment of He~ Approv~ .................................... UNDERWRITERS CERTIFICATE No ............................................. 7~ Wavecre~ ~e~ ~-~ttitu~ N.Y. HOUSE NU~ER .............. S~eet Building Inspector FORa[ NO. ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SC)UTI'tOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6346 Z PermisSion is hereby granted to: .~,~ c~'~e..~..~3~Le~..~ ~ g ............................... ........... ~,~e..~,e,~..Le ..................................... ..................... ~.~.t,J..t~ ................ : .................... to'. I~uJ,I~L..z~.. ~u~o~s ~'~..IkT~d~.....C ~t o~e ~ ...................................................................... at premises located at ...... L~..~. ........... ~1 l;..~J, ra..J~r~t;,~S ..................................................... ................................ ~e.v~,.C~,es$,..Lene ........... 14e ~c.'b S.t. uo.k ....... N.v~.y ...................................... '... pursuant to application dated .......................... ~I~, ......... 2~ ........ , 19..~.~., and approved by the Building Inspector. Fee $..,1.0J~,QO .......... Building In~tor~ TOWN CLERK'S OFFICE SOUTHOLD, N.Y. ~. c~ Application No ................................. E×omined ..~.......~...~.., J9....?..~ Approved ..~.. ............ ./..~......~...(. ...... , 19..~..~- Pemit Nh....~...~.....~....(..~.. Disapproved a/c .~....-......... .......... APPLICATION FOR B01LDING PERMIT Dee INSTRUCTIONS e. This application, must be completely filled in by typewriter or in ink and submi~ed in triplicate to the Building Inspector, will 3 sets of plans, accurate plot plan to scale. Fee a~ording to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, giving a detailed description of layout of property must be drawn on 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 the premises available for ihspection 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 a Building Permit pursuant to the Building Zon Ordinance of the Town of Southold, Suffolk County, New York, and other al~li~able 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, bu|lding code, housing code, and regulations, and to admit authorized inspectors on premises and Jn buildings for necessary inspections. (Signature of applicant, or nameTif ~'corporation) ~I~-,~ ]. Stere wh~th, er applicant is o~_~_r, lessee, agent, erchitect, engineer, generel contrec;to, r, electrician, plumber or builder. ............. . ... ' ... .ame of ow.er of prem, ...... .................................................. , ........................ If applicant is e corporate, signature of duly authorized officer. ..................................... :..-.'.....-; .................... {Name and title OT corporate o.f.§cer)., Builder s L~cense No ......................................................... Plumber's License No ......................................................... Electrician's License NO .... Other Trade's License No ................. : ................................. q~/7'~, ~ ~ , ,, ,, ~'~ 1. Location of land on which proposed work will I~e done. Map No ........... .~....~..~.....~... .............. ,.Lot Naj ,~...~. ...... ; ......... Street and Number ~,.~/~.~.~.C.~.~....~....-~......~'~...~....~... ........................................................ ~2~r~''~ Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .~J~.l~..~..~..?. ............ .#.~...m.....~ ............................................................................. use and occupancy ....... b. Intended 3. Nature of work (check which applicable): New Building ;..~-~.~.¢,.~ ........ Addition ..................... Alteration .......... .~... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) ' ,.- LO-- 4. Estimated Cost ...... ~.'~.., ................................. Fee ................................................................................................ (to be paid on filing this application) $. If dwelling, number of dwelling units ...... .Q. ....... Number of dwelling units on each floor ....... ~. ............................... If garage, number of cars .~. ........................................................................................................................................ 6. If business, commercial 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 structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of~ntim, new construction: Front ........ ,~..jJ~.. ...... Rear ...... ~.~..... .......... Depth ..J'.~..~,~... ............... Height ........... ~.....~.. ........................... Number of Stories ..... ,,/. ................................................................................ 9. Size of lot: Front ...... /..~...~ ....................... Rear ..... /..~.~...~...~. ................... Depth .....~.~...,.~..~.'.;~.~ .................... Date of Purchase ..... ..~....~....~./. ................ Name of Former Owner ...~..~} ........ 10. /.J 11. Zone or usa district in which premises are situated ...... /..1..~ ...................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded .... J~.0.,,~ ,~, ,~,~Will excess ,fill be rero.oved from premises: [ ] Yes [ ] No 14. Name of Owner of premises ..... .{~...~./}~...~....~.....X'Z.Z,.G..~......~=~J.I~.~.~ ......................................... · . I '~,- (Addr~J . , ,,~ (Phone No.) ~.~ Name of ~ ............................................................... .~ .......... ~.....,<~./.~...~...~.' .~.. ....... ~, .......... (Address) (Phone No.) Name of Contractor .......................................... , ........................................................................................................ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. COUNTY OF ............ . ,~,~,~ .~,~., .~...~.'.... ,"~. ......... ) ~'~ ..................... '~~i~'~7~i~'~"~ .......... bein§ duly s~om, depo.~s and says that he is the applicant abova named. He is the ............................. ~ .................................................................................................................................................... (Contractor, agent, corporate officer, et¢.J 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 perfor ~l~,~d in the manner set forth in the application filed there~h. ...... · ~.......~....day of .....