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HomeMy WebLinkAbout8973-zFOIhM NO. 4 TOW!~ OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No...~...~.~. ?...~ Date ........................... 1 .... THIS CERTIFIES that the building located at . .~ ..... Street Map No ..... ~ ...... Block No. ~ .~ ...... Lot No, . X .... ~~'.~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~. ,dated ......... ~. ~.~: .... 19~., was issued, and conforms to ~1 of the requ~e- ) ments of the applicable provisions of the !aw. The occupancy for which ~is certificate is The certificate is ~ssued to. ,~... ~E.~[~ ...... ~ ........ (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of Health Approval . ~'~.' ......................... UNDERWRITERS CERTIFIC~E No. ~.~Y .......................... FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~.EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8973 Z Permission is hereby granted to: ~.,:~¢:.:~'.. A.. ~Lo.r.~.o.~.....ftZ~.. ~.r. ~.?~...~..e.~.$~..e .................. (~.~.~p~t~ ......................................... to ... J~,~Llg,.. ~z',.. ~.~Li ~.~.~:~:~.. ~z....~,:,~:~ .'L ~,~..~.. £~.~w,. ?~.~ f, ]~.~ ;~.~ ................................................. at premises located at ..... ~/..~,...O. El~,~.~...~O~t.~. .......... ~ ....................................................................... .............................................. ~zt, charp, te .......... ~ ~: .......................................................................... pursuant to application dated ......................... .~O.V ....... ~.~ ........... , 19....~ and approved by the Building Inspector. Fee $...'t,.~.e.O0 .......... - Bui ding nspector ~ Examined ..........~ ................ ~-'~"-, 19.?~ ....... FO~M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. Disapproved a~jjj.; .............. ~~f]L.~..,:_~ _(....._.~ ~---~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. (~' Dote Nov 22 19..7.~ a. This application must be completely filled in by typewriter o¢ in ink, and submitted in triplicate to the Building?t Inspector, with 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 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 througt~out the work. e. No building shall be occupied or used in whole or Jn part for any purpose whc~ever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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. Midgley & Horton Cutahogue (Address of applicant) State whether applicant iS owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................ ....................................................................................................................... . Frank McBride Nome of owner oT premises .................................. ; ................................................................................................................. If applicant is o 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 Trode's License No ............................................... Location of land on which proposed work will be done. Map No.: ....... .~.~ ......................... Lot No ...... ~.~. .............. Street and Number ....~../.~......0..z.~.e.~..o.~...~..o.~. ............ .C..~...t..a..b:...o.~f..~..e. ....................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use ond occupancy Far~i~ B~i]Ldinf~ b. Intended use and occupancy same with an addition 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. Demo it.or~ ..., .......... Other Work ................................................... (Description) .~ ~ Z,. ~ (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, spec,fy nattlr~ and exteRt of' each'type of~Lise .~; ......... 7. Dimensions of existing structures, if any: Front ............ ~Rear .......... · ...................... Depth ........ Height ........................ Number of Stories ..... ................. ...... 7'~7'"~ ........ ~ ........ .".'"=7 ........... ~ ....... ~ ........... ~ ...................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ~ ........... ~,,,~ ........... Reo~ ............................ Depth ........................ Height ...................... Number of Stories, ~ ......... ~'~'.';F', ................................................................................................. ~' . · ? - 9. Size of lot: Front Rear .......................................... Depth ................................ 10. Date of Purchase .......................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Narne of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ 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 ~vhether interior or corner STATE OF NEW YORK, ~ S.S COUNTY OF .......... .S. ~.~ f...o. ~.k,..... f ......................... ..W..i..1...1.~...a.l~....~f£.~g.],~y. .................................. being duly sworn, deposes and soys that he is the appiican~ (Name of individual signing contracf) above named. He is the ¢ont~acto. r. ..................... . ................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 tho* the work will be performed ih the manner set forth in the application filed therewith. Sworn to before me this ........... ~ ~.P,.ql.... day of ....... bJ.o%~lllh~ r .................. , 19.7..6... ~,~,~ ] ~ ~ Nato Public, ~.~O.lk Coun~ z~.~rz.:~:: r~ . .. .................................. ................. ..........................