Loading...
HomeMy WebLinkAbout8472-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's O~ice $outhold, N. Y. Certificate O[ Occupancy No..Z?.~.20 ...... ; Date ............ Feb ...... .1.~ .... , lg.??. THIS CERTIFIER that the building located at .E/8 .West; .Mill .Larva ..... Street Map No...g.x ........ Block No. ~ ...... Lot No, XX,x...Ma.~.t.$$~.e.l~.. ~.¢.,.~.: ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... April...2.., 19.7.6. pursuant to which Building Permit No. dated .......... April .... 2.., 19.~.6., 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 . .Pri.v. ate..c~ne, f~milY..dwelling .... (. 1 s.~. flo.o.r. C~O~pl~e.d ) .(..a. pp?pved by Bct Appeals ) The certificate is issued to Rabt. Krado.p .&. J.~mes..14olber.~....0~rs .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .D. ec....2.8...~.9.?.6...b, lr..R.,..V..i.l.l.~. .... UNDERWRITERS CERTIFICATE No...N. 3!37.~9.. ..... .~gY..~3. J.9.F..6 ................ HOUSE NUMBER .... 1~80. ..... Street .. ~..~ilL ,R~at ·.. ~tti t~t~k ........... Building Inspector FO~ 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? 8 72 Z Date ........................... A~L....~ .......... 19.76.. Permission is hereby granted to: .... ~.ab~.~.X..,~top ............................................ .... ilex...~8~ ....... ~ ......... t~-ve~,i~e a4 ............. to ..J~ 1~ ..new...one.. J:lua~l~..~lwell~J~j .................................................................................... at premises located at ...ii',/~..tdes~..J4$.l.~,...Roe.~ ............................................................................. ................................................... ~,~.~k....~;~ ......................................................................... pursuant to application dated .................. ~J~.:~. ....... ~, ............... , 1~.~..., and approved by the Building Inspector. Fee $2.~.QG ............ Building Ins~ctor J ~, THE ~NEW YORK BOARD OF, FIRE ,UNDERWRITERS,,, :' ~:`' I ~4 , ' ' ~ I .' ' 'i~ ;!~ h.,,~ ~ - : 85 JOHN STREET. NEW YORK, NEW yORK 100381 i i i ' , ~ ' ' ~i~' ~ ~ ~ ~ ;~; ; i, N', 313759 '! only the e~ctrJc~ equipment ~ d~scrlbed below and introduced by the'appllcan~ ~med on the able opplicatlo~ number ~n ~ J~e~ Wolbert, e/s/o MilI Rd~450' s/o,Bayview ~ye.~. ~ ~,Mattituck', ,L'I'~ ~ OUTLETS R~EPTAC~ES ~WJ;,- ~{' -- '~*~I~ANDESCEN)' ~ © FLUOEESCENTRXTURES ~e~cu,~ .yAm, ~ , '~T.'; ~;R~G~ ,;;4 .. [.w. ' COOKING ~S~T. ' K.W.' q~Z.~ ;[~ QV~5 ;~'~ ~' K W'. ' DISHWASHERS~T K w. ~EX~UST.~T. H. pEANS'" ~?. g.W, OIL ~J' GkS: ~.P.' 'AMTf ~O, ~.W.d' ~T. ~F. ~T j AMPS ~aANS. ~T. ~'H.P;' NO. OF ~ET AM1 WATTS , . '"! 30 ; "- - ..... METER ~2 3 ~ 3W H-L OF HI-lEO 1 '200 ',CB ,,: 1 -,: 3/0 ~ ' 3/0 1-Smoke Detector ~ ' Jos h' D. ~Mazzoni COUtlTY ~EA~H D~PART~EN! inspected by ~i:~ d,o~r~mxnt a~d found ~ief of G~neral Eng~6~ng ~ervices K UDOP AT' 'V j~ :I 2' t ':-,FL, t F - r:Gq ROBE ~- .-_1 KAUPOP MATT I TUC'A water supply a~d sew~qe dispos~ systems for this ve~id~ce ~!I c~o~ ~ ~e ~d~s of the ~fo~ '~y ,~t BUILDING DEPARTMENT z3~*,,~ TOWH CLERK'S OF.CB INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 setg of plans, accurate plot plan to ~cale. 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. - Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit d. 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 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 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 nece.~ i//nspecti~onL /.~ /? '~ '""~, n~'~'t'~'~oq:~orat ion) /7 ~- (Add,ss of a~licant) . / State whether applicant is owner, lessee, agent, orchltect, engineer, general contract'S/r, electrician, plumber ar builder. Name of owner of premises ...~...:/L/, ,/~. (,.j If applicant is a corporate, signature of duly authorized officer. .\ (Name and title of corporate officer) Builder's License No. Plumber's License Nol ........ Electrician's License No. ~.~ ...................... O~r ~'~ ~,~n~e "o.....~.~ ..................... I. koc*tion o{ I~nd on which p~o~ work will~ don~. M~ ~o.: .......................... kot ~o ................. ~r,~ ~ ,~ber .................................... ~~......~L-- ............................... '"'"" ............ Munici~li~ 2. State existing use and ~cu~ncy of premises and intended use and ~cu~ncy of p~osed construction: ~. ~.ng u~e ~ ~.pa.~ ...... ~.~~ ............................................................................................ b. Intended use ~nd ~cu~ncy .......................................................................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................... Other Work ................................................... ~'x, ~h~ ,... (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 type 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 ................................ D mens ons of ~ntire new construct on Front ../7~. , Rear .~..? ............. Depth~.......°~..O - Height ..../..~. .......... Number of Stories ....................................................... ~,./. ........................................................ 9. Size of lot: Front ........... /..~...~-~.. ................................. Rear ........ .?.~,...~ ...............Depth ...o~...~...~...!.?..~...~...~...~..G 10. Date of Purchase .......... ./..~,~_~./..Z../.../~..~. ......... Name of Former Owner .~..~......b~...0../.~ ............. 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 . .......~...~...S...: ......... Will excess fill be removed from premises: ( ) Yes (~ No 14. ,ame o Ow er o premises' ~........-~..~...'.~. .......................... Address ............. ~ ........ Phone No.~..~.~.?.../...~....~- Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ ~Ph~jne No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ......... ........................... ~.~,,..,JJ~'~JlJl~ ............................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contracf) above named. 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 applicction are true to the best of his knowledge and belief; and thaT the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Notary Public,. ................ ,~l~.~lr. ................. County ...~/.~...~....Z .......... ~.........~...-Z. ..................... / (Signature of applicant/ No. 52-8125850. Suffolk Co Term Expires ~ar£h 30. 19