HomeMy WebLinkAbout8713-zNO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
THIS CERTIFIES that the building located at . .~,l~..V.~! .I~.~0~ .1~..o.a.d. ....... Street
Map No. ~ .......... Block No. ,~ ....... Lot No, ~... ~ghOld.. ~.*.~* ..........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............. J~. al., i9 .~6. pursuant ~ which B~ilding Permit
dated ............ ~..a~..t', 1976., was issued, ~d confo~s to ~1 o~ the requ~e-
ments of the applicable provisions of the law. The occupancy for which this ce6tificate is
issued is .P~$Ya~O. ~. ~.~!$~ .~!!~g.~i!h. a~i~l~n ......................
The certificate is issued to ' . .t~I'~'~.. 3.eil~elll:lt~ ....... 0trla®x'. ........................
(owner, lessee or tenant)
of the aforesaid building:
Suffolk County Department of Health Approval Ii,R,,
UNDERWRITERS CEi~TIFICATE No..1}~llililqg ...................................
HOUSE NUMBER .//.t.87~ ....... Street ...Ca~.v.O$. ~.e.¢k. ~d ....... l~ovi;llQld:...
~uilding ns~/oemr
FORB! NO. ~B
TOWN ~OF SOUTHOLD
BUll.DING Dr~ARTMENT
TOWN CLERK~ OFFICE
SOUTHOLD, I~. Y.
BUILDINg PERMIT
(THIS PF.I~AIT MUST BE KEPT tGTq THE PREMISES UNTIL FULL
COMPLETION~ THE WORK AblTHORIZED)
N? 8713 Z
Permission is hereby granted to:
~o~%hold
to .......... ; ................ : ................................... ~; .............~ .......................................................................
at premises located at ~/~
ao~thold N.Y.
pursuant to application dated ............................. ..~...~....e...~.~ .......... , 19...?..6., and clpl~roved by the
Building Impector.
Building ~ !
FO~ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
ormit ~o .....................................
Examined ........
Approved .,...~
Application No...~..~..d,./..,~ ..............
~'~ (Building Inspector) /
APPLICATION FOR BUILDING PER/~IT
D June 21, 19 ............ '~'~
ate ................................................. 76
INSTRUCTIONS
a. This application must be completely filled in by typewriter o~ in ir~k and submitted in triplicate to the Building
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 or
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 o Building Permit 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
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, o~ 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.
Robert L. Hyatt Ina
(Signature of applicant, or name, if o corporation)
............. S~u~ho~Ld ..................................................................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
builder
. . Harry Schwendt
Name of owner or premises ....................................................................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officeX)
Builder's License No ........ /..~..:...JT....J..~..:....~7. ..........
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.: .......... ~ ...................... Lot No .......... ;~ ........
Street and Number ....~.../.~...g..~..'.J...~..e..~..~.~.O.~....i~.°..~.....~.O.]~.~.~P.~,~ .......................................................................
Municipality
State existing use and occupancy of premises and in.*ended use and occupancy of proposed construction:
a. Exisiting use and occupancy ......ct:~.?.~.].:,z.~ ........................................................................................................
b. Intended use and occupancy .......... .~.~.~.,e...,~,~..~..~....~..~,~..~.~..~,,o,~. ...........................................................................
3. Nature of work (check which applicable): New Building .................. Addition .....~..%.. .........Alteration .~.~:.,...~,'
Repair .................. Removal .................. Demolitiar, .................... Other Work ..................................................
(Description)
l ,oo
4. Estimated Cost ............................................................ Fee ..........................................................................................
(to be paid on filing this application)
5. If dwelling~ number of dwelling units ............. .O..1~..~.. ........ Number of dwelling units on each floor ............................
If garage, number of cars ............................................................................................................................................
6. If business, commercial or mixed occupancy, specify noture and extent of each type of use ............................
7. Dimensions of existing structures, if any: Fron~ ............................ Rear ................................Depth ....................
Height ........................ Number of Stories .................................................................................................................
Dimensions of same structure with alterations or additions: Front .................................... Rear ............................
Deptb ................................Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................
Height .................... Number of Stories ....................................................................................................................
9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................
10. Date of Purchase ........................................................Name of Former Owner ........................................................
uA" ~ist
1 1. Zone or use district in which premises are situated ....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~.O.. .............................................
13. Will lot be regraded .......... .~,.,O. ............. Will excess fill be removed from premises: ( ) Yes ( ) No
14. Nome of Owner of premises ..... .~.......S..q..~3f.~)2.c]-...~ .................... Address ...S..o.~.h..,o.,]..~ ........... Phone No .......................
Name of Architect .............................................................. Address ................................Phone No .......................
Nome of Contractor .~.*..~....}.~z.a,..~..~...Z...~..9 ............................ Address .....S..o.,,~.~.o..]_.,~ ......... Phone No .......................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
property lines. Give street and block number or description according to deed, and show street names and indic'ate
*hether interior or corner IoL
_qA~[: OF NEW '~1¢,~,~,
........................... .].~.O...b..~..:...~.~.fkt~..~ .......................................... being duly sworn, deposes and says that he is the applic~m
(Name of individual signing contract)
above named.
He is the ...................................... ~&~¢.~ ..........................................................................................................................
(Contractor, ~gent, corporate officer, afc.)
of said owner or owners, end is duly authorized to perform or have performed the said work and to make ~nd file
this application; that all statements contained in Ihis applicction are true to the best of his knowledge and belief;
ik, af the work will be performed in the manner set fo~h in the application filed therewith.
Sworn to before me this
Notary Public,. .................. ~PZ~"" .......... ~oup~ ............................. ~;~'~'~;;';;';¥';~'z:'-~v-'"' ......................