HomeMy WebLinkAbout8012-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certific;,te Of Occupancy
No..Z..6 .~.~. ..... Date ........... .J..~.~...2.~ ......., 19..7.~
THIS CERTIFIES that the building located at . .Ifel~y. l~.o. id ............. Street
Map No ............. Block No ........... Lot No ..... $.c~tlthold.. ~.~¥, ............
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ........... June. 2.3..., 19. ?.5[ pursuant to which Building Permit No..80.~ 2.a..
dated ............ J~e.. 2,~., 19..7.~, 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 .. P. riy~.l;e, aC.q~ $ ~.o. ry..(.~t;orag~.)..bl~lld~ .........................
The certificate is issued to . Ni~hol&a. Suctc ..... 0wnel'. ...........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . N..It, ..............................
UNDERWRITERS CERTIFICATE No...N...H.,. ......................................
HOUSE NUMBER ....2.6.1.~ ...... Street ..... .K.e.n.n.e.y..f!.o.a..d ........................
Building inspector /
FOEtal[ NO. 2
TOWN OF $OUTHO/D
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? 8012 Z
Permission is hereby gronted to:
N&c~c~a~,.~u~ ...............................................
....~..lY.....~,~a~aY.,.~d....,a~t~l~t .........
to ...~ kz.:.'L.~::...LL~.?L ..~.g..q ~.,~;Lg.~ Y-.- ~.t ~:a ~-:e -. build :t ~~ ..................................................................
at premises located at ...;~.l..~..~¢~'~e~f...~tea~L. ..................................................................................
............................................................... S~-t.h~Icl'--'"}~'~'T-~ ................................................................
pursuant to application dated ........................... ;,[~%¢~.--..~.~ ......... , 19..~..~.., and approved by the
Building Inspector.
Fee $.4~.00. ..........
Building Inspector /
Date ....... ~.......~......¥......, , 9....?..~...'~.
INSTRUCTIONS ~-~,
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building
Inspector, with 3 sets of phons, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing Ioc~Tion of lot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and giving a detailed description of layout ofpreperty 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 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 Deportment for the issuance of o Buildi.ng Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other epphc.able Laws, Ordinanc..es 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 c..ode, housing cnde, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
.. I
(Signature of applicant, or name, if a corporation)
............................... ('~1~'~' ap~Ji~nt) ...............................
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nome of owner of premises ....~..]...~...~/~,.~? ........... 5.(~'.~:../...C~.~. ..............................................................................
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 propo~,~.~ork will be done. Mawr No.: .....~ ....................:~ .......... ~ No; ........................
Street and Number ................ ~ ....... .~..~ ........ -~...~.- ............ ~ ........ ~ ...................
~/ ~ Mumcipality
State existing use and occupancy of premis~,~ and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy .......... ~.~. ....... ~;~ .......................................... ~l .................
b. Intended useandoccupancy ............................ I.~ ................ ,....~ ..... ,....~....~.;~......f..~..?.t~..~'~e~'
3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration .................
Repair .................. Removal .................. Demolition .................... Other Work .................................. :, .................
~ /~ 0 ~ (Description)
4. Estimated Cost ........... ,-....,-..,z.. ..................................... Fee ..~. ......................................................................................
(to be paid on filing this application)
5. If dweiling, 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 ................................
8. Dimensions. cQ~ entire new construction: Front ...... ./.~. ..................... Rear ............................ Depth ..................../....U...
Height ...../.. .......... Number of Stories ......................................................................................................................
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. ...i..i..~...:(~.~...~../;,~.....;..;;..~o d nan e°r regua o .............. ..~....(~";'7'~; ..................................
12. Does proposed construction violate any zoning law, ' ' : ..; ...... ; .............................................
13. Will lot be regraded. ........................... Will excess fill be removed from premises: ( ) Yes ( ) No
14. Name of Owner of premises/f../..~/?~;~......~..~.../....~. Address~/.~'.~,,t/,e/~/..~...-Phone No. ~7~.,5.~..~...7./..~
Name of Architect .............................................................. Address ................................ Phone No .......................
Name 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
whether interior or corner lot.
-
STATE OF NEW~,g~d~/~ ~ c c
~ '" --(Name of individual signing contrac~
above named.
He is the .......................................... ~..~.~.~----~-- ..................................................... ~ ..........................................................
(Contractor,-- -- agent, co~orate officer, etc.)
of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file
this application; t~t all statements contained in this application are true to the best of his knowledge and belief; and
thaz the work will be performed in the manner set fo~h in the application filed ther~ith.
Sworn to before me this
J~OTARy PUBLIC, State of New York
~o. 52-Bl25850, Suffolk County..
~ll[rn £_xpJLes March 30,