Loading...
HomeMy WebLinkAbout8032-zFORM NO. 4, TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at liOx'tb. Zield .Larva ......... Street Map No. X~ ......... Block No.x:r,x ....... Lot No~XXX .... Sou.ttaold...N,Y., ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. .J..uO.~...~019. ?~. pursuant to which Building Permit No..80~2Z. dated ........... J..u~..e... ~.0..., 197~.., was issued, and conforms to all of the require- ments o£ the applicable provisions of the law. The occupancy for which this certificate is issued is .. p~i¥~.t.e.. ~¢g.e.e ~v~.' .l~l~f~],ctllag ....................................... The certificate is issued to .. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~ :~.; .............................. UNDERWRITERS CERTIFICATE No..~.,.R., ....................................... HOUSE NUMBER .... ~ 0~.0 ..... Street.. N. crth£iold..Lane ...................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON T~E P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHOI~IZED) N? 8032 Z Date ............................ J~.e....-~0 ......... , 19....~.~ Permission is hereby granted to: ................... ~'OXtt;ri~q:~L' ......................................... to ..;~,.~.l.l~V ..;~t e¢,~ .. e~e ce ~.$ ory...(, st. ora~e .) ...b~.].d~.n~ .............................................................. at premises located at ..].~3-.-.-t~'¢;}l~2.J:e.,l:&"-']~e .................................. .................................................... f~a¢~J:cl' ........ ~'~ ...................................................................... pursuant to application dated ............................. .J~...-.~) ........, 19~. .... and approved by the Building Inspector. Fee $.~, ~.'u ............ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE 19 ........ Permit No .......................... APPLICATION FOR BUILDING (PERMIT ~. ~ INSTRUCTIONS a. This application must be completely filled in by typewriter o~. Jn ink and submitted in triplicate to the Building ~'~. Inspector, with 3 set~ of plans, accurate plat 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 st?ets o~? areas, and giving a detailed description of layout ofpraparty must be drawn on the diagram which is part of this apphcation. 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 w~li 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 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 herei.n described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cnde, and regulat,ons, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) //97) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... ~....~....?....~.....~... ........ .~......~...!....~,....~.. ......................................................... : ......... ~ .................... If applicant is a 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 Trade's License No ............................................... 1. Location of land on which proposed wark will be done. Map No.: ........................................ Lot No ......................... Street and N~.mber'. ............. .~...~....~..~.........~..~..~....T...~...~..../...~.'~.~.....~.. .......... ~...J~..../~....~.. ............ ..~...0....~...~..~..L..~. ............... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy . . / ..~...~..../~...~L'1' ~)~/.~..L...L. IN~,~ · /x//-7-/4 . . . b. Intended use and occupancy ............................................................................... ~. ........................................ whetherPr°perty interiorlines' GiVeor cornerStreetlot.and block number or descri~.ti~Oc~aCcording to deed, ond show street names and 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair.. ................. Removal .................. DemOlition .................... Other Work ................................................ . .... 4. Estimated Cost ............. ...~....0..0....0.. ................................ Fee / ~ ~ .... (Description) (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 ................................ / f 8. Dimensions of entire new construction: Front Rear Depth ..... ./.....~'~... Height ..../..~.... ...... Number of Stories ...............~..../~...~ .......................................................................................... 9. Size of lot: Front / aa Rear /....~....~'.. _ . ~1'7 --~.~7 ...................................................................................... ]Jepth ................................ 10. Date of Purchose ........................................................ 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. Name of Owner of premises/)....~....H....~.. .......... ~)Ul N N,.,................ Address ...... .E+~rt,~t~..D... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...... ~.0........~-.~...~..~....~....~.....~..t .............. Address ......:~...?..?.../.~..?.~.~. ..... Phone .............. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from indicate STATE OF ND/V YORK, COUNTY OF ................................ .................. ............ J i/oo NO'C-TH' F I E L,~ (Name of individual signing contract) above named. He is the ................. C.D....~....'~.....~...~....~..~..O../...~'m... ......................................................................................................................... (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 application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this · ~0 da of ~L)I~Z 19"/~ ~ /-/ /)\ ............................. NOTARY PUBLIC. Stet* o{ New York No. B2-4522026 - SuffoJl~ County Gornrnlsslon Expires March 30, 19...~..