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HomeMy WebLinkAbout8054-zTO~N OF $OUTHOLD BU~,~I~G DEPARTM'~'~T Town Clerk's O~iee Southold, lq. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at..C.u. ~.t.e.r...i.v.e. .............. Street Map NoSnif~hrteld. ~ock No ........... Lot No.?...S..o.u.t.h. 9.1.d.. )! :.~.: ............. conforms substantially to the Application for Building Permit heretofore ~ed in thl. office dated ...........JuLy.... 7.., 19.?~. pursuant to which Building Permit No..~0~+~. dated ...........~.!~Y.... ?..., 19. ?~., was issued, and conforms to all of the require. meats of the applicable provisions of the law. The occupancy for which thl, certificate is issued is P~.iy~te .~.e.c.e.~.o.~.. { stor.&~e) b.u$. ld..i3~ The certificate is issued to ... NI~cL~..lilmh&to~e ...... .0~no~ ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .H..,.~.,. .............................. UNDERWRITERS CERTIFICATE No. N HOUSE NUMBER ~700 Street Custer Ave $outhold ' Building FOBM 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? 8054 Z Date ............................ ,T~I].~, ....... .~. ......... 19.9~.. Permission is hereby granted to: · .l~,~i~ie....&~mbet~vte .................................. ..... t2~O.....l~te r...~,~e ................................... ltu~Lld ne~...m~g.e~.o ....(~.~ ~). ~.~J.~Um ............. to ...................... i~. ~ ..... ~ ................................................... at premises located at .]~.~..~. ......... ~ll~J,t,J~:Le~d..~..~-Ir ................................................................ ......................................................... ..~..~..~.e.~...~,~e .......... J~.a~t~o~. .................................................. pursuant to application dated ..................... .*T....~'. ....... .~. ............... , 19~.~...., and approved by the Building Inspector. Fee $.~ .0...e....O~.. ............ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ............. ~.....~, 19.~.~..~ ~OUTHOLD, N. Y. , pr ed ............. ........ L?..., ....... APPLICATION FOR BUILDING PERMIT ........... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink 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 o~ areas, and giving o 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 shaU be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until o Certificate of Occupancy shall hove 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, end other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal' or demolition, os 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. (Signature of applicant, or nome, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~.~..~..~..1..~ ......................................................../..~L~. 14~L.~ ~t "/-0 ~ /..C.. .~.. ......................................... 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 ............................................... (~ ~ ~2~' ~ Location of land on which proDosed worl~vill be done. Map No.: ....... .~.- L~ot No ...... .;.. ............... Street and Number ............. ~...~ .......... ................ ' ................................................... Municipality State existing use and occupancy of pre~/~ .and, i~t~nd~e~d use and occupancy of proposed construction: . a. Exisiting use and occupancy .......... ~~....-~..~..~ ........ ~ ...................................................................... b. Intended use and occupancy ............ ~.~.~~....~..~....:.:.:~ ..... ~ ....................................... ~ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. RemoVal .................. Demolition .................... Other Work ................................................ . .... ~ S°T- / ~) ~ (Description) 4. Estimated Cost ............... /.. ........ ~ ............................ Fee ...... i .................................................................................... (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 c~rs ............................................................................................................................................. 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 of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10'. Date of Purchase ..................................................... ,<.~a~e(~ For~er Owner ........................................................ 11. Zone or use district Jn which premises are situated ..~.x] ...... ~....~..-. ........................................................................... ";"~,"t 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 .................................................... Address ................................ Phone No ....................... 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 N~~ ~¢t couNw -/ '_ ...................... ..~....~/r/~...~..~,~.~....../.~.~.i....?~..being duly sworn, deposes and says that he is the applicam (Na~of individual signing contrac~ above name. He is the ........................ ~ ........ ~ .................................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly aut~rized to perform or hove performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thaz the work will be perfor~ in the manner set fo~h in the application filed therewith. Sworn to bef~ me this ~ ................... dov o* ..... ............. ...... ...........