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HomeMy WebLinkAbout8098-zFOBM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . p.Vt. l~ .l~..~ .(.Dte~.iel~ .Rd~ltreet Map No...;~. ......... Block No. ~ ....... Lot No, :~. '...O~!.e.~.~..~....Y: .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. JUly.,. 2~ 19.~.~. pursuant to which Building Permit No .... 809J~Z dated ......... J:a3~y....~..., 19.?~., 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 .Private..(.acce.s. sorY.)., gr.e.e, ahou~e. ................................... The certificate is issued to ... Ar.~,h~t~'. ~o~t~&x,d ...... 0wae~ ...................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) .~,1~.o ............................... UNDERWRITERS CERTIFICATE No..N,R, ....................................... HOUSE NUMBER ...t.0c)0. ...... Street. IUi~ FilM, IT (THIS PERMIT MUST BE KEPT ON TIlE PREMISES UNTJL FULL COMI~uL:TION Of: THE WORK AUTHORIZED) lgo. 8098 Z at premise~ lacated at .~,~O~...~,..~c~..~..4L....~.~.ev~i,~l~..Ro~, ........................................... ....................................................................... l~'.~ ent, ....... ~i.~¥~ .......................................................... pursuant to application dated .................... ~ ......... ~:>br .......... , 19..~., and appreved by the Building Fee $'1...~.e.~). ............ J TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~proved 19...J... ~*rmlt ~o ................................... ~isopproved o/c ............... a. This application must be completely filled in by typewriter o~ 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 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 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, 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 name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. .............. (Name and title of corporate officer) Builder's License No. C~"~-~-~ ...... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... State existing use and occupancy of pre~;~ses and intended use and occupancy of proposed construction: ', t, use and occu anc a. ex'si 'rig P y .............................. .~ ............. *"~ ....................................................................... b. Intendea use eno occupancy ........................................... ~ ............................. 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ (Description) 4. Estimated Cost ....................~,T......O~...~.......~'.. ..................... FeeZ (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 ................................ 8. Dimensions of entire new construction: Front ................... ?..'T=. ........... Rear ....... ].~.....~ ........ Depth ..~....~.. ................ Height .................... Number of Stories ........................................................................................... w; ...................... 9. Size of lot: Front ........ ..?...~.....(~. ................................ Rear ...... '...~T...].'?T.....C~... ................... Depth ...... .~....~....O. ............... 10. Date of Purchase .................................................... ~..~r~e of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..¢~..., .................................................... ~-~,,-"2D"~' ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... .z...,?.._~ ........................................ 13. Will lot be regraded . ............. .,....~,~..,~Will excess f~ll be removed from premis~,~.~ ) Yes ( ) 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 ali 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 Iol. STATE OF NEW./-~YOR~.~,. ~l~ COUNTY OF~. ~l"'~ ...... '~'~ , ..................... ~..l~J(.l~/v..~. ......... .~,.i~"..~..I.$...c~..~....~ ........ being duly sworn, deposes and says that he is the applicant (Nome of individual signing contract) 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,j~make and file this application; thor all statements contoined in this application are true to th~..~be.s~of his kno~4e~ge and belief; and thor the work will be performed in the manner set forth in the application f.,,jJ~""fhere~,.~d,t~,-~ Sworn to before me this ~.~ / / .... ........... ........ Notary Public ......................... ~~ C. ounty ........ ..... ~-.-~- ~ ~- - ...................