Loading...
HomeMy WebLinkAbout5133-zFOR,M NO. 4 TOWN OF SOUTItOLD BUILDING DEPARTMENT Town Clerk's Office Sonthold, N. Y. Certificate Of Occupancy No. Z 4281. Date Jul.y 8,. , 19 71 THIS CERTIFIES that the building located at t~ur~qalow raane Street Map No..XXX Block No. I~X Lot No. ;gEE conforms substantially to the Application for Building Permit heretofore filed in this office dated F~brmar¥ 8, , 19 71 pursuant to which Building Permit No.5133 dated Peb~lary 9, , 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 . private one. £amtly ~elll~g .......... The certificate is issued to Raymond A, H. lller,. Jr, ..... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~f~ ....... Building Inspector House ~ 165 Bungalow La~e TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) lq.° 5133 Z Permission is her,eby granted to: to at premises located at ..........~ll~llll~lx~...~l~l~ .................................................................................. ................................................... ,ll~t&t~ml~. ........ ti.~.. ................................................................... pursuon¢ to application dotted ......................... ~.....%...~ ............... , 19..~.~., and approved by the Building Inspector. ~ Building Inspector FORM NO. I 'rO~N OF $oUTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. , )97/ Approved ....... t ~ t ~ ................................. , 19 ........ Permit No. ~'( '~ ~ ~-- App, t,on ........... Disapproved a/c ~......~ ...................... ,~' ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT Dote 19..~.../..... (/ INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjo n ng prem ses or public streets or areas, and giving a detailed description of layout of property 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 progress of the work. e. No building shall be occupied or used in whole or in port 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 o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances 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 code, housing code, and regulations. (Signature cf applicant, or name, if a corporation) .... ....................... ~ (Ad'dress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ......... ~.~.~.:.;..,..~._~_......~..'.r.. .~ ................................... , .................................... If apj>Jicont is a comorate, si~natuCe of duly authorized officer. {Nome and title 'of corporate officer) 1. Location of land on Which proposed work will be done. Map No.: ........................................ Lot No.: ........................ ~, Street and Number ...~...~/~/~ ..................... ~~...~....~.. ................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~ a. Existing use and occupancy ............ ~ .............................................................. b. Intended use and occupanc,'. ...... i..~~.- ............ 3. Nature of work (check which applicable): New Building .................. Addition..................~ Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............................................................ Fee (to be paid on fi!lng 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 ......~'.-2:./. ....... 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 .............. ~'...r~.. .......... 10. Date of Purchase ........................................................ Na~;~o.f:F~,rme~r ~)wner ........................................................ 11. Zone or use district in which premises are situated ......... ~....-~....~..~ ................................................. 12. Does proposed construction violGte any zoning law, ordinance or regulation? ............... ~ .................................... 13. Name of Owner of premise~~.~l~...Address ~.4~,..~.... Phone No ..................... Name of Architect ..~, ................... ,~ ...... ,~ ................. Address .......................................... Phone No ..................... Name of Contract .... Address ,~. .. Phone No~..~...~.~..~' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propert~ lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. £XI TF, v L '%'V z-'- STATE OF NEW~YORI~ - IS.S. ...... ~,-~r.~.~,~..~~.. ....................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above nGmed. He is th~ ................................................................................ (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 tha~ the work will be performed in the manner set forth in the application filed therewith. Swam to before me this . ......... ...... o, ................... . ,?.... ......... .... Notary Public, ~.~~ .................. ~ounty (Signature of applicant) ........................