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HomeMy WebLinkAbout5246-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z.~32~ ...... Date ............. A..1~...~.. ? .... , 19.7!. THIS CERTIFIES that the building located at .l~Caml. L~ ................ Street Map No. ]gait. ttl~... Block No... ~ ...... Lot No... ~ ....... .~.~.e.enl~e~'~...~.~., ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Ap~-$1...1.9--, 19.7.1. pursuant to which Building Permit No. ~21~.. dated ........... Apr$~,..19., 19.7.1., 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..olde. £a~ily .dwalling ..................................... The certificate is issued to ...Robe. rt. l[~rtol~, .&. ~/;l,f~ ...... .~N.~. ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... I~..~ o ........................... House Building ~pector 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) N? 5246 Z Permission is hereby granted to: ............. ~'tl~.. ,{{~.¢~n.. dr.. MiL~.# .................. to ......... ~..~-~4i~...¢~e~k)..,n~n..e-~lmt. l~-.~v,~.{~i~ .................................... at premises located at ............. {iiltj..{{t..~....llillj~..~lliltX, illl ........................................................ pursuan¢ to application dated ........................ ~1, ......... l~t ........ , 19..~{.., and approved by the - Building Inspector. Fee $-.-.-{i,~N~ ......... Building Inspector ·OWN m SOUTHOLD-- BUILDING DEPARTMENT - ~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .................. .t.~ ........ ~......, 19....~!... Permit No..~..: ...................... Apallcation No ............................ · Disapproved a/c ...... ~ ................... (Building Inspector) APPLICATION FOR BUILDING PERMIt' Date ..................... ~' "./....~ ........... , INSTRUCTIONS P ' ' tt · I du Ilcate to the Buildin '~ a. This application must be completely filled in by typewriter or in mK una suomi ean p g~ Inspector. . b. Plot plan showing location of lot and of bu Id ngs on premises, relationship to adjoining premlees or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram wh]ch Is part of thle appllcat on. 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Bud ng Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southo d, Suffolk County, New York, and other c~a~llcable I.a~., O. rdl .nanc.e,s or Regulations, for the construction of buildings, additions or a terations, or for removal or demolition, al nareln aescrmea. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. /9 / , (Signature ar applicant, or nam, I (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a coq~orate, signature of duly authorized officer. '~ 1. Location of land on which proposed work will be d9qe. Map No.: ...... Street and Number ..~,,..~41~Aq~4~-~ .................................................... Municipality · 2. State existing use and occupancy of t.l~!.:_.~.~a~nd 'nt ended ~q.4d...occ.~.c.u~..pa~ncy.~mPaeed c°mfructlon: b. Intended use and occupan? . ......... ~ ...... 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~ing 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 alto/arians 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 ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction__ ,-~ , · ~,.--,-vi°l~'te any zoning,law., ordinance or regulation?~, ..~ .......................................................... 13. Name of Owner of premises~l,..~..~..Address .~..~... ~¢~J~L..~.~3'4~'e~ ........ 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 indicoi'e whether interior or comer lot. STATE OF NEW,~P-~s nb lee COUNTY OF ;..~Y,,~...J ....... j'"~' . ...... ~..;.~,~.-.~ .............. being duly sworn, d~es and says t~t he is the applicant (Name of individual signing a~licati~) above nom~. He is the ................. ~]: ............................................................................ 'j ........................................................ (~ntmctor, ~t, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said wor~ and to ~ke ~d file this application; that all statements contained in this application are tree to the best of his knowl~ge and belief; and that the work will be perfo~d n the manner set fo~h in the applicati~ fil~ t~r~ith Swam to ~fom me this ~ ~ ' ...... ...... .... ...... :..... _ / , . ................... Te~ ~rch ~, 19~ '