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Home My WebLink About199-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~8,~)b~.t...Lltzte ............................... Street Map No .......................... Block No ............................. , Lot No ~_,~st,..l*Ii~$OZlt ..... ~oY', conforms substantially to the Apphcat~on for Building Permit heretofore filed m th~s office dated ............................. J~.,. ~.6 ......... 19 ~"~.., pursuant to which Building Permit No ........... Z..'lCJC~....., dated ....... .D~e~l~-~..,'~6 ........ 19.~[~' .., was issued, and conforms to all of the requirements of the apphcable provisions of the law The occupancy for which this certificate is issued is ............ ................................ 1~ I:V'ATE ..D¥/ET.T.,]~G- .................................................................................... This certlficote is issued to ...... ~)~1'~,~..~,~,~1~. ................................................................... (owner, lessee or tenant) of the aforesaid building Building Inspector FOI{M ~0. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES ~T~I~6~T.~F ~P~9~IV~J~I~I~t~S~P~Fi~S~UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ...... De.cembe.~.... 2.6 ......... 19.~.. Permission is hereby granted to R~ehter Home..Imlu~.o~ent .... A/C /)onald ,.CF~.~acks ..... 7.t . ................................................. .... ~reempo~t~,.. N.Y. ............................. to .]~J~l~. ~u..addi.tior~. ~ .ext~in~ .dwel~i.n~ .............................................. at premises located at ~./S l~lg. bh~L~ .T~e.I. ..F.~I.S'~ Mal~ion~ /'~.3~. ............... pursuant to apphcat~on dated .......... D~.~.~I* ....... ~ .............19 ~..., and approved by the Building Inspector. Fee $.. ~.~.0...0. ........... FOR~ NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTIGE OF DISAPPROVAL FHe No ~..~.9..9. ......................................... Date ....................... .~...~..?..e.~..b.?.?.....~...6....197.?.... · .~ O..S ape~. i~:.. £¢o~d ............................. · .g..e...Z..Z.~.q~.e..~..~'b..Z... ................................... PLEASE TAKE NOTICE that your cpphcation dated ....................... .D..e..~.e..~..e.~...~.~ ..... 19...~.~.. for perm,t to construct ...~.?{.e.~.]r.~.~...g. ................. at the prem,ses located at .~../~...~.'D~..~...~.~..~?.., ..g. ~..S ~....~,~...~. ~.9.~.~.~ ..~.e..~....¥ .o.~ ~ ................ Street Map .... **~ Block *** Lot *** is :¥z~e..~&~~.dmapproved on the following grounds ............................................................ .................. .~ ...o. ?... ~..e .?..s.~....~.e_q ~.t..o..~ ...~.,o.~.. q~....~.e....~.~...g. ~ ................. Building Inspector FOF. M NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ~:~...~.~.....~.. .......... 19....~'...? ,, , No... ~../....~....~. Approved ........................................ 19 ........ Permit Disapproved o/c ~..'...~-. ~ ~'~, ....~ ~ ~ ~ ~ ~ ............. (Building Inspector) Application No ........J....~....~ ......... APPLICATION FOR BUILDING PERMIT Date . ~...~_ ,~.......~.. ........ 19...,~..;~... INSTRUCTIONS a. 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 adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drown on the diagram which is part of this location. 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 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, and other applicable Laws, 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 and regulations. ............ ............................. (Signature of applicant, or nome, if a corporation) (Address of applicant) State whether applicant is owner, le~,~ee, agent, architect, engineer, general contractor, electricon, plumber or builder. Nome of owner of promises .................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No ................ ~.. ........... ".~,.. Block .......... .~'.i .................... Street and Number ..~....~....~ .............................. .?...~...~,..~ ........................... 2. State existing use and occupancy of premiese.~.~nd intended use and occupancy of proposed construction: a. Existing use and occupancy ................... .~ .................................................................... b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition ...... ~...Alterat on .................. _ Repair .................... Removal ............... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .~.C~ C~ ~ Fee ~' ~ .......................................................... (to be paid on filing this application) FEES: 5. If dwelling, number of dwelling units ..... ~.. Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................................................................ 6. If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front ......... ..'~:.....~. ......... Rear ........ ~..~ ............ Depth ....~......O.. ................ 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 ...... I.....O: ............... Rear ......... ~ ............. Depth ..]..~......~ .......... Height ............................ Number of Stories ....~.~ ......... 9. S ze of at' Front ~..~....'~.. .......... Rear ...... ~...O. ............... Depth ..../....~..?...ff.'~.. ........... 10. Zone or use district in wh ch premises are s~tuated ................................................................................................ 1 1. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 12. Name of Owner of premises.i~...t.~,./.~....C'.~,c~.....T..TT...Address'"' '' ..~.~.~~?r...:...~. Phone NO ..................... Name of Architect ................................... u~ ............... Address ....~~ .......... Phone NO ..................... ~.'..~.., ...~...~ ~ ~ .............. Phone Name of Contractor ........ .q Address ... ~.:...-¢r~..~ 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. ~,~o .~r J'~/~' 7 STATE OF NEW YORK, - ) COUNTY OF ~b~'~...) "// ..... ..~.. ~. 3(.~~~....:.....; ............... be,ng (Name of individual signing appl car on) duly sworn, deposes and says that he is the applicant 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 to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...... day of ........ ................ [',0(, D£N My Commission Expires March 30, 1!~ (Singature of applicant)