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Home My WebLink About31-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE: OF OCCUPANCY No. ~.~.~.0. .................. Date ....................... ~t'~.~'J.~....'[6 ......... , 19.6.1... THIS CERTIFIES that the building located at ........ .~.t~..~[O&~ ................................... Street Map No.C~lp.~..~:Ll~,~Block No ....................... Lot No ....7.1. ......... ~a~tt,:Lt,/J.~k.....[;[.~.~ .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ......................................... ~.~,'~.~.,.,..~..~......, 19...~.?.. pursuant to which Building Permit No. ~.~. ......... dated ............................. ~l'i.~te ........ 2.~......, 19...~.~., was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .............. · ~ ~,.~.w.~ e. · · ~'~ e. · .~m .~.:L.~t · · ~'e~.~.~.n.l~ .................................................................................. The certificate is issued to ...~.O~J~t...~,~ ............... I)~f~rte~ ................................................................. (owner, lessee or tenant) of the aforesaid building. I~OP~VI NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWI~ CLEBK'S OFFICE $OUTHOLD, N, Y. CERTIFICATE OF OCCUPANCY No. ~ 9~.0.... Date ...................... ~le~',,]~.~.....~.6. .......... , 19.~.~. THIS CERTIFIES that the building located at P,~l~./kOl'~.-t!d,.,. ~gt;.&~gk ........ Street Map No. C..~p[:.,...g;!,.~ldBlock No ...........~..~...*. ....... Lot lX~o ............ ~..?~ .............................. .................... conforms substantially to the Application for Builc]ing Permit heretofore filed in this office dated ............... ~.~.:.~.~...~.4.. ................. 19....5..? pursuant to which Building Permit No ........ ~..~t.., dated ............. ~.~..~.~.....~.~ .................. 1~...7....,, was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ......................... ~R~g*~...O~41~ .~.~..t~E~I~ ........................................................ This certificate i~ issued to~'i~l ling, .~'~fl~ . .......... · .......................................... (owner, lessee or tenant) of the aforesaid building. FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No....Z,..~l ............ Date ............................ ~.t:l~..~e ........... 19~"~.... Permission is hereby granted to: .~t, on~...~bJ.t,~.. ~V'.a.....,T~m~ ..~k ........... ............ .................. t,. ,.~.,. ~......~,.~Z.,. ................................... to ~ ~ ~...~n.. m:lcL~.t,~.on ..t~ .. ~ ..~.~me3.3,~.z~ ................................................................ at premises located at ..]~.,J~.~ .............................................................................................. ...................................... ~a~t,.,...ir,,l. dc1: .. ~.e% ee .............................................................................. ........................... ~t,.~.~.~.~.,......~.~i:.~. ............................................................................. pursuant to application dated .................................. ~t'~ ..'1..~, ........... 19~/:...., and approved by the Building Inspector. Fee $...,,~,~0 ....... Building Inspector FOI~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. v. .......... Approved ................... :.: .................. 19..::....Permit No......~...~..f . ......... Disapproved ............................... ~ ....................... ~ ............. ~r;;?' ....... ............. ....... ] ....................... Application No...~ ................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter ar 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 a detailed description of layout of property must be drawn 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building inspector. APPLICATION IS HERESY MADE to the Building Department for the issuance of a Buildiag 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 name, if o corporation) (Address of ~/pplicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder. /Nf°ampep~ia°r~;~ra°fcoP/;or~ist~s,"~;'~'[~';'~;'~'~f duly au;'~'~;;';'~ ...................................................................................... (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No ................................... Block .................................. 2. State existing use and occupancy of premi~ses and intended use and occupancy of proposed construction: a. Ex~st~ng use ond occupancy ........... ~ ................................................................................. b. Intended use ond occuponcy ................................................................................................................................ 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 filing this application) 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 ............................ Height ............................ Number of Stories ............~ ......................................................................................... Dimensions of some 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 Pot: Front ....~...~...~......~..... Rear ............................ Depth ....../, .~..,~.......~ / 10. Zone or use district in which premises are situated .............. ' ...................................................... 1 1. Does proposed constructiom violate any zoning law, ordinance or regulation? ........ ~ ................................ 12. Name of Owner of premise~......~ ........ Address ..~.~.....~ ........ Phone NO ..................... Name of Architect ............. ..................................... Address .....~ ........ Phone NO ..................... Name Con ractor ...... ~,~-~.~...--?,~....~.~r~..~/J~ddress ................C-. ........ ~ ............ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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. STATE OF ,/z ) s s. · ..(o~~~ ................................ being duly sworn, deposos ond soys thor he is the opplt¢ont (Name of individual signing application) above named. He is the ........ ~.~' '~Y--¢~ .......... (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 ,~ .......... ~.'.~..,. (Singature of applicant) NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Aro Nor ,,,,,~,~ ~,~ / pp ved ........................................19 ........ Perm t ................................. Disapproved a/c .......... ....... ............ (Buildin~ Inspector) Application No...~.... ................... APPLICATION FOR BUILDING PERMIT 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 adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is port 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 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 o 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 aFl~licont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eJectricon, plumber or builder. owner af premises ............. ~ ....... ~ ........................................................................................ Name of If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No ................................... Block ................................ Street and Number ....~ ............................. State existing use and occupancy of premieses and 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 .................... Alteration .................... Repair .................... Removal .................... Demol't,on . ................... Other Work (Describe) .................... F 4. Estimated Cost ......... i. ............................................ ee ......................................................................... (to be poid on filing this applieotion) 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 ............................ 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 ............................ 10. Zone or use district in which premises are situated ............................./...1......~ ............................................. 1 1. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 12. Name of Owner of premises. : ..... Address ..... Phone NO ..................... Name of Architect ................................... ,~ ................ 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 numbers or description accordi.ng to deed, and show street names and indicate whether interior or corner lot.\ ' STATE OF NEIgV YORK, ,~ ) COUNTY,.~._.~_.~,,/t,~_,__.,,O~.~..~....) SS.' ..~,~¢~...~~ ........................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ~~~ . . (Contractor, agent, cat, rate 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. S worntobeforemethis~~ ~ 19.~. /~ ~~ ~ :~~ ~. (Singatura of applicant) Notary Publi .~.~ .... County