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Home My WebLink About20-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located atShi.~'Tey..~.i...~..~L.~:d..1.e~..Ro.&d. ....... Street Map No .............. 'X'~' · ............... Block No ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................... J~d~e'"'~ ........ 19~..., pursuant to which Building Permit No ...~O ................. , dated ..................... '~'1~ze'""~ ................... 19~...., was issued, and conforms toall of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ............ ...................................... :PR 'IYA ~'}~? · 'D~'P., ~']~ t~f~ ................................................................................... This certificate is issued to 'C~e~rg'e"~¥'"~e}[tt'~'~w~n~r,h .......... lessee]("'°or e~nant~)~k? ................................................. of the aforesaid building. ...... ~'Mi:~.z;':-..,, .............. :: .......... Z ........................... t' .... Building Inspector ~ FOl~t~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL[RK'S OFFICE SOUTHOLD, N. Y. BU~LDING 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..20 ............ Date ................................... ~T.~.e.... B, ....... 1 ~ ..... Permission is hereby granted to: ...~....~.^....~.~¢~, ........................................ .......... ~,~6.......~,~t,...~.e .................................... ............. ~...~......e..$. ~. ~.~ ...... ~:~: ............................. to .......~...t.~ ..~..~.e.~.Z..t.~e ................................................................................................................... at premises located at .........Sj~l,~'~e~..]9~e,~,~..~e.%~ee~...$~0~..,~*e,,.~z~c~..~[~e..~o~ ................... ............................................................... ~.~,.....~.~ .................................................................. pursuant to application dated ................................. ~e....~.~ ............... 19..~%?..., and approved by the Building Inspector. Building Inspector FORI~/I NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×amned ...... Approved..... ........ ........... ........ Disapproved a/c ......................... ~ ............ ~ ......... ~..~ .......... y.~ ............ (Building Inspector) / Application No.....~ .............. APPLICATION FOR BUILDING PERMIT Da t e....~.....~.....~..~.. ........ ~.. ........................ 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, rdotionship 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 o 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 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) ......................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder. If applicant is a corporate, signature of duly authorized officer. 1 Locatonof and on wh ch proposed wor~ w bedone Mo-No 2. 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 appUcab[e): New Building .................... A~ldltion .~. .................. 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 dwellin§ units on each floor ............. : .............. If garage, number of cars ...... ..~--.~.~'~.'~. ......... ~ ........................................................................................... 6. If business, commericol or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimons~ons of exist~n~ structures, if any: FronL.~. Rear ............................ Depth ............................ Height ............................ Number of Stories .............................................................................................................. Dimonsions of some structure with alterations or additions: Front ................................ Rear ................................ D~pth .............................. Heioht .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front...~Z.~.~ .......... Rear .....~..~.~ ......... Depth ...... g.~..~ ......... Height ..../~..~'--- ........... Number of Stories .........~.~ ...... ............. 7/.; ...... ......... 7/; ........ ..... .... 10. Zone or use district in which premises are situated..Z~~.~'~.Z ........................................... 11. 12. Does proposed construction violate any zoning Iow, ordinance or regulation? .................................................... Name of Owner of premlses..~....~,.....~.~..~".~. Address,~i...~.~.~.~,/.,~........~......J-...~!:.~hone Name of Architect ............................ ~: .................. Address ..................... .~.. .................. Phone NO ..................... Name of ContractorZ~...~/'~..~.'.~i.'~'~'.~ddress .~...~'."~m~ .............. Phone NO.~..~.~.....'~r~I 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. STATE OF NE~)YO~, ~ b) COUNTY OF~ S S.· (~e of Jndiv~duo~ s~nJn~ opplJc~1Jon) (ConCepcion, ~ent, corporate officer, of s~Jd o~ne~ or o~ners, ~nd ~s du~V ~uthorized to perform or h~ve performed ~he soM ~o~k ond ~o moke ~nd 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 ~pplication filed thezewith. Sworn to before me this . /~/~ ~~ (Singature Of Notary PuN Jc,.~.~ ....... County ~n~a~sS~on ~.x lraa Mslch 8~, ~ FORM NO. 1 TOWN OF 5OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exom ned... '. ................ ............. .................... (Buildin~ Inspector) APPLICATION FOR BUILDING PERMIT 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 adioining 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 HEREBY MADE to the Building Department for the issuance of a Buitding Permit pursuant to the Building Zone Ordinance of the Town of Southold, SuFfolk County, New York, and other applicaNe 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 a corporation) .................................... (Addre~ss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. . ....................................................................................................................... owner ~re ~ ~ ~ ~Z~~ ~ ~: / ~ Z.~ Name of of~ mise~..~ .~. ................. m ....... ~ '~ ................ /~"'"~/'~ ........... ~1 .................... ~. 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 ..... o .....~..~/ ........ State existing use and occupancy of premieses and intended use and occupancy of proposed construction: o. Existing use and occupancy .......................................................................... b. Intended use and occupancy ~ ................................................................... 3. Nature of work (check which applicable): New Building ...... ...~..........A~dition .i .................. Alteration .......... ; ......... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... /. 4. Estimated Cost ............................................................ Fee (to be paid on filing this application) 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 ............................ Delgth ............................ 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 ...... ./..~.f, ........... Number of Stories ...~.~..t~. ............ 9. Size of lot: Front ............. --7/.....~ ..... Rear ............... --'~' ./....i..- Depth ....... . .~-...~....~..../. .... 10. Zone or use district in which premises are situated..../~.~.~./~.~'..~....~./~'./... .................................................. 1 I. Does proposed constructio~ violate any zoning law, ordinance or regulation? ............... ~ ............................. 12. Name of Owner of premmes.~.¢~.,.. ,~..~..x. Address.~?.J.~r,~/..:..'..~..~'.~... hone NQ~..~....,~..~..,/t 7 Name of Architect ............................. .~. .............. · ..... Address ................. ,...~. ................... ;Phone NO ..................... Nome of Controctor~/..'~/~..~.~..~.,J..~Cfl~..~..~..~,~t~ddress ..~-~.~.'. ............ Phone NO..~...~..~.:~.~ii~l 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. STATI: OF NEN~' Y/$q]g~, JJ/ ) COUNW ........ i ss., (Name of individual signing application) 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 Jn this application are true to the best of his knowledge and betief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn ~,.before me this .......... ~ ........ ,day of .~ ............ 19..~'~..~ Notary Public,.~~....~.~....County Go~mnission Exi)ii-c~ iVt~rch 30, l~llJ (Singature of apphcant)