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Home My WebLink About61-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY Date ........................ J.'u~.e... ~'. ................... 1 THIS CERTIFIES that the building located at .... E/C.J~......0a~'J&~lrl,..A.~.e..,E~t ............. Street conforms substantially to the Application for Building Permit heretofore filed/in th~s office dated dated ......................... ,,T.g..1.~...]..O. .............. 19..~'.~...., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy fo.r which this certificate is issued is ............ (owner, lessee c~r 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 ~-~,l~/'f,l~c~,/~N~c~[f~/~d~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: pursuant to application dated ............................ .~Y~.....~O~ .............. 1 ..~.., and approved by the Building Inspector. Building Inspector FORM TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 5OUTHOLD, N. Y. Examined ........................................ 19 ........ Approved ........................................ 1 9 ........ Permit No ................................. Disapproved a/c ............................................................................................ Application No ............................ (Building Inspector) 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 Iocatioh of Io~ 'ahd of buildings on premises, relationship to adjoining premises ar public streets or areas, and giving a deta¢led description of layout of property must be drawn on'th8 diagram which is part of this location. c. Th~ work covered by lhis abpli6ation ruby not be commenced before issuance of Buildlng Permit. d. Upon approval of this application, the Building Ir~spector will issue a Buitding Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress oF the work. e. No building shell be occupied or used in whole or in part for any IPurpose 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 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. ............ ......... .................... (Si~nature'of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. If applicant is a corporate, signature of duty authorized officer. (Name and title of corporate officer) Location of land on which proposed work wi!.~ bec;Jane. Map No ................................. Block .................................. Street and Number .. ~: .... .~..~.C .........~ ...... ... .: ..... State existing use and occupancy of premieses end intended use and occupancy of proposed construction: a. Ex st ng use and occupancy ....................... , . . . b. ntended use and occupancy ~'*¢' ~* ~"~ ~'~"~'-~ ' .......i'" .'" '".', "',,'", ..... 3. Nature of work (check which applicable): New Building ......... .~. ......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition ................... .gther Work (Describe) .................... 4. Estimated Cost ........ ~.~,.,0...0~...,..0.,0. ................................ Fee ..,J, ..................................................................................... (to be paid on filing this application) FEES: 5 rooms & bath 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor all on One ............. t, lZ66t~ ..... If garage, number of cars ................ .0.,.e.....e~..~..&~.8. g.~ ............................................................................................ 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 ....... 8.~...~.. ............ Rear ..~,6.....~..: ............... Depth Height apprX,15 ~ Number of Stories one 116 ft. ,:, , 116 £~- 100 X 109 9. o~ze of /at, Front ............................ Rear ......................... ;,. Depth .................. ~,....i;. ]0. Zone or use district in which premises are situotea .......................................... ~.........~ .......................................... n~ 1 1. Does proposed construction violate any zoning Iow~ ordinance or regulation? .................................................... ~avenswood .re~is~.An'con Petra~i~m Arlrl,~¢~2:,~4) B~oadway,.A.s~.orla, Ph~n~ 6-4930 12. Name of Owner of ,, ... ............................................................................. N'~:u~ .............. NO ..................... Name of Architect ....... E,.~.,P.~t.e~.r~ ........................... Address ..................... ~l~.~O~'J.~-.~N.,ff. Phone NO ..................... Sou: d Name of Contractor....J..O.~.e.p..h....R.~.d..l..°..h. ....................... Address .....SO~Hold,..N.,Y., ........... Phonef~ .5.~3~,1 ....... PLOT DIAGRAM Locate clearly and distinctly ail 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 NEW YORK, ) SS.' COUNTY OF .... ~.0~ ......... ) ................... .~,,0~,,~[~__~_.~,,[_.~. .................................................. being duly sworn, deposes and says that he is the oppUcont (Name of individual signing application) Contractor 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 flied therewith. Sworn to before me this ~gth,,., ~ /% ~ ~ly, 19 §?' ................ .v~oy ~.~,.~ .~- ,... ........................... Z/l~')~ ~ / ~' Notary Public,. ............................................................. (Singature oF applicant) FORM 1~I0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....~/ .~'.':/.... ~ .......... 19..~..17.. Approved ........................................ 19...~..~.Permit No....~..~..(. ............. Disapproved a/c ' ..................... ~.r;~ ........................................................... ~ .~.. ...... ...... .......................... (Building Inspector) Application NoZ~ ......... A UCAT,ON UlLDING Date ................................... 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 end of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detai~ed description of layout of property must be drawn on the diagram which is port of this bcation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this app~ic~tlon, 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 ~nti[ ~ Certificate of Occupanc~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building E~epartment 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (S~gnature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Name of owner of premises....~~..'~........b/.~..CK..L.....~.., ................................................................. 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 , ~ State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................. b. ntended use and occupancy /L-~--',- .... , 3. Nature of work (check which applicable): New Building ........ Z .......... Addition .................... Alteration .......... ' .......... Repair .................... Removal .................... Demolition ................... .~ther Work (Describe) .................... 4. Estimated Cost ....... ,~1,~,,000..00 ................................. Fee ....~..~z..~' ............................................................................ (to be paid on filing this application) FEES: 5. If dwelling, number of dwelling units ............................ Number of dwelling units qn each floor..a]~l.,ol~.,.~. ..... 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 ...... §~..~t~ ............ Rear Height .~.~..~..~....~_~.....1~.. ..... Number of Stories ..........Ql~e. ........... 9. Size of lot: Front ....],~,~....~...'. .......... Rear .,..~..~.tt..'. .......... Depth ].t~0...Z...1,,~.g. .......... i0. Zone or use district in which premises are situated ...... .~..O.~.~..O.~..~.,...N..?~.: ......... ...~..~ ...................... 11. Does proposed construction violate any zoning law, ordinance oF regulation? ............ 1~¢~ .................................... 12. Name of Owner of premisesli~.~l~..[#.~l~l~,.~/t~. ......... Address2.~..J~.o.~.~,~,l~,~.~,~..Phone NO. ~..4J~,,,~O ........ Name of Architect ...... E,.,i'.ol~lt,®l'J ............................ Address .................... Name of Contractor..~.O~el~..~.~.~t~ ........................ Address ..... 8~t~1~..~.,~..* ...........PH~I;~,,2~'/'~ ........ J 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 NEW YORK, COUNTY OF ....B/~.~.OI~ .......... ) ................... ~Jl~.l~[~t{..~4~,0~,~ ................................................... being duly sworn, deposes and says that he is the applicant (Nome of individual signing application) above named. He is the ........ ...C~..~...I?.~;....~'... .............................................................................................................................. (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 Notary Public,, ............................................................. County