The URL can be used to link to this page

Home My WebLink About72-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...... Z...~6 ......... Date ................... ~T~').l,l~r~......8 9 ............. 19.~8... THIS CERTIFIES that the building located at .E~/S....~z'aZhwoh'l...Hoad ................... Street Mop No..~.~.~ ........................... Block No ......... ~. ................ , ~t*~ ....~.~W...S~.fO],~...]'~. conforms substantially to the Application for Building Permit heretofore filed in this office dated ................. AI:I~,s.t~ ....... ~ ............ 19.~.~..., pursuant to which Building Permit No ..Z...~.2 ................ , dated ................... A~.~S~.....I~ ............19.~...., was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ............ ....................................... .................................................................................. This certificate is issued to ..... ~l~&....~,...G'l~de,~. .......... (...~e~.) ............................................ (owner, lessee or tenant) of the aforesaid building. mullalng inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES ~,:TfHf~Gt~Ht~E~fO~F ~AP.~,~¢~gg~¢A~,R~$~cg~-~&~I~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) *? Permission is hereby granted to' pursuant to application dated ...................... .A.~G.~.zt.~.t.......~-.~ .................. 19~.?...., and approved by the Building Inspector. Fee $ 10,,00 tJ';'r''~' -'L Building Inspector FOP~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No..../..~......?.. i~ .... APPLICATION FOR BUILDING PERMIT Date .~. ,8 / ')~' ~ o 5ri ................ ,...~ ,tt ................................... : ...... 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 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 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 have been granted by the Building Inspector, APPLICATION IS HEREBY MADE to the Building Department for the issuan~ze 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 constructioh of buildings, additions oi' alterations, or for removal or demolition, os herein described. The applicant agrees to comply with alt appllcable laws, ord'inances and regulations. ',, '~'" (Signature of applicant, or name, if o corporation) : ............... ..................... "~' ''(Ad,ess of app)'icant) ~ State whether applicont is owner, lessee, agent, architect, engin, eer, g~ne. raJ co'ntractor, electrican, plumber or builder. ................................................. ~.e.~..~Z....~g.~.o..~.o..~. ........ ............................ ............................................................... rem ses F~na H. Glandez* Name of owner of p ...................................................... : ...... .., .................................................................................... 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 .....? ........................... G a hwoh~ Ro New SuFfolk Street and Number ....~....~. ........... ,~,..,...,~ ................................................................................................................ 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: Vacant e. Existing use and occu anc b. ~tended use ~d occupancy ................. ~i~e..D~l~ ......................................................................... 3. Nature of work (check which applicable): New Building ...X ............. Addition ....................AKerotion .................... Repair ....................Removal .; ..................Demolition ................... .O~her Work (Describe) .................... · 4. Estimated Cost ~],0~(~OO~JQO Fee~' ! j~ (to be paid on filing this application) FEES: 5. I{' dwelNng, number of dwelling units.~..~.~.~.~.,~..~l.....~u~mber of dwelling units on each floor...~,./~.QD~llt ........ Ii: garage, number of cars ........................................................................................................................................ 6. l i: businessf commerical or mixed occupancy, specif~'n6ture-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 ~ntire new construction: Front ...... .~,f~..;~l~.~ ....... Rear ...... ~6...~..~* ........ Depth ...~..~.~ .......... Height ....... [.~...~..~L~. ...... Number of Stories ..... .~, .................... 9. Size of lot: Front .....].0.Q..~ ...... Rear ..,~.~.,*~/~.~ ........... Depth .~k~O...~ ............... 10. Zone or use district in which premises are situated ...... ~,'J.~ ........... /~..~ .......................................... ]'. .......... 1]. 12. Does proposed construcitio~ violate any zoning {aw, ordinance or regulation? ........ ~0~.m ..................................... ..... ~,. ;~.... ,~.,~..~,,~ ............ Phone N 0.~,..4....~.~..~. Name of Owner of premises..~.~LJ{~...~..~l~.~..~....Address e J~ Name of Architect ...................................................... Address ............................................ Phone NO ..................... N~me of Contractor.....~....~...,~-~,.~..~...~..~.. .................... Address ..... .~.~'~...°...b:..O.l]~...~. .................. Phone NO.~......~.....~.~..~.. PLOT D(AGRAM 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 O~ NE~_YOR~ ~ ) ~ . ~-~ co,Mw I ' (Nmme of ind~viduol signing mpplicmlion) mbove homed. 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 fo make and file this application; that ail statements contained in this application are true fo the best of his knowledge and belief; and that the work will be performed in the manner set forth Jn the application filed therewith. Sworn to before me this / · .............. ...... day of ....... (Singature of applicant) FO~M NO. 1 TOWN OF $OUTHOLD BUILDING ~EPARTM[NT TOWN CL~R~S OFFICE SOUTHGLD, N. Y. Disapproved o/c ............................. ...._.._,_~ ~__~ , _ ~_,~, ,~._._.~,~~Z~i ......... . ~', ~ . ~- ...... ....... ...................... (Building Inspector) Application No ............................ AP~LICATION~OR BUILDIN~ PERMIT INSTRUCTIONS a. This application tnust be completely filled in by'typewriter or in ink and submitted in duplicate to the Building Inspector, b. Plat 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 JocaHon. c. The work covered by this application may not be commenced before issuanc°e of Building Permff. 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 fha progress of the work. e. No building shah 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 Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk ~ounty, New York, end 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 ap,plicant, or name, if a corporation) [fk~aress at ~ppuobnt~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber, or builder. General Co~ractor Nome of owner of ,~r~;~o~ Edna H, Glander If applicant is o 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 Orathwoh]~o~ New Suffolk 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: I~ac ant Lot a. Existing use and occupancy ............ ~ ................................................ . ..................................... b. Intended use and occupancy ................. ~pk.'c..a...~.f~..,,,~,e.~.~..z....t?~... . . 3. Nature of work (check which applicable): New Building ....~ ............. Addition .................... ,~.lteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ..~,:L.0,~,C),Q0...0.0. ................................. Fee .......................................................................................... (to be paid on filing this application) FEES: 5. If dwelling, number of dwelling units.,~....,~.?..~.~..&..~..e.....~..~uemb~r of dwelling units on each floor...~....~.g..o.~ ......... If garage, number of cars ............................................. ~ .......................................................................................... 6. If business, commericol or mixed occupancy, specify notu(e and extent of each type of use......-. ......................... 7'. r)imensions 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 ................................ Front ...... ~.6.....~.A ........ Rear 2¢ ~,, 8. Dimensions of entire new construction: )? ..... ~,¢...~.* ......... Depth ............................ Height ...... ~k.5....?,~.~. ....... Number of Stories ..... ,]-.. .................... 9. Size of lot; Front ,,..~..QQ...:~:t,., ....... Rear ..6.',~./..*.Q~.! ............ Depth .],.5...0....! ................ 10. Zone or use district in which premises are situated ...... ~-.~ ............... ~....~ .................................................. 1 1. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~.o.... ...................................... 12. Name of Owner of prem~ses~.~P...~...]~....G.~..&..~..~.e..~,....Address ....~e.'ff.....S.~/..o..Z..]~ ............. Phone NO]?~ &, 6].~8 Name of Architect ...................................................... Address ............................................ Phone NO ................... ;. Name of Contractor....~..~..:.,. ~,1:.~.. ~.e...e..b...e. .................... Address --.C,,~i~.,°..br...°.¢~..e. .................. Phone NO?.~... ~,...8..6..8...2:.. 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 N.~ ,Y~I(2 ~ ) COUNTY~--~ '%.~- ..-, - . ,_ _0~"'~"'") ~R~ ................. ~..~...:....~..~.~.¢....,~~,,,.being duly sworn, deposes and says that he is the applicant (Name of individual signing application) r obow homed. ~e s ne ........................................................................................................................................................ (Contractor, agent, corporate officer, afc,) of said owner or owners, and is duly aufl~orized 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 / /~X I// ............. ? ....... day of ~ .......... 19.,,~,..',/,., Notary Pub ic ......~"at ....,s.~.~.,**.~ , Y (Singature of applicant)