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Home My WebLink About1-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 .F~..~ ....... ~i~,],..L~ne ............................. Street Map No ............ ~(,~X. ................. Block No ......]r~¢)~ ...................... , ~ .... ~.O¢O~O.~......N~,.~o conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................ ~......p. ................. 19.~8..., pursuant to which Building Permit No ........... ~....~. .......... , dated ........................ ~.~.~.....~¢ .................. 19~..., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ............ .................................................... P.~I.VATE.. ~.W~LLI ~.~ ....................................................................... This certificate is issued to ..1~o..&..l~r~...11o~e~.d..~en~...]te~n~l-1. ....... ~o~r~er~.) ................ (owner, lessee or tenant) of the aforesaid building. FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLI~RK'$ OFFICE SOUTHOLD, N. Y. · ~ s, 2 ~7 E Y xommed ........................................ 19 ........ Ma ~, 57 · Z 1 Approved ............... ~... ...................... 1 9 ........ Perm~ No ................................. Disapproved a/c ............................................................................................ Application NO....Z..,...r~ ............... (Building InspectorJ APPLICATION FOR BUILDING P~RMIT Date ....................... ..Y:~,~F......~ ...................... 19....5. Z .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. PI6t 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 approva~ of this application, the Building Inspector wil~ 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 OccupancG 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. (Signature of a~plicant,~.~e~e,-i-f..~-c,4~ti~x~) E/S Mill ~, Pe~o~, New Yo~k. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Howard Kent RenJ~ell and Muriel Elizabeth Rennell, Name of owner af premises ..................................................................................................................................................... applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which p, roposed work will be done. Map No ................................... Block .................................. Street and Number E/S Mill L~3ae~ Peoonio~ Ne~ ~ork. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: o. Existing use and occupancy ~..~..~.&.l...i~.~ ................................ b. Intended use and occupancy dwell?£irtg 3. Nature of work (check which applicable): New Building .................... Addition ...... X ............ Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... ~ F ~ 5.00 4. Estimated Cost ............ t[~.,.0.OO...0.O .......................... ee .......................................................................................... (to be paid on filing this application) FEES: f~ 5,00 paid 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 ........ .?~....O.. ........... Rear ...... ,'.~r..~.. .............. Depth .....'~...?...~ ............... Height ............................ Number of Stories ....... ~......~....T..°...~..L..~....%. ........................................................................ Dimensions of same structure with alterations or additions: Front ....~..,~....~.. ............... Rear ................................ Depth ........ .,~..Z ................ Height ...... ~...~.. ................. Number of Stories ~..6.'...~..9../.~..~..~..~ ....... ../.72.......~. ............. Depth ............................ 8. Dimensions of entire new construction: Front ...... /....'~'......~.....i .... Rear ' ~ c:~tD /D Height ...... ..~.. .................. Number of Stories ...['~....~.~.~q."./.!.~.~.. 9. Size of lot: Front ....~.~.~..~..!....~.... Rear ..... Depth ....~..~...8.....~.~ .......... Zone A 10. Zone or use district in which premises are situated ................................................................................................ 11o 11. Does proposed constructio~ violate any zoning law, ordinance or regulation? .................................................... Howard Kent and 12. Name of Owner of premises"M~t~'l'e~-"E""'Re~!J~e~Address~[ll'''~e'''Pe~°n[~''''Ph°ne ~e t at Name of Architect.~.h.l~..~..1..e.../L..~-.,...W.gq~ ................ Address .H~..V.~.V.['I,~a~,..~,.~, ....... Phone NO.~a...~'..-..~)/~7.0 Nome of Contractor .................................................... 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 according to deed, and show street names and indicate whether interior or corner lot. see seperat e sheet STATE OF NEW YORK, ) COUNTY OF ...$.~.~,,~.0.~1~ ........) S S.' ~e .... ~. ,f'x~......~.X. ....... ~ ........ .... :K-~. ........... being duly sworn, deposes and soys that he is the applicant (Name of individual signing application) o-wnel~ above named. He is the .......................................................................................................................................................... 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 ~t~~ ~ ........ ~.~ ....... day of ..~ ....................... 19.?..~...... '~'~'L4~?~'Z~'(Z'~'L(Singature of apl2icant) Notary ...... , ................................................................... . MARION S, ARNOLD r Notary Public in the State of New York ~ ~a~/ ... No. 52-5106600 ~ l~esiding~in Suffolk Cotmty Commission Expires March 30, FOI~NI NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL[RK'S OFFICE SOUTHOLD, N. Y. Examined ......~ ~'.]....~. ................... 19...~.~... Approved .............. ~a~.....~ ........... ] 9.....~ermit No ....... .~.~. ...................... Disapproved a/c ............................................................................................ (Building Inspector) Application No...~..1 ................. APPLICATION FOR BUILDING PERMIT Date ........................ ~ia.~.....2 ..................... 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building inspector. b. -PI6t plan showing ~%ation of 16t and of buildings on premises,'relationship to adjoining premises or public streets or areSs, and giving a detailed description of layout of property must be drawn or~ 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 Building Permit pursuant fo 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, ............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder. owt3.er 8 Howard Kent Renuell and ~uriel Elizabeth Rennell, Name of owner of premises .................................................................................................................................................... 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 .................................. Street and Number ..........J~/'..8..~&,l,~..~8~C..,...~¢..qp~.&.O.~...,~.e..~.....~..o..z?~, .............................................................. 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy .............. ¢t,~.~Z.~&,~4¢ ................................................................................................. b. Intended use and occupancy ............ ~E~,I-.~$~-~ ................................................................................................. 3. Nature of work (check which applicable): New Building .................... Addition ...... ~ ........... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ............ $~.,.0.Q.Q.,,.0.Q .......................... Fee ~ .5..,..0...0. ....................................................... (to be paid on filing this application) FEES: i~ 5.00 p~.~ id one 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................................................................ 6. If business, comrnerical or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front ............................ Rear ............................ De~th ............................ Height ..... ~.~...' ............. Number of Stories ..... .~.....~..T.Q./~..!.~..~ ............................................................................ Dimensions of same structure with alterations or additions: Front _~ 6' r ~ ', Rear Depth ...... :~..~..t. ............... Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ./..~.......~.. ......... Rear ...../.~.t....~....'.' ........ Depth ~(3 /O Height ~' ~/' ' Number of Stories ~ y 7-0 R I t-',~ 9. Size of lot: Front ..... ~):1...£.~ ........... Rear ..... ,~.DZ..9.1...~'.~.. Depth ...... 3..4..~...~.~ ........ Zone A lO. gone or use district in which premises ore situoted ................................................................................................ 11. 12. Does proposed constructio~q violate any zoning law, ordinance or regulation? ........ .~...o. ....................................... Name of Owner of premises..~r, ie&..~....~eZ'~3.e3.1Address~l,.~,,.~.60.Ot';d.O.,..Phone NO. Ch o ~5 e~ ~ ~'We t Mai t., Name of Architect ....... a~..~.8...a......WCL..~ ................ Address .~.~.e;~zleaa.,....~.,.~.o ....... Phone NO. ~.~t,*.~.~3../Jr.?..C) Name of Contractor .................................................... 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 according to deed, and show street names and indicate whether interior or corner lot. SEE SEPE?~TE SHEET STATE OF NEW YORK, ) COUNTY 6F ...~..u..~.~..qlif ........ ) S S.' (Name of individual signing application) duly sworn, deposes and soys that he is the applicant above named. He is the owner (C ' . of said owner or owners, and is duly authorized t~ perform or ave per orme ~ e sa, 'work and to make and file application; that all statements contained Jn this application are true to the best of his knowledge and belief; andthis that the work wilt be performed in.the manner se~ forth in the~application, ~filed therewith.~. ,,,~ ,~_., ~/r~,/'~ "~ ~) Sworn to before me this ~ Jt'~"-~7-/VvYu'~'~ ~ ......... ./...~o~... ..... day of ...~: ...................... 19.~.~.~..... ~/&-,~/'~//¢,,/~k//'~U_/f (Singature of appK~:ant) Notary Public,. ............................. ...~.?./..~...~.~.~....':~/. ......... County M^~ZO:¢ S. a~;~L~) lt_esiding in Suffolk County ..y ~f: Commission Expires March 30, 19-.----