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Home My WebLink About91-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No....$.....~-.~-. ...... Date ....................... A-ag.us.t.... 28 ........... 19~... THIS CERTIFIES that the b?lding located et ,~./.~.....~or.th...~o~_~LlZe ................. Street Map No ............... X2LX ............... Block No ............... $~ .............. , L~(~ ...~O~j:~3.~,r....}~o..7, conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. ~f~.t,.~'ffl]g.dE..,,~ ............... 19.~'~...., pursuant to which Building Permit No ...... Z..~'1 ............ , dated ..................... ~..e.~.t:.?,..~..b..e...r......~ ...... 19...~.~..., was issued, and conforms to all of the requirements of the applicable provisions of lhe Iow. The occupancy for which this certificate is issued is ............ .................................... ,~ Z.~..,~.~,..I~W.~ T~L I ~,IG... ~ ................................................................................ This certificote is issued to ....6er.~z,.d.,...G.~Zto~l~,e....,.(...or~e~..) .................................................. (owner, lessee or tenant) of the aforesaid building. 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 W4J,~,~t,0~F~'][':~F ,~P~,~,~V~,,E~,~4.~P~g~,~.~4~C~~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to' pursuont to opplicotion doted .................... 4~[~l~m~ ....... ~... ......... 1 .~¢~...~ ~nd opproved by the Building inspector, Fee $.,$D.~-0~ .......... FORi~[ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am,ned ......... Approved ........................................ 19 ........ Permit No,......'~..~...,..,./,.../. ........... Disapproved a/c ............................................................................................ ........................................................... (Building Inspector) Application No...~..?.~.~ .......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This epplication 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 port 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 Lows, 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) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder. 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 ........ ~,~.~.,~?,,~..'.~..~,. ...... B~.,~...,~..~.,!.,( ....... Street and Number .~./.~.......~..:....'-~..:.~....~... ....... ~.~.~.'.~ ............ ~..,~:~.(..!~ ...................... 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 .................. ~.7. .................................................. 3. Nature of work (check which applicable): New Buildlng ...... ~......Addition .................... Alteration .................... Repair .................... Rem~al .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ....../~.,~....~..?..~ ......................................... Fee ../, ....................................................................... '~ (to be paid on filing this appticatfon} .......... FEES: 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 ...i ........................ ueprn ............................ Height ............................ Number of Stories ....~?~:~ ....... 9. Size of lot: Front ...../...f~ ............ Rear ....... ~...~?~ .......... Depth '/~ ¢ ¢' '~''~ 10. Zone or use district in which premises are situated....,t~....~..~).~...-~ ......................................................................... 11. Does proposed constructio~ violate any zoning law, ordinance or regulation? ........ ~.....~,/. ................................ 12. Name of Owner of premises ........................................ Address ............................................ Phone NO ..................... Name of Architect ...............j ................................... I~ Address ........................................... ¢~ 4J___.L '~"~--' Phone NO ..................... Name of Contractor...~,~..*~..,....~.¢.~~... ........... Address ....~.~....q,,,f,A.~'.~l/..¢~..'.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. STATE OF NEVi, YORK, ") S S ' ,;?.' , . ..~.......(/..;.?..L~...~...:~.'n.~.~Z¢'.~ ................................. being duly sworn, deposes and says that he is the apphcant ' (Name of inaividu¢ signing appl~ation),.,,~ above named. He s 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 hls 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 ........ ......... dayof .......... ........... Notary Public,....~--o~,.'t.~~.....Coun y (Singature of opplic/~nt) FOIU~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLO, N. Y. Examined ......... ~5,.~. ~1.~..~..... i:.~..... 19.:~...~. . ........... Approved ........................................ 19 ........ Permit Disapproved a/c ............................................................................................ Application No...Z...'C.~.~ .......... (Building 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 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 port for any purpose whatever until o 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. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is own/~, lessee agent, architect, engineer, general contractor, electrican, plumber or builder. Nome of owner of premises ..... ~ .......... ¢: .~.. . ..: ~..:.t...'Z.~.'...~':..T: ......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of and on which proposed war< wil be don~ Map No ~ ~ ;.~. ~ ....... I~...~:..~...!."t.!..!.. Street and Number ,~./: ........ ~ .................................................................. ..~....~.....% ............... ~'....~.~ ....................... 2, State existing use and occupancy of premieses and intended use and occupancy of proposed constructioh: a. Existing use and occupancy ........................ i ................................................................................................ b. Intended use and occupancy .............. ' .~...~ ......... ;--'~'~'~-' ..~. .............................................. 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) FEES: 5. If dwelling, number o¢ dwelling units .......... ~ ............ Number of dweUing units on each floor ............................ I¢ garage, number of cars ........................................................................................................................................ 6. If business, commericol 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 .i..~...~. .................. Depth .~....~.. ..................... Height ............................ Number of Stories .....~ ...... 9. Size of lot: Front ..... Z.C')~-~.. ........... Rear ........ 7..~.].) .......... Depth .......~.....0....O.:....~'~.,.. 10. Zone or use district in which premises are situated ...... /~....~.~ ......................................................................... 11. Does proposed construction violate any zoning Iow, ordinance or regulation? ......... ~....~. ................................ 12. Name of Owner of premises ........................................ Address ............................................ Phone NO ..................... Name of Architect ...................................................... Address ............................................. Phone NO ..................... Name of Contractor..~.~r~,~...'~.~...~/~..~,~."-' -- ........... Address .....~t..a.~,~..:;:~¢..b:...~f~...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. STATE OF NE V Y.O,R K COUNTY OF :~:.) S S.' ..~.. ................................ ,.~ ............................................ i ........... b~emg du y sworn, deposes and soys that he ~s the opphcont above n~d. ~e'is"th~ ......... ~ ...... ~.~ ............................................................................................................... ' / (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 cOntalhed 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 ~rewitk Sworn to before me this ............ ~ ......... doy of .,. (Singature of