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Home My WebLink About92-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .W/.S.....~.e~o_tl~c,..~...]~L~ri~ .............. Street Map No ..........)~)L ................... Block No .......... ~,X.'.~, ................ , ~[~JJ~..~[,~Iz~.e~Lt..~o~e ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................. ~.]3~,.el~,l~e~. ....... ,~ ........ 19.~.~'...., pursuant to which Building Permit No ..,,~,...,¢~. ............ , dated ....................... S.~t]~.'~emb~.....~.. 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 ............ .................................. ............................................ This certificate is issued to ..(~...~,,.~,~l~t~' .......... (~..~e~....). ........................................................... (owner, lessee or tenant) of the aforesaid building. FORM TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE ]KEPT ON THE PREMISES ~,W~;~I~¢R~Jx¢~,t~¢~: ,~[~¢~P~~~T~UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No ...... Z~..~. ......... Date .................. Permission is hereby granted to: che~t(m o~m.~:~ ........ ~.....~...~.~:.. ~ ~:~ ................ . ~t~.~,,~r..'. ~ ~ ~ ~ ........ to ......... ~,~,..~,.~,C1~,,¢,],O~..~.O.. e,~t~ C~ ,7~,~tf ..................................... at premises located at ..... ~e~L,O..;~3~,?.~?~.~. ............................................................................ ................... : ...................................... ~" e~' v'"' '~:~ "~" ........................................................................ pursuant to application dated ......................... ~9~,~.....~ .................... 19~..., and approved by the Buitding Inspector. Fee $' ~ ~ O0"'"~_)~coc~. Building Inspector FOR~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approyed ....................... ~.: .............. 19.f?.,...Permit N o.', .':'- ~ ........ f.. ................ Disapproved a/c ..7~C:...~].~....~ ............ ......... ....... ............... (Building Inspector) / Application No ........~,..Z~ ........ 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 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 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) ....... .......................... ~Addr~,ss of opp cont~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder. Nome ofownerofpremses .~. /~,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. Mop No ................................... Block .................................. Street and Number .....~'" '[.~....~...'?~e'J~'~,.....~.c~..,.~~-~ State existing use and occupancy of premieses and ~ntended use and occupancy of proposed construction: a. Existing use and occupancy ......... :.~.........~....'~..~..-~'...'m... . .......... 3. Nature of work (check which applicable): New Building .................... Addition ,,,,;~,,,,,,,,.,,h[t(;~'Qti0fl ................... i Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... : 4. Estimated Cost .......... ~..'; ....~.~...,~::~..,.../..~.~ ........................ Fee ........ iig'bg"~gi~"~Z'fiii;:~'~g'~Tg~;ii'cTti;;'i~' ' "'~ ................... FEES: ~f dwelling, number of dwelling units ............ /. .............. Number of dwelling units on eoch floor ....... ./.i .................. If garage, number of cers ................................................................................................................. 6. If bus/ness, commerical or mixed occupancy, specify nature and extent of each type of use ................................ t' ~' ....... ~.....~.. ............ Depth 7. Dimensions of existing structures, if any: Front ........... ~'.. .............. Rear ~ Y' / Height ........ /.~ .............. Number of Stories ...........~ ........................................................................................ same structure with alterations or additions: Front ........... ~.~ ............. Rear ...... ~...~.~ ..... Dimensions Of Depth ....... ~.~ ............... Height ....... ]..~..f. .............. Number of Stories ...... .~ ............... 8. Dimensions of entire new construction: Front ....... 3.~. ............. Rear ....... ~ ............... Depth ....~..~.~ ............. Height ....... ~.~. ............... Number of Stories ..... ~ .......... 9. Size of lot: Front ..... 7.~.. .............. Rear .......... 2.S;.: ....... Depth ....~..~...~ .......... 10. Zone or use district in which premises are situoted...~~~ ................................................. ] 1. Does proposed constrcction violofe any zon ng aw, ord noncp pr rggulation?..~ .......... /~ .............................. Name of Architect ....................................................... Address ......................................... Phone NO .................... Name of Contracto ...... .'. .~~: ........ Address~ ..... /...~1..[...,....Phone PLOT DIAGRAM L~ate clearly and distinctly all buildings, whether existing or proposed, and indicate ali 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. s~zT~ o, NEW YORK, ~ "S COUH~ O. ~<~......~ ~" ...... .~~.~: ........................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) obove homed. He is the .......................................................................................................................................................... (Controctor, o~ent, corporote officer, etc.) of said ownor or owners, ~nd is duly outhorized to perform or have performed the s~id work ond to m~ke ond this applicotion; thor oll stotements contoined in this opplicotion are truo to the host of his knowledoe ~nd and that the work wffl be performed in the manner set forth in the application filed thercw~th~ ' Sworn to before me this ~.~ ,~7 ~ ~f ......... .......... .......... ......... ........ Notary Public ..:;~A~,.~~,..C~unty FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ...... ~.*.'....._~,~. ::: ....... :~,~:i';.~..'.-......~,~,,,. :; ........ ~..,.., ...... ........................... ........ ........ %;.711'i. ........... (BuiMing Inspector) Application No ............................ 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 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 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 to t~e 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) .................................. : ................................ ................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder. Nom~of owner of prem ses ~ .~...'...~..~,~..,-~;' 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 .I.~..~...¢~:~¢~,~,/...~.~/,~~. ,~,.'"~ -- ¢'~ State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~ ..... :.~....':~~.~z.., , ................ b. Intended use and ~ccupancy~.~.~..~..~.~...~.~g..~..~...~...-..~...~......~.~..~..~"~Z...,~..~...~..~.:~.~.= 3. Nature of work (check which applicable): New Building .................... Addition ..... ~' .......... Alteration .................... * Repair .................... Remov~a,~ .................... Demolition .................... Other ~W. ork (Describe) .................... 4. Estimated Cost ....... ~...,~...~..~.....~. ...................... Fee .......................................................................................... (to be paid on filing this application) FEES: / If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ....... ./.i .................. 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 ............Z ................................................................................................ D mens one of same structure w th alterations or add tigris' Front ............ .~.....,.~'.. Rear .3 ~ Depth ......~'~...~'.. .............. Height ......... /..~ .............. Number of Stories ......... ./ .................... 8. Dimensions of entire new construction: Front......~.....~...:' ..........Rear ........ :~..4~....:' ...... Depth ...... .~...~.. ............... Height ..... /..~ ................. Number of Stones ...... ~...~ ...... 9. Size of lot: Front ...... ~....-~ ............... Reor 10. Zone or use district in which premises are situoted....~.~..~.~. ......................................................... 1 1. Does proposed construction violate any zoning law~ ordinance or, regulation?. ....... ~ .................................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali 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. OF NEW YORK, - ) ...... .~...~.~~ ................................... be' g duly sworn, deposes and says that he is the eppllcant -~- (Name of individual signing application) obove n~med. He is the .......................................................................................................................................................... (Controctor~ *~ent, corporo~o officor~ otc.) of s~id owner or owners, end is duly authorized to perform or have performed the soid work end to moke end this opplicationj that oll stotements contoined in this ~pplic~tlon are true to tho best of his knowledge end that the work will be performed in the monner sot {orth in the oppli~cofion flied therewith. Sworn to before me this .,f. ..... ~/: .............. day of ......:,....~..,[/~....: ............. 1 9..,~.../.... (,S[,ngature of applicant)