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Home My WebLink About93-zFOP~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY N o ....... ..h.. ~. ............ Da te ................. No.V. eraber......1.9. ........... 19..~.~... THIS CERTIFIES that the building located at ..N/S...S.~gab~...~toad ........................... Street Map No....X,X~Y, ..................... Block No ............ X~.X. ............... , ~ ..'J~'tt~.t~l~.~k.t...~.'~', conforms substantially to the Application for Building Permit heretofore filed in this office dated ....................... 8.e]~om'bo.~....3. ...... 19..~.~., pursuant to which Building Permit No ...~.'...~21 ................ , dated ............... ~.f~ti~oml~.9.~......Jl' ............ 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 ............ ........................................... I:~R.~V~T.E...DWI~LL~$.....r .......................................................................... This certificate is issued to ...,l:rv. in~..Ba.:L.t; ....... (...f~wner.}:r ......... : ................................................. Lowner, ~essee or enant) of the aforesaid building. Building Inspector FOP*M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WI~,.. ONE,~SET,OE APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby grunted to: pursuant to application dated .............................. ~)%.;..? ................. 19.~,~..., and approved by the Building Inspector. Building Inspector FOI~FI NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam ned ....... ~..~..~. :~./...~.. ,¥./ 19,r~....i A , : . pproved ........................................ 19...~....Perm~t No._~./,....~.L~ ........ (Building Inspector) ,/ Application No .......~./....:.. .... 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. Up.on approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pefmit 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 sha(( have been granted by the Building ~nspector. 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 ali applicable laws, ordinances end regulations. (S'gnature of applicant, or name, if o corporation) .............. ................... ~ c~'ress of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Name of owner of premises ........ ~. ....'. ...... ..~. . .~ ..... ! .... ¢ ...... 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 .................................. Street and Number ..~?~ ..-~.~J~....'m.. ....... b..q..~,~.~):2..'~,. ........................................................ State existing use and oc~uponcy of premieses and intended use and occupancy of proposed construction:' Intended use and occupancy/~....°~'..tT.~'...~_. ~,~, 3. Nature of work (check which applicable): New BuJlding .................... Addition ....... ~ ........ Alteration .................... Repair .................... Removal .................... Demolition .................... Othe~Work (Describe) .................... / 4, Estimated Cost ............................................................. ~ ~,~ ~ ~%t ................................................ ~.... (to be paid on filing this application) 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 s,me structure with ~lter~tions or oddffions: Front ....~.~ .................. Rear ...... ~.~ .............. Depth .....~..,.~ ................. Height ..... ~..~ ............... Number of Stories ..... ~.~ ............ 8. Dimensions of entire new construction: Front.....~.~ ............. Rear .....~..~ ............. Depth ............................ Height ..... /.~.~ ............ Number of Stories ....~ ........... .......... 9. Size of lot: Front .....~.~ ............... Rear ...m..~ .................. Depth ..... or use district in which premises are situated.Z~~.,..~¢..¢~~....~..~~ -- ............... 10. Zone ] 1. Does proposed construction violate any zoning law, ordinance or regulation? ....... 2~...2 ................................. 12. Name of Owner of premise~,t~¢d~....~.¢,~...Address ...~~../.¢¢...y.:....Phone NO)~ff~.~k.~/.~..~ of Architect ........................ ~ ...................... Address ............................................ Phone NO.'--,::.~'m~.~.~'~ Name of Contractor.~...~~.....Address .~~ ............ Phone NO ..................... Name 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 interior or corner lot. .... { STATE OF NEW,YORK, - ) ..... ~..~~ ............................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) bow ,h. (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 bls 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 ........ ,, .~,'. .......... day of .......... ,~, ,', ............ 19.~,~, ..... Notary Pub I i~,..~,,~-~.~,.~t....L~ ........... County . JLOliJ 8OW~I ~ My Commission Explrcs ~a ch 30, '~)t'~.-~,/ (Singature of applicant) FOI~M ~0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Perm,t No ............................ Disapproved (Buildin~ Inspector) Application i'~o ........................... APPLICATION FOR BUILDING PERMIT .......................... INSTRUCTIONS o. This application must be completely filled in bV 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 o 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 part for any purpose whotever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or nome, if o corporation) (Ad'ess of opl~licont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder. , Name of owner of premises ...... .x.: . ........... .! ...... · ............ ..... - . 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. Mop No ................................... Block ............................ · ............................... ...... ~,~ ....~[eet and Number ... .-~,l.~.~,. .~-~,...~ ............ )O~..~¢.~..L.:~. r. 2.Sta~ existing use and occupancy of premieses and intended use and occupancy of proposed constru?ion: o. Ex.st,rig use and occupancy ...... ~...~Y~..~..~ ..... r~....~ 3. Nature of work (ct~eck which applicable): New 13uildlng .................... ,~dd~tion ..............~.lterarion .................... Repair .................... Removal .................... Demolition. ................... Other Work (Describe) .................... 4. Estimated Cost ..................... .O. ................................ Fee .......................................................................................... (to be paid on filing this application) FEES: If dwelling, number of dwelling units .......... /~....' ............. Number of dwelling units on each floor ....... Z ................. 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 ...... /..,~.-~T... ............. Number of Star es ........ ~ ....... 8. Dimensions of entire new construction: Front ......... ~.~.. ........... Rear Depth ........ Height ..../....~.-'~... ............ Number of Stories ..... ~ ........ 9. Size of lot: Front ...... ..~..~..r?..~... Rear ........ ~'....~...fl ...... Depth ..../......~..i...~...~.....~(~,, .. (. . . ._. 10. Zone or use distr,ct ,n wh,ch prem,ses are s,tuated...~-~..-¢,~..../~.~..,....~/.~.~.~.~.......~.;....~.:...~.~.~...- .... 11. Does proposed constructio~ violate any zoning law, ordinan, ceU or regulation? ....... ~ ................................. · .. - , . · ............ ne N o.J%q.: z.'.-'.. ~...~..~ ~' Name of Architect...~ .................................. .~ ........... Address ........................................... Phone NO ..................... Name of Contractor~,.~.~.,.~..~: ...... Address~..r-~'~..}:t.;z'7~.'..Phone NO.t~.~.~.~..~ 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. ~ cf Cf ! STATE OF NEW- OR ,. ) S S.' ~.~.~ ~..':~.,~,,~: .......................... being} ~ .......... duly sworn, deposes and says that he is the applicant (Name of individual signing application) ~ z, above named· He is the ................................................ O...~.~ ............. f..(.~.~...~-~..' .......................................................................... (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 oil 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 ....... ........... day of ................. 19..: ......... Notary Public,..~.~.~.~-,~C,,~,,~Z...~. ........ ~C~unty My Commis~io~ £xp,~ M~rch ~0, I~' ~.~