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Home My WebLink About103-zFORM NO. 4 TOW'H OF SOUTHOLD TOWH CLERK'S OFFICE SOU?HOLD, H. Y. CERTI~ICATE OF OCCU~AHCY No ........ ~ ..~.9.,!, ..... Date .............................. ~uzaa...2 ........... , 19,~0.. n/s M~n Road, Map No. *~* Block N~.t ..................... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated Sep'tember 13 57 ........................................................ , 19 ........ , purs~at to which Building Permit No ......... ~...i~.~..~..Z 104 ~.~ Septe~er 13 19.~.~...,wa.s issued, and conforms to all of the requirements of the applicable provisions of the law. The ~cupancy for which this certificate is issued is ................ ~ U~R BUHG~OWS . Ra~on<~ DcidrJ.ck~ This certificate is issued ro ..................................................................................................................... (owner, lessee or of the aforesaid, building. Building Inspector 'FORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, FI. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL EULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ¢~olc! sr~i tI~.. J~Z?O.S ,..... &/~..... ~t~.~.TmOZ~d...~)~.if]ri.~ ....... ........ ~ouf~,I~l d~.... J~,J~(., .................................... to ..... B~l~%. ~..d.~T~3,t~'~,G ........................................................................................................... at premises located at ..~..[.~r~¢~e...~.~...~/D...~[(~¢`~...~...(...~~e~..~`~..) ................... .................................................. .~[.er~t.,.....~i,~ ........... : ................................................................... pursuant to application dated ................. ~e~.c~m].~ofc.....].,,, ................ 19p.~...., and approved by the Building Inspector. Fee $..~,DO ........... FOEI~/ N'O. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES ;gg,~,~l~t~,~6~;~,~O~ ¢,~,9~,~I~..~.,~,N,..~,~g!;k'J,~!~,S~.UNTIL FULL COMP.LETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .......... ~oz,~tlzc~%~,, ....... I~;,. ~ ................................ to ..~l.ld..mc.,,.. ~Sw~?,~,.:~:~ .............................................................................................................. at premises located at PP~.a¢.¢....~b~`d..~...::~Z~:`....:?L~:~>¢~..~.~...¢..~¢~u~::s..~.~z:~."~. ..................... ........................................... O:z!&nS.~....,Sb.~[, ...................................................................................... pursuant $o application dated .......... ~SP:~:l~.....]~ ....................... 19.,~.., and approved by the Building inspector. Fee $.10..0~ ........... Building Inspector FOP~M NO. 1 TOWN OF $OUTHOLD BUILDING Ds:PAP-,TMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. xaminea......' ......¢! .......................... ]9 ........ Approved ........................................ ]9 ........ Permit No ................................ Disapproved o/c .................... .~..~ ............... .~.: ........... ~ ....... ];:;;~ ........... .; ..................................... .... ....... ....... ....................... (Building Inspector) I APPL'ICATION FOR BUILDING PERMIT Date ...... ....... ........ .... 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, end giving a detailed description of layout of property must be drawn on the diagram which is pert 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 permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shell be occupied or used in whole or in port for any p,urpose whatever until o Certificate of Occupancy shell 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 ap,plicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder. .... ~/..x..o..cf...~ ............................................ Name of owner of premises ....... ..~...~..~/..~X~.~2 ......... .~.....~.~..'..~.../.~./..~ ..................................................................................... 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 ~..~7.'~. ~..~'~.~FT ZZ.F.~9/.~.' 4:'.r~... 0~'F.~;.~C ' .~.~.~.~.~...Gl. r'~..C~q./~.~.~.. 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use end occupancy .................................................................................................................................. b. Intended use and occupancy......~.~/~r/./'Jx4.~.,4~ ......... ./~.~.~.G..c4.6..c~q..~ ................................................ 3. Nature of work (check which applicable): New Building ...... ~ ....... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ........ ~.: .......... ..-m .................................. ee .......................................................................................... (to be paid on filing this application) FEES: If dwelling, number of dwelHng 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 ....... .~.....~.. ............. Depth ......~.....z:z.......i ......... Height .....,//,'.~.~ ............. Number of Stories ..... /. .................... 9. Size of lot: Front .~.~r~...¢..~..~'..~.~.~. .... Rear ............................ Depth ............................ /~' //c~ 10. Zone or use district in which premises are situated ....... .~........~.....~... ....................................................................... 11. Does proposed constructio~ violate any zoning law, ordinance or regubtion?/)/~.....~'.~..,,C/.~y....,.~.~..f..r~.?....&~:.~,,,,g.¢.'" 12. Name of Owner of premises..~.~../~.~Ar~.....~.¢K~..~.C~Address .,~¢..~.~//,~.~. ....... ..~.~t4/M.,...Phone NO. ~..~...~..g....¢~.. ..... Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor...~.4-.~..~'/~Z.~..~....4~.~.e.~.. ........... Address ....~...~../T/~.e&.~.. .................... Phone NO.,J:x~..?.'.::.z..~..?.-~. PLOT DIAGRAM 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. // (Name of individual signing application) above named. He is the.....~~ ........................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or ow~ers~ and is duty authorized to perform or have performed the said work and to make and file this oppmication; 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, (Singoture Notary Public,.~.,.~.~ ................. County EOISE BOWDEN N~ ~blic State of New Y~ FORH NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. Approved ........................................ 19 ........ Perrnit No ,~'/0 ~ (~ ~' ~ O ~ Disapp roved a/c ............... ~]..~.] ............ :~.<:~;.; .............. ~:~'~'~":'"' ..................... ........... (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. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shah 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 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, electrican, plumber or builder. ...~....u.r.~,,~..~.,..c. ............................................... ' .................................................. Name of owner of premises ....... ..~...~.~ .~....~...~...~.. .... .~..~..(.~.~'.~/.¢. ......... If applicant is a corporate, sigr~ature 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 ...........~TZ....c"v~.'¢,..,.~......~..~..~ ......... .~...~.....~..~) .................................... 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 ...... ..~....~...~J...~.....~..../~ ....... .A~...~..~...~/.~..~,~ ...................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ~'~ ..... Fee !0 ~ (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, spec[fy 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 ...~..~...~..~..~..~...~...¢/f. Rear ............................ Depth ............................ 10. Zone or use district in which premises are situated ....................... '. ...................................................................... 11. Does proposed constructiot~ violate any zoning law, ordinance or regulation?.~./~..../T'~...iR~...~..A'.~..~.~...~'r~. 12. Name of Owner of premises..~..~'~.fJ~¢..~.....~..~.f.~.~Cf..~Address .~.E~I.~'./.A'.i¢ ....... .~.~'.~...~'.: ........ Phone NO.5.~..~...o.~.?..7./.~'fl Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor...(~¢4~..~.C.~'.r~'...../..~...~/~.~. ......... Address ..,.~4~'.~it4.~...':,..,~.. ................... Phone NO?.~.-.¢.~::..~.¢.~.3 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. STA'T'E OF NEWnYORK, - ) CO NW s s.. ...... ~ .... ..~-~..~.~..~.."..~. ................................. being duly sworn, deposes and soys that he is the applicant ~' (Name of individual signing application) above named. He is the ...... ~/~z~'zz.~'~..¢r.?....,~-.. ....................................................................... . ~ (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 his knowledge and belief; and that the work will be performed Jn the manner set forth in the application filed therewith. Sworn to before me this Notary P u b I i c, .-.~.~1~. ~4~.~..~..~,( ............. County ~LOISE BOWDEN ~rotary P~blic, State e New Residing in Stfffolk Cou,~ty No. 52-0357~00 My Commission Expires ~4arch 30, 19