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Home My WebLink About105-zI~OR~ 1~0. 4 TOWN OF SOUTHOLD ~UILDING DEPARTMENT '~'OWN CLI~RK'S OFFICE SOUTHOLD, ~]'. CERTIFlrCATE OF OCCUPANCY THIS CERTIFIES that the building located al: ~/.~..R.~,.....~..$.~. l~la~...g.&gU..ck. ....... Street Map No ............. ~.~...~.... Block No ........ ~.~.. ......... Lot lXfo ...... ~.~..~. ....................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................. ~ .~.2.~n~?.~....]'..~, 19.~..7... pursuant to which Building Permit No... .................. dated ................ ~.~.]~;.~l;0~.. ~,..$.., 19...~.7.., was issued, and conforms to all of the require- ments of lhe applicable provisions of the law. The occupancy for which this certificate is issued is ....... Pl~?A~l~ O~ F~I~L~ This certificate is issued to ..... .I..t..~..~..~.....~...~.?~.i..l..~ ~ ................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMrT MUST BE KEPT ON THE PREMISES ,.~'~.~]:~.t~y.,FF~¢~,?,~¢f~l~¢~:~,~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N o...Z...1.0,~ .......... D o t e .......... ~.~¢-'.Ct~) e~..... ~.~ ~ ............... 1 ~.~. ..... Permission is hereby granted to: ~r?,.~ ~...~.~,:1,~,~ ........................................................ ....... ~.~.~:~.e,...~5. ..................................................... ............... ~,~.~.~,t ~., ~,~ to . ~,_.~.,...a~.. e,~. ~,__o, z .. ,, ~... ~.~ _.,~..c,,_~,,~..~ ~,~:~ ........ : ............. at premises located at f,/..?....~?:/~,~,~,..,,,! ~ ............ ~....(~f.~:~,~.~..:-c;.~.~O..~r..~Z?~?~¢~f~?~.~....) ......................... pursuant to application dated .................. ~J.Ct~.~.(.?.l~.OT,¢......~.,'~ ~ ............. 19.~.~..., and approved by the Building Inspector. Fee $~., fi~.,O. ............... Building Inspecfor I FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No.......~.'.ff~'~ Approved ........................................ 19 ........ Permit Disapproved a/c ...~f:~~.'. ...... .......... .................. APPLICATION FOR BUILDING PERMIT Date .............. ~..:....!..i~ ........... ,9...~..? .... 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 part of this location. c. The work covered by this opplication 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 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 Iqws, ordinances and regulations. ................................. ~//(Sig pp ' , o am , 'f a corporation) (Address of applicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. ' Name of owner of prem ses...../.'.....~ ......... ~~~'.4~.. ............................................................ If 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 ...................... 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: o. [x~sting use and occupancy ................................................................................................................ b. Intended use and occupancy ............................ ~~ ........................................................................ J Alteration 3. Nature of work (check which applicable): New Building .................... Addition ........................................ Repair .................... Rem_~val ....................Demolition ....................Other Work (Describe) .................... Est mated Cost ~,~0C) Fee ~ (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 some structure with alterations or additions: Front ........ '.~....~ ............ Rear ..... ..~...~ ........... Depth ......... ~.~....~. ........... Height .............................. Number of Stories ....~ .............. 8. Dimensions of entire new construction: Front ......... ~......~m. ......... Rear ........ ~..~ ......... Depth .../....<~.. ................... Height ............................Number of Stories ..... ~ ......... 9. Size of lot: Front ..... .~.....~....O...i ........ Rear .......... ...~....O. .......... Depth ...... ..~...~..0..~ ......... ,~<~ r I0. Zone or use district in which premises are situated......~......~ ................................................................ 11. Does proposed canstructian violate any zoning law, ordinance or regulation?.....~..~. .................................... 12. Name of Owner of premises ..... Address ............................................ Phone NO ..................... Name of Architect ...................................................... Address ........................................... Phone NO ..................... Name of Contractor.~......T~..~ ............. Address ...~/~.~~--~.. ........... Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from whetherPr°perty interiorlines' GiVeor cornerStreet lot.and block numbers or description according to deed, ~,n~ ~show street names and indicate STATE OF VOR , . , cou w S S... ...... ~~~~ .................................. being duly deposes and soys th he is the applicant ~ (~i~d~l signing application) sworn, obove homed. Ho ~s tho .......................................... ~;;;r~'~t;~ ;~;~;, ~or~rot;' offi~;7, etc~) ............................................ of s~d owner or ownors~ ond is dul~ outhofixeO to por~orm or hove performed tho soid work ond to mo~e ~nd fi~e this ~pplic~tion~ thor oll statements contained in this ~ppllcotion oro true to the bost of his knowledoo ond boHo{~ ond that the work will be porformod in tho monnor set {orth in the opplicotion {Hod thorowffh. Sworn to before me this ......... /.~..~..~..... day of ...~,.- ................... ELO1SE 80WDEN ~'ota~J Public, State of New York Residing in Suffolk Cou~y No, 52.036/800 My Commiss;on E'pir~s March 30, 1~ ~ 7 (Si~g~ature of opp~ . _ Exommed ........................................ 19 ........ FOI~'I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ......{..~.2.~' ......... Approved ........................................ 1 9 ........ Permit No ................................. (Building Inspector) APPLICATIOI'4 FOR ~U, ILDING 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 port of this Iocc~tion. 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 shall be occupied or used in whole or in part for any p~urpose 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 o~ 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, a~:.herein described· The applicant agrees to comply with all applicable lows, ordinances and regulations. -- /'(Signa'ture of at~plicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eJectricon, plumber or builder. .......................................... ........................... Name of owner of premises......].:.?..(.~.Q':.~. ~. ........ ~?.~.Q.~Z~...~.:tG.~-~ .............................. : .......................................... 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 . ~ ...................... ].. ............... 0.~,:0..~: ............ ,4. ...... State existing use and occapancy of premieses and intended use and occupancy of proposed construction: o. Existing use and occupancy ...................... ~ ............................................ b. Intended use and occupancy ............................ .~:,.e.~,.?n.~ ........................................................ ~ ........... 3. Nature of work (check which op.plicoble): New Building .................... Addition ......... ~ .......... Alteration .................... Repair .................... Remgval .................... Demolition .................... Other Work (Describe) .................... 4. Est mated Cost Z'~ O':) Fee (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 rnixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front ................ ~....¢T.... 3~ ~ ................. 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 ............................ Height ............................Number of Stories 9. Size of lot: Front ~ ~.~'O ' ?~..:' ............................ Rear ~O Depth 10. Zone or use district in which premises are s teated ?.~ ....................................................... re u ation 11. Does proposed construction violate any zoning law, ordinence or g ..................................................... 12. Name of Owner of premises.. .~ .... Address ............................................ Phone NO ..................... Name of Architect.....~ ............................................... Address .................... i .......... ~ ........... Phone NO ..................... Name of Contractor.....~...~..~%.:L~.......:¢~-~-''~ Address .....~.~XL¢:.~i~.¢~.~]i~.~-~.. ......... 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 accordfng to deed, ~p~,show street names and indicate whether interior or corner lot. / i~ ~' ' ' , . ,.,Gj~ cou. ......... /..,,;....~...'..-¢,..4-¢~...%;,¢,~.,~,*.,,~,~;&¢ .................................... being duly sworn, deposes and says that he is the applicant (Name of'individual signing application) above named. He is the .......... ~.Z% .......... (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 in the manner set forth in the application filed therewith, Sworn to before me this ...... /.~...~. ....... day of ......... ~.: ................ ] 9...~.~..7..., Notary Publlc,..U~t~.~..~.//.~/~... _M~.~..~. ............... County Residin~ in Suffolk C~ No, 52,0367800: ' My Commission Expires March 30, 1~ ~"] (Singoture of applica-nt;)~