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Home My WebLink About111-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPAI4CY No... Z" ~ ............ Date ........... J~l~e~....'!.~'. ........................... 19~j~... THIS CERTIFIES that the building located at ........ W./~.....A.aa~.le.l...Roa(} ................... Street Map No.B.~O~...&....[~y:j;rl~... Block No ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................ j~e.~t~...];¢) .......... 19~,..., pursuant to which Building Permit No ..... .Z...1.'I~ .......... , dated .................... .Sep¢'"'19 .................. 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 ............ ................................................ P~ 'i~JkTE' ·" 'D~E~L~'N(} ........................................................................ This certificate is issued to ......... T~omas..J~,...H.~.e~eF ......... :..(..o.~e~,) ...................................... t. owner, lessee or tenant) of the aforesaid building. FORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SO~ITHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No....~....i..L..L. Date ................. 19 ..... Permission is hereby granted 2~: ........................... ~ .................................... >qt ~ ....... ........ ~.~'..%~~.~:5.~:....~:~-::.~- ,o ...... ~~..,~....~::~.~.:~ ....... .~v~:::~.~:~ .......................................................... .............................................. ~., ....................... : .......................... :.....:..; ................................... o~,o~o~do~.~ ........... ~;..~; ........ ~.~ ........ ~. ........................... Building Inspector. Fee $..~,¢....% ......... Building Inspector F01~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL G:r..~, e,~,~l ~.~r..~ ~'o.~,,~.. ~o~:~ PLEASE TAKE NOTICE that your application dated ....................... .~.e..g..b...e.:f~.]?.?.:[:....~..~.. 19...~.~..~. for permit to construct ..~f...c~.?/~.~;;~.~[~. ................ at the premises located at .'~ff/.~...~.~'...~.~[~:t q~'.~ ~ ~.9.~ ,~. ~... ,~'~...~ ~'~ ......................... Street Map Sunz'ise ]~stc, tes Block ~ Lot 2}~ 2)-k~ 2~ is ..~:..i:.L..!.: ....... ~; ...... ~ ....... %.: .......... ~F¢~AFd~e~a~l~disepproved on the following grounds ~b%o_o Z.LZ, ,~00~0~1 ~0} ...... ~.q~¢:b.(~g,~..2.~2.s...~b&z;.. ],g.q...f.~.~. ....................................................................................... /s/ }];owaz'd J~. %'erz'y Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam ned ' .~. z.'~.~.. ·.../... Z ........ 19..~....~. Approved ................. !..' .................... 19 ........ Permit ............... Disapproved ale ..... . ..~...~ .~_....~.... F...~:~:~.~:~Z ....:..~..~?,/~ ......... : ........ ) .......... i' ......................... ~ / (Building/Inspector) App"cation No....../..!.! ............... APPLICATION 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, 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 opplicoble Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with oil applicable laws, ordinances and regulations. ...... / :_~%.~ .... (Signature o~a'p,plicant, or name,~orporation) (Address of opp[icant) State whether applicant is owner, ~architect, engineer, general contractor, electrican, plumber or builder. Name of owner ot p em ses .............. ,r..,,¢~..~..--.: .................................................... .....f ................................................ , ........ / If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on whichjproposed workwiH 'be done. Map No~:...~k ...... ~ ...................... Street and Number ...~.~../~.....~.~ ....... ...~.....t,,,,~...~...f:~ ............................................... : .................... 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: b. Intended use and occupancy ......................... i ................................. i.i: .......................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition . ................... Other Work (Describe) .................... 4. Estimated Costg'3-~ 00 Z , 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 same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ..,~.....O.. ....... Rear ....... .~......~.. .......... Depth ~- ff Height ............................ Number of Stories ............................ 9. Size of lot: Front ........ ~...~.. ......... Rear ......... "'~.'.....O.. .......... Depth ......./...~)....O.. ......... 10. Zone or use district in which premises are stuated /~ ~... ~~-- ng Iow, ord nonce or regulation? ......... ~ ...................... 11, Does proposed construct on voate any zon ............. 12. Name of Owner of nrem ses 7'"~ /..~..'.'~.~..' ~- ................................................................................ Address Phone NO ..................... Name of Architect ................................................... Address ............................................ Phone NO ..................... Name of ContractorT~4~....~n ................ Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly oil 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. H ' cic f.-I STATE OF NEW. YORK, ) S S OF " CO~UNTY (Name (~indiVJdual ~gM~plication) above named. He is 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 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 .... /.r/...~ ....... day of ' ........... ................ Notary Public .......................... .~'~. .......... ~., .~7~,.-~. ........ County £LOISE BOWOEN No~ Pubhc State of New York Residing in Suffolk County No. 52-0367800 My C0mmiss,un Exphe,~ k/a,ch (Singature of applicant) FOI~ ;NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. i 57, No..~.L..(.../.. ........... Approved ........................................ ] 9 ........ Perm t Disapproved ~/C ..~:,.C.~,.~.~?~(.,.,~.?.~ / :,~7 ............. t~.~..:...:..%.....4. ....... ~%.-~ .......... (Building Inspector) / APPLICATION FOR BUILDING PERMIT ~ t? 5'7 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 5. Plot plan showing location of lot and of buildings on premises, relationship to adioining premises or public streets or areas, end 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 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 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/~@hcant, or name,~(.--~rcorporatlon) (Address of applicant) State whether applicant is owner, 1~,5,ee, agent, architect, engineer, general contractor, electrican, plumber or builder. ............ i .............. ......... .......... :i ......... ........................................................ ame of owner or p em se ............... '...::.,:...;..: ............................................................ / ......................................................... If applicant is a corporate, signature of duly authorized officer· (Name and title of corporate officer) i. ,ocotion of land on which:oposed work w"l be done. Map No~'~..~ock ...... :.--..: ....................... Street and Number .................. ...~..~/..~.i' O~'"-'~''C''~'¢, .............. ...... ............ ' ~<~:%'../]~%1 ........................ ............................................ 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: e. xist'ng use end ccupQncy ............................ ~ ................................................................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost~8~}' 0('') ~ Fee 10 O~.~ (to be paid on filing this application) FEES: If dwelling, number of dwelling units ............. .J .............. 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 ............ ..,~.....O.. ...... Rear ~*~'/ O Depth '~" ~( Height ............................ Number of Stories ............................ 9. Size of lot: Front ...........~.....0.. ........ Rear ......... .c~..?. .......... Depth / O 10. Zone or use district in which premises are situated ...................... '~ ................................... ] ], Does proposed constructio~ violate any zoning law, ordinance or regulation? .................................................... 12. Name of Owner of premises....~?......J..~..~'..~.'."2?JAddress ............................................ Phone NO ..................... Name of Architect ................. (1 -.'/C),'"*"'""',~ ............... Address ............................................ Phone NO ..................... Name of Contracto~...J..~.~ ......................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinct?y 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 ) S S COUNT* ....... ) .... :~.~ .~c...~,',,~.~, .............. .,/,-/~,.,.~.'r:~?.~. .................................. being duly deposes and soys that he is the applicant (Name (~indigidual sign~pplication) sworn, above named. He is the (Contractor, agent, cor~rate 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 therewffh, Sworn to before me this ....t..c/:.¢;f,;, .......... day of ......... ~.~ ............... 19...~..-.~',.... Notary Public,..~ ...... __ ELOISE BOWDEN ~ota~ Public, State of New Yor~ Residing itl Suffolk County No 52 (Singature of applicant) {~. ~..(> - t " ,,, i~ /