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Home My WebLink About124-zFORM NO. 4 . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOL. D, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located Map No. (}.~.][~.~.~t:!t~lock No ..... .?.~ ............. Lot No....]3. ........................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................... .~..q.p..~.l~..~,.~.l~.~..,.~..~......, 19.~..~...., pursuant to which Building Permit No ........ ..Z....'~'.~..~.. ........ dated ....................... Q~b~l~..],t!]. ......, 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 ...~...~....a...~.&.~.~.~...~.'~....~..~..~..~...~..~i~..~..~.~.~..~.~..~..'~.~. ..................................... (owner, lessee or tenant) of the aforesaid building. FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. BU~LDING PERMIT (THIS,I PE,RMIT MUST BE KEPT ON THE PREMISES ,~¢~,'~ ,~.v&~,~I~.~P~C~F~TJ~]~, UNTIL FULL COMg[ETION OF THE, WORK AUTHORIZED) Permission is tere~y granted to: at premises lacated at ..... B~aT..Ave....&,.Di~%h-.-S.~ ....................................................................... pursuont to opplic~tion dated .................... ~ep~l~lT..-...~ ............. ]9~...~ ond approved by the Buildino Inspector./ Fee -!],0..00 ........... l. Building Inspector FOP~M NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL r. et-~rn.od ~herc',;'ith anc~ disapproved on the f,ollowinggrounds ...................................................... : ..... ..~.~~....~~.....~.:....~.~.z~~ Building Inspector REASON FOR APPEAL (Con't.) (d) (e) (3) The VARIANCE would observe the spirit of the ordinance and would NOT CHANGE THE CHARACTER OF THE DISTRICT because: A TEMPORARY PERMIT IS REQUESTED because: EXTENSION TO A TEMPORARY PERMIT IS REQUESTED because: STATE OF NEW YORK) ) ss COUE~iY OF ...... ) Sworn to this day of .19__ Signature Notary Public A F01~'~ NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLO, N. Y. Examined ...... . .~....'D?...~?......'?.. ~...... 19..~../... Approved....(~.....~.........?....?.. ....... 1 9.?'..'~..Permit ~ ~ / ~L ~--/ Disapproved e/c . .~~% ................................................................ .......... ...... ............................ (Building Inspect6r) Application ~'~o ............................ APPLICATION FOR BUILDING PERMIT Date .............. Se~t,.cmher.....~8 ............... 1957 ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink an~l 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 gi~ing a detailed description of layout of property must be drawn on the diagram which is part bf 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 Laws, Ordinances or ReguIations, 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) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builddr. Name of owner of prem.ses ....... ~,~.t..~.....&...:,:~G.zZ...t.~..~.,.~?.,~..J...~t~..b.¢~. ................................................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No..CJ'.,...I.~...~tLt.7~;l.l~.. ~rZ~I~....LO.t_.~..~ ............... Street and Number ....~ ....... ~.~,~...~...~$.~...~t., ....... ~..ti.bwek.r.....N~.~. ................................................... 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 occu~anc,, D,:~elll~ 3. Nature of work (check which applicable): New Building ....~ ............. Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ...~....~.,.g..qC).,.~. .................................... Fee .~...l~,DO ........................................................................ (to be paid on filing this application) FEES: 5. if dwelling, number of dwelling units ........ .~f~ ............. 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...~J......~[~ ........ Rear ..... ~ .................. Depth ...../~ .................. Height ....:1.[~..,~ .............. Number of Stories ....... ~PJI~ ............. 9. Size of lot: Front .50 ...................... P,ear ..50 ...................... Depth ......~.50 ................ 10. Zone or use district in which premises are situated.....~.....j~C~l~t,~,,~ ......................................................... Does proposed construction violate any zoning law, ordinance or regulation? ......... .~,~ ................................... Name of Owner of premises....~,...~&OJ:d~em~....Address ............................................Phone NO ..................... Nome of ,Architect ...................................................... Address ............................................ Pho~.~l,,,O ...... ~ ............ Name of Contractor ..............P~tL~t ............................ Address .f}.~Le~d~,],~......~.t.ee~,8....Phon~O. ~.?.~!.~ ........... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exis'ting or proposed, and indicate all set-back dimensions from property lines. Give street and bloc numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWgYOP, K,...k ' ~'. ,//~ ) SS.' , couNTy . ......... ~,.~,,.,~.,.,..,~,,..~,-~.~/..'.~...~,/'.'~.~..~.~2,.,..,.'.,,./.,~...~..~..~ .~..beJng duly sworn, deposes and says that he is the applicant ~/ '(Name of individual signing application) above named. He is the ............... .Q~ .............................................................................................................................. (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 .... A.~.. ........... day of ........ ~..: ........ 19..~.~.....~... · . Notary Pu b, ic,.~.~.. ~J?:z~-~ [L01~I~ BOWDEN ~olary Public, State of New Yorlf Residing in S~ffolk County t?, ~-': n/:;r~0 ;--cz'