The URL can be used to link to this page

Home My WebLink About128-zEOBM N~O. 4 TOWN OF SOUTI-IOLD BUILDING DEPARTMENT TOWN CL'ERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ........2;.. 99J~... Date ....................... ~.~I~l~y... ~..9. ........... 19..~..~. THIS CERTIFIES that the building located at l~&ila, l~lo.,...Y~&t;.g~.i;ll~.q ............ Street Map No .............. ~.~... Block No ........ *.~.,~ ......... Lot No .......~.~ ....................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................... Q.~Q~..e..~'....~.. ........ 19...5..7... pursuant to which Building Permit No ......... .Z....~? dated ................. ~.'..~.~...~..X...~ ......... 19....5.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ............. ~ LVA~ _ .CJ~I~.. ~I~.Y...1~.~...~ .................. This certificate is issued to ..~.~.~;...~.~...~/,'.~W~.~.~....~.e...~. ............................................. (owner, lessee or tenant) of the aforesaid building. FORM NO. 2 T~)WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No 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. Z /~ ~' ~ote ~~ I Permission is hereby gra~ted to: ................... ..-:)~k.~..~.~.~: ........ ~o '""~'"J"~ ..o0(24~A~"~"'""'~': ......... ~~..,[ ...................... /,,~ l/']//~ ~1 (h, at premises located at ~.,.,/~'.....~...~/.C~'~..~..~O.~....~.~-.'.'.'.'.'.'.'.~... .......................................................... .......................................................... 2.C~,~_z.~...~ ........ :~...~: .............................. pursuant to application doted ..................................... 19.~ .... and approved by the Building Inspector. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................ Approved ........................................ 19 ........ Permit No ................................. Disapproved a/c ................................................. ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This applicetion must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of Jot 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 app,[ication 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 purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION I$ 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, or removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances a~J' regulations. / (Signature of op.plicant, or name, if a ~orporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Name of owner of ~ ......................................................................................................................................................... If applicant Js a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work ~ill be done. Map No......... .......................... Block .................................. Street and Number ..~.....~...~/k/ /~C~, ~..../4f----/. [ / T-~,'/~. 2. State existing use and occupancy of premiese~,~nd intended use and occupancy of proposed construction: a. Existing use and occupancy ..................... ~...~ ...................................................................... b. Intended use and occupancy ....................................................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... era ~on......¢....z ........ Alt t' Repair .................... R~r~oval .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ...~...0....?..~ ....................................... Fee .....z-fR...........-~.. ................................................... (to be paid on filing this application) FEES: 5. 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 ............ : ................... ea ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ~ Rear Number of Stories Height 9. Size of lot: Front ....... ~ '~ Rear ~' ,,7,,' ~' ................................................. Depth ............................ 10. Zone or use district in which premises are situated ....... 1 1, Does proposed construction violate any zoning law, ordinance or regulation? ............ ~ ............................. 12. Name of Owner of premises.~...'~..~..~';;-.....-C~....Address ............................................ Phone NO ..................... Name of Architect......~...:,,..f._.~ ~,, ................................... Address ............................................ Phone NO ..................... Name of Contractor...~.L..~..~ ................. Address ............................................ Phone NO. PLOT DIAGRAM whether or proposed, and indicate all set-back dimensions from Locate clearly and distinctly all buildings, existing property lines. Give street and block numbers or descr)ption acco ~ing to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ) SS.' COUNTY OF ............................ ~ .............................................................................................. being duly sworn, deposes and soys that he is the applicant (Name of individual signing application) above named. He is the ........................... ~ ............................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that all statements cantained in this application are true to .tl~e best of his knowledge and and that the work will be performed in the manner set forth in the application/~fled therewith, belief; Sworn to before me this ........................ day of ........................................ 19 ............ Not~ry Public,, ............................................................. County FOR~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam ned 1 o Application IN ............................ Approved ........................................ 19 ........ Permit No ........... D~sapproved a/c ........... ~ ......................................... ~,:~ ........ , .~.T~ .................. ......... r' ....... (Building APPLICATION FOR BUILDING PERMIT ua e ........................................... I ................ 19 ............ 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 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 ~ntil 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 fer removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances ag~t/regulotions. (Address 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) 1. Location of land Oner which.,./.~. ~/~/pr°p°sed work~.....~. 'will be done.~Mape~NO..T.... ~~'"/ .......................... 7~ b' (--'-- ,/~.'~ ....... Block .................................. ( Street and Numb .../} ........................................ ..~/~ ................................................. .~....4,.~/..~ ...................... State existing use and occupancy of premieses and intended use and occupancy of proposed construction: Existing use and occupancy ..................... .~,~h,~.~..,,..~.~......~.f..*~r.. ~. .................................................................. a. -~ ~ b. Intended use and occupancy ............ ~,~.~ ~. ................................ 3. Nature of work (check which applicable): New Building .................... Addition ....................Alteration .................... Repair Re~ova .......... Demo t on Other Wczr¢ (Describe) ............. ~,,~ ..zL..'"zf~' ,.~ ~¢~ ~*0 (,) ~ Fee ~-~ ..... 4. Estimated Cost ................. ' ..................................................................................................................................... (to be paid on filing this application) FEES: 5. 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, speclf~n~ture and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front...,,~Z..j ................. Rear ............................ Depth ............................ Height ............................ Number of Stories .................................................... E~%;;~ ................................... Dimensions of s~me structure with elter~tions or ~dditions: Front ............. :T.% .............. Rear ................................ Depth ..............................Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Frant.....~{:~ .... Rear ............................Depth ............................ Height ............................ ~TNumb~ of Stories .............. ~ ~ ,/ ............ /~. ~) ff~ 9. Size of lot' Front Rear Depth ............ 10. Zone or use district in which premises are situated ....................................... ~,~ ...................................................... 11. Does proposed constructio~olate any zoning law, ordinance or regulation ..................................................... ]2. Name of Owner of premises ........................................ Address ............................................ Phone NO ..................... Name of Architect......J...~,[ ...................................... Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM ~ocate clearly and distinctly all buildings, whether existing ar proposed, and indicate all set-back dimensions from prop~,rty lines. Give street and block numbers or descr~iption acco'ding to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ) SS.' COUNTY OF ............................ ) ................................................................................................ being duty sworn, deposes ond soys thor he is the oppllcant (Nome of individual signing application)t~_,r,~ ,~ ~ 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 ail 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/filled therewith. Sworn to before me this J/ , ,¢"/~ ........................ day of ........................................ 19 ............ (Singature of applicant) Notary Public,. ............................................................. County