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Home My WebLink About135-zFOI~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...... ..~..~,~.....~.Q..I~... ................................. Street Map No ..................................... Block No ..................................... , Lot No...~. ................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ .~.~,O~.~Jl~'..]J:~..~l~ ............ 19....~.~., pursuant to which Building Permit No ....~...'.~.,~. ........... , dated .... .Q.g.~.~.~..e~....~'.j ........................... f9...~..~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is i~sued is ............ ................................ ...................................... ,,. .......... ............ This certificat~ is issued to ...(~..~.~'.~..~...~.~..~ ................................................................................ (owner, lessee or tenant) of the aforesaid building. ' Building Inspector FORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES ~gP4~¢,~-,C.Ax~..,~Ii~,~,~P~cE,~.C,.4T~(~I~.~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No ...... Z'"' 't'~' '" Date .............. 0eteber..-. Permission is hereby granted to: Geoo t~..~&.t;h..&..Son.....A/C....C.l.~'enee...Ba~e~. ................ $~u.l;hold.,......N,~)~, ............................ to .................. Buit~"'New"D~,e~3;ing .................................................. . ............................................. at premises located et ~lt/8,...~e~e¥...~oed ...................................................................................... ............................................................... ~u. thol~. .............................................................................. pursuant to application dated ............... O~t,~el~....bt ......................... 19...~'., and approved by the Building Inspector. Fee Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................ !! .............. 19 ........ Permit No ~'~/' ~ 5- Application No ............................ Disapproved a/c " , .... (Building Inspector) APPLiCATiON FOR BUILDING PERMIT Date...~~.....~.. ....................... 19..~..Z.. 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 o Building Permit pursuant to the 2~lud iant~ oZn s°,n ~o rO rt%ien %~Cn~ t(~ crt ihoen Zo?/~ u~ ltd iSn°gUst, h; Id~ itSi aU Fnfs° Iokr Ca ic~ rr ~ tY/o nN~ rYf°orrk'r eamn odv;tl hoerr ~¢1~' ~w~ r?i~,nd i(~easr~Cr i~ I~ e c~ ~ The applicant agrees to comply with all applicable laws, ordina.~~_~io~,¢~', ~7-----¢~/,~~ ~ ¢ ( ignature of a~'~"~orporation) (Address of opplicont) State whether appJ~ant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Name of owner of premises......~~_....~~~ ................................................................. If applicant is a corpora,,t,e, Znatur~of duly authorized officer. ............ kocat on of and on wh ch proposed wor¢ w be done Map No .... ~t 84eek- "/~0../.~.,.~........7... o,, ....... ............................... a. Existing use and occupancy .................................................................................................................................. b. Intended use and occupancy ....... ~ ................................................................................................. 3. Nature of work (check which applicable): New Building ..... ~,. ......... Addition .................... Alteration ............... ..~ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Co O ~ Fee / ~ ~ (to be paid on filing this application) FEES: 5. If dwelling, number o,~ dwelling units.....~.....~...~... .......... Number of dwelling units on each floor ............................ If garage, number of cars ............... .~....;..T: ............................................................................................................... 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 ..'~..~...i .................. Height ...... ~.6'..~..../. ......... Number of Stories ..~2 .~_...~., ............. 9. Size of lot: Front ../....~.~ .............Rear .../....~?..~.. ............. Depth ./...~....~....~ ......... 10. Zone or use district in which premises are situated construction viol te any zoning law, ordinanc or regulationP ~'~' 11. Does proposed ~ ~~ ~ ~..~,..~ ............................................ 12. Name of Owner of premises .. .;Address ~ .......... '.....Phone NO ..................... Name of Architect......,, ............ .J.,.~.~_,~'/'~: .................... Address ...........................................//-.~ ,.~ Phone NO ..................... Name of Contractor~..'....~..C~.~..~ ......... Address .~.~/~'. ............ 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 according to deed, and show street names and indicate whether interior or corner lot. /~ STAT£ OF NEV~.~YORK, ) ss.. COUNTY O~/_.~ ~ ~ ~") ~" ~//~,,., obove nomod. He is th .......... .~.~.~...............~... ...................................................................................... (Controcto Oe c.) of s~id owner or owners, ond is duly ~uthorized to perform or hovo performed the soid work ond to moke ~nd file this applicotion; that oll stotements contoined in this opplic~t[on are truo to the best o{ his know~ed~e ~nd boliefl ond thor the work will be performed in the monner set forth in the opplicofion {Hed thorewit~ ~ .......... ........ o, ......... ..................... (Singature of applicant) Notary E~l~E BOWDEN ~ p. blic, State of New York Residing in Suffolk County No. 52.0357800 ~ My Corniness:on EXlmC~ ~rch 30, 19 ~ FORI~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om ned Approved ........................................ 1~ ........ Permit ~o ................................. Disapproved /c ....................................... ...... · ............. 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 adioining 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 appJication 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 fo.r 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 alteratio~s, or for remov, gJ/or dem_~oli~n, ~ herei~ described. The applicant agrees to comply with all applicable laws,~~~ord inan,c~s,,c~_cl J'eg~;~ i~:~~~ ,~ (Signature of applicaj:¥t,")or name, if q~corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, p umber or builder Name of owner of promises ....................................................................................... If applicant is a corporate, s~nature of ,q~ly authorized officer. (Name and title of corporate officer) on hch ro osedwor<w be n M -~4,,~ ,;~ Location of land w ' ,~P p Street and Number ............ ~, .................... t~' .......... ~, ..... i' ............ ~" .............................................. 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 ~..~..'-~.. ..... 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: 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 ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... ...~...~. .......... Rear ...~ ............... Depth ...'~...~.... ................. Height ..... ./~.~..'~..~ ........... Number of Stories ...~ .......... 9. Size of lot: Front ...... . ./....~....'~....~.' ..... Rear ...... ./..~.....'..... Depth ...."~'~....~.,..~ .......... 10. Zone or use district in which premises are situated ...... ,~..~.~4~....~...~....7~...~J~..~.. .................................................. 1 1. Does proposed constructio~ violate any zoning law, ordinance or regulation?...~ ........................................ 12. Name of Ownerofpremise~..~..~..~ddress~ ....... Phone NO ..................... Name of Architect....../~ ......... ..,,J ................................. Address ...~,,~._...._~,~ ............ Phone NO ..................... Name of Contractor~.~...~.,..~.~'/,~ ....... Address .~.:~ .............. 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 according to deed, and show street names and indicate whether interior or corner lot. /0o ' ./On ' STATF OF NE~ YORK ) couNw ........................ ~~ ..................... being duly sworn, deposes and' soys that he is the applicant (Name of individual signing application) above named. He is the ...... ~~<......~....~~._~~). ..................................................... (CohtroC'tor, agent, co,~Cfrote 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 oll 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 ......... ................... , (Singature of applicant) Notary Pub I lc,.....~.~ .~.-~,k-¢~. ....... County [LOISE BOWD£t'I No~ry Public, State of New York Residing in Suffolk County ~/ly C(imrnisson £';p~ros [,~arch 30, ~g