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Home My WebLink About139-zFOP~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES ~ID*I~I'A't~ACC4~,~'I~h~K~'~t~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No...Z,..t.)9 .......... Dote ......................... (~'%'0']9e'~-" "Iii. ir...' 19~.~ .... Permission is hereby gronted to: Coffin C. Gr~,th~b,t.-,..A/~.,.,.l~:y~&...~,aBe~ ................. ........ ~ai~.~..~oad .................................................. ....... (~la.t~e~o g.ue.t-.-...N-~ .~ .................................. to .....Met~,ce...a.l.t;e.r a~o~s-., t~cr., e~i-~ ting. -ct~e.]:~:ng' .............................................................. at premises located et ..N/S.....~f~i~..~oa~W,...Or,t.en~...pofm%......N.:.~ .................................... pursuant to application dated ................... 0~¢Obe.~.....1. t ................... 19~?...., and approved by the Building Inspector. Fee $.~.,,.QO.....tOaid APPLICb This application must be filled tor with the following; for new 1. Final survey of property wi1 natural or topographic featu ~ 2. Final approval of Health Dep 3. Approval of electrical instalh - , , SEP I 1 1986 mm to the Building Inspec- lines, streets, and unusual form or equal). 4. Commercial buildings, Indu~ ............. = ......... ~ ....................... ilar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C, Fees: 1. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling $ :].5.0 0 3, Copy of certificate of occupancy $I,00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 Date.. , ~...6~... NewC°nstructi°n ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .?..~.. ~.~,'~ .~ ........... /~.,,~../z¥.../~'~..~. ........... ~./~/Y .~. ...... -. ,,. :,-=.~..~- , ,, House No, Street Hamlet Owner 0r,, 0wners.. of Property ~,~.~.,~., .~. ~. ~../~'.~...h(7. ~,d~./.~..~. ~.~.~.~',4~.~. ....... County Ta~ Map NO. 1000 Section ,z/..~.. ......... Block .. ~ .......... Lot./'~d..'~. ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Ptanning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. - 3?3 FORM NO. 4 TOWN OF SOUTHOLD BUiLDiNG DEPARTMENT TOtflN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the, building located at - ' -, - ~-' ', ~' -- · Map No. ~** Block No. *'~* Lot No. e,e conforms substantially to the Application for Building Permit heretofore filed in this office dated Oct;obez. 10 57 Z 139 19..':....., pursuant to which Building Permit No. dated .......................... Q.~t~.~..],l.... 19.~3~..,was iss,ued, 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 ~o ~ ~ ' ~ ' '~ ' ~ ...~O~d..L~.. T~.., ~Zn ~ ..................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector X~OI~V~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ......... ../.../.. ....... .......... Approved ........................................ 19 ........ Permit Disapproved a/c ..................... Application mo ............................ 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 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 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 lows, ordinances and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. ........................................................... ................................................................................ Name of owner of premises ............... ~y~..~..~l~'~'.~.'-Z::7/~ .................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1, Location of land on which proposed work will be done. Map No ................................... Block .................................. Number "~..~ .~..,/~.'.~'.'_~...~ ~"~'"~. 2' State existing use and occupancy of premieses and intended use and occupancy of proposed construction: Existing use and occupancy ......... ..~....~_.~ ......... . .~...~...~.... ....... . b. ~'"'(~ ~.-,' ' ............................. Intended use and occupancy .................... ..":,~..,~-d~..~.~.<?...~. ................................................................................ 3. Nafure of work (check which applicable): New Building .................... Addition ....................Alteration...~ ...... Repair .................... Removal .................... Demolition. ................... Other Work (Describe) .................... 4. Estimated Cost ......... ~.Tf~..r.~ ................................ Fee ...................... ~..~ ....................................................... (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 .....~...~.;Z./. ........... Height ....~¢~..~. ............. Number of Stories ......... ~ ............................................................................................... Dimensions of same structure with alterations or additions: Front ..... ~..~r~...../.. .............. Rear ....... ~.~..~ ........... Depth ........ ~.~..~./. ........... Height ....... ./.d.../. .............. Number of Stories ......... ./.. ................... 8. Dimensions of entire new construction: Front ...... ~.~-~../. .......... Rear ...... J;%~.../. ......... Depth ....-~...~.~'.~../. ............ Height ........ ./.4~..~ ........... Number. of Stories ........ ../.. ................ 9. Size of lot: Front ...... .~(...~.....5 ........ Rear ...... ./.....~....../. ........ Depth ...../.~....~...../. ......... 10. Zone or use district in which premises are situated ....... ~,~.~. .................................................... 11. Does proposed constructim~ violate any zoning law, ordinance or regula~tion? ......... ~. .................................... 12. Name of Owner of prem.ses.. Address .~..,~ ~.r....~.... ............ Phone NC~.,~.,'(.~..~ Name of Architect.....,~ ................... ~ ......... · ............... Address ............ ; ............ ~ ........ Phone NO ..................... Name of Contractor..~,~.~.-...~~.... ...... Address .~z~.~?~.¢~...~.~hone NO~.~./,~..~t~.:~..~. 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. STATE OF NEW/,,,,~ORK, ) ~. /'/~?~' /~Z) COUNT . ben du,y swam. deposes and says that he ,s the app,'canf ..... %q,,%..~. ~."'..; ............................................................ g (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 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 .....~....~. ................. 19...'~..~ .... Notary ~ublic,. .......... ~...~.:. x ~...~,,~.~'~.i, ~, f~}~.~ · .. y (Singature of applicant) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No... Disapproved a/c ................................................... ....................... ................................. ,nsp'"" INSTRUCTIONS a. This application must be completely ill[ed 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 layoui'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 Southo]d, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, at for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of agplicant, or name, if a corporation) (/(Address of applicant) State whether applicant is owner, lessee, agent,,,9~chitect, engineer, genera[ contractor, electrican, plumber or builder. Name of owner of premises ........ .x. ... If .applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. - Location of I~nd an which proposed work will be done. Map No ................................... E~lock .................................. Street and Number ~, ........ ' 2. State existing use and occupancy of pr~mieses and intended use and occupancy of proposed construction' "b ntended use and occupancy ,~<., ~ ~-~ 3. Nature of work (check which applicable): New Building .................... Addmon .................... Alteration....~......: Repair .................... Removal .:~ .................Demolition .................... Other W~rk(Describe) .................... 4. Estimated Cost ......... ~...~4¢~..~,..-.~.. ............................. Fee ................ ..~. ....................................................................... (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 ..... ~..7¢,,.~ ................ Depth ..~ ...................... Height ...... x~..~ .................. Number of Stories ....~.. ........................ 8. Dimensions of entire new construction: Front......~..'~.../. .............. Rear ..~d.~-~...../. ............... Depth ...~.. ...................... Height ........ ~.~.../. ........... Numberpf Stories ..... ../. .................... 9. Size of lot: Front .../.¢.,'~.~ ................ Rear ../.~ .................. Depth ...~.~ ............... ]0. Zone or use district in which premises ore situoted .............................................................. 1 1. Does proposed construction violate ony zoning law, ordinonce ar regulotion? ....... ~ ..................................... 12. Name of Owner of premise~.~/~......Address ~.r..~..:p .............. Phone N~'-fl..~./..¢'.~.. Name of Architect ............................................. Address ........................................... Phone NO ..................... Name of Contractor.~..~/~. ..... Address . hone 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. STATE OF NEW/'/YORI~, . ) cou : ....... £xCT/CY~...~~f.~. ...................... ; ............... being duly sworn, deposes and says that he is the applicant (Name of individual signing application)/,q, 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 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 therewifh, Sworn to before me this / Notory Public,,.....~.:~ ?,C~o~,~ity