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Home My WebLink About395-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ~ 62.9, Date ,~'1.1~e ~4 60 THIS CERTIFIES that the building located at .,bT~.~..~OB,~,...(~'.~X)._~A.3T~ ............... Street Map No. *w* B o '" *** ' , *** ........................ cK ~No ......................... Lot No .................................................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................................................ , ., ~. 395 ~U,.J,~ 25 19...5..~., pursu,ant to which Building Permit ~'~o ........................... dated ...................... ~T~:L.~...:Z5 ............... 19..5~,., wos 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 .................. ~o~r~..,~'o~,~l, est...o~e,~ .................................................... (owner, lessee or tenant) of the aforesaid building. ']'OWN 0~: $O~)THOLD BUILDING D~:PARTM[NT TOWN CL[RK'$ $OUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 395r Z Date ........................... ,~':~.... 2 ~. ........... 195J~.... Permission is hereby granted to: Bake~ c~¢ Fieke£s~on.....kZC.....Joba~..~oll~s ................ ........... 8o~.thci]:& ................................................. ............................... · ~..~.0 ......................................... to. Bu.i.~d... a~ .. e~d:i ~.i. ot~...o~ .. eh., e~.~ s.t.~ng. · ~e 1.1.~ ~g ........................................................ at premises located at .[~'/'~q....'~t~]P't,'h"~O'~¢] ........................................................................................ ......................................................................... ~,~,~,!.~:~.~....--~,~.~ ~ ................................................. pursuant to application dated ........................... .~F~,.~.y'-,~' .................... 19.~..., and approved by the Building Inspector Fee $...~,,.0~ ............ ......................................... ~'.~..:...:':'.2.~.. Building Inspector -- TOWN O~: SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .... ~...'~ .............. 19 Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c/...>Z~ ......... ;~ ............ ~ .......................................................... ............................................... .~..~: .............. ~ .................................................. (Building Inspector) Application No ......?...~. ........... 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 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 ~ept 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 puFpose whatever until .a Certificate of Occupancy shall have been granted by the Buildlng Inspector. APPLICATION IS HEREBY MADE to the Building Department for the is~uanc.e of a Building Permit pursuant to the Building Zone Ordinance of the Town of SouChold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or a IteraHons, 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) State whether c~pplicant is owner, !essee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................... i'; .............................................................................................................................. Name of owner of premises ...... ~Z']¢.~..¢(:¢~,'¢~.......-,~.'~...?..~..~t...~..~--'~: ..................................................... : .................................. 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: ............................................ Lot No: .................... Street and Number ........................ ' .............. ......................... ~"~'~' ................................ Municipality 2. State existing use and occupancy of pr,emises and intended use and occupancy of proposed construction: a. Existing use and occupancy.......~¢/..~'~ .~........~.~:~..../~./..~f.'- -- -- -- ...... ~....~?...~...'~.~...1:'~:.!~.'./...¢.~...~:: ................. ] .................... b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applica'ble): New Building .................... Addition .....~.... .......... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ........ .".~.~.~ ....................................... Fee ......................................................................................... (to be paid on filing this application) 5. if dwelling, number of dwelling units ................................ Number of dwelling units on each floor ............................ If garage, number of cars .........~......: ........................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front ........ .~..~....~. ............ Rear....~:Z.~..' ............... Depth ..~ ...................... Height ....../.. .................... Number of Stories ....... ./. ................................................................................................... Dimensions of same structure with alterations or additions: Front ..... .~..,f,~ r (,~(- ' ....................... Rear ..... ~....,... .................. Depth ........ ~.~ ................ Height ......./....~... ................ Number of Stories ...... .('. ........................ 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ .... ~..¢ ................... Rear ........................ 9. Size of lot: Front '-o ~ / o · ~.oo .. ...... '~".'~.. ................ Depth 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ II. Zone or use district in which premises are situated ........................ ./.~.....~./...-C~.... .......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ..'~.. ......................................... 13. Name of Owner of premises~.'~//.~:....~.~.~.~./;,.Z~.~[ ...... Address ...~.'.'..~...~.'~.~,"~ ,/?.~..~.~..?.i ........... Phone Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor,~.//J.~...~.. (-,:~:./.'/:.'.'/..cr..f:f:~.~....Address .?.~..'~..C..'~..../.~...~.~../). ............ 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. STATE OF NEW YORK, ) S S. COUNTY OF ................... .\ ....... ) .... ,~"-4..~....~Z.~.~....,X~-..z(...~.'.~.'~'?..,~'; ..~..-.~.J.,,,.~].,<k:.... ................... be ng duly sworn, deposes and says that he is the applicant (Name of individual signing applicatio/~) above named. He ~s 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 w be performed in the maDDer ~/,.forth in the applicat~n filed therewith. · ~ , Sworn to be~re me this ~ ~ ..... ~)..~ .... dov of ~..~]~ .......... ,~,,~.~[~., oun~ ' (S,gnotu e of oppJ,cont) TOWN O1: SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S O[:FICE SOUTHOLD, N. Y. Exammed..y~.../.:......~...~. .........19 ........ f_/ - ,, ,, ,, . Approved ........................................ 19 ........ Permit No. (Building Inspector) t Application No.....~.~..?.*..~i .............. 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 inspecti9n throughout the progress of the work. e. No building shall be occupied or used in whole or in ~art for any purpose whatever until .o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION 1S 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applioable laws, ordinances and regulations. ...........(~ ' ~ppl ....... ;'"" '/Sr~aCr~e ~¢'~:' ' :~'~:~;¢-4C~corpoK~ .................. (Address of applicon ;Y State wheth,er appJj_c, ant is owner, le~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ ...~..~.....~..:..~.......~....¢~¢./,.4~.~.~ ....................................................................................... If applicant is a corporate, signature of duly authorized officer. ' (Name and title of corporate officeri 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street aid N~mber '""/~"~¢)'/~'~"~'"'"'~t'"~: ............. ;~'~."~;i"~?';1'¢"¢¢7L'¢2'/~'2"~'"'""'~'"/'~¢:'~/': ............................... 2. State,ex'istin¢,2 use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existih~u se a nd occupa n cy......~d~/~/.~% .... ~;¢'¢;¢~,~'y '~J ...... · '4Z..~ · I.~' ' e ' '~" '/~" · (: '/~'~ ...................................... b'. ,~,~.'~nded use and occupancy ................................... .¢~ ....... ~ ................ 7""; .......................................................... 3. Nature of work (check which applicable): New Building .................... Addition ...~ ..........Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ......... ,,,~.,-2.~.~ ...................................... Fee ...m. ..................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ................................ Number of dwelling units on each floor ............................ If garage, number of cars ........~.. ................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front ....... .~..-...~'...~ .......... Rear.....,,~.~...~....~ ........... Depth .....-~....~..~ ............. Height ...../...~.....r. ........... Number of Stories Dimensions of same structure with alterations or additions: Front ....... ~.?...~...~.. ............. Rear .....~....'~-T....~.. ................ 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 ....:..-~..i..~...~..:. ...... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................ ~ZT..[...~.~ ......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? 13. Name of Owner of premises,~.~.~4,...z,~'~4~Z./~,6'.$....Address '"~'~¥f~,~,~j')~'z),u ......... Phone NO.~,~.,~,F...~.,,./~,°/'~ Name of Architect ............................................... , ........ Address ............................................ Phone NO ..................... Name of Contractor.~.,'~Z/.~'/.~..~....,~../.f,'.4~..</..J.)]..,~.Z~..Address ....~..u..~,~i.O./~.f~ .......... Phone NO. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propert~ lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. /do ' STATE OF NEW YORK, ) S S. COUNTY OF .................. , ......... ) , ...... ~..;.~....../~..../....'~.......~....,<'..F,-~....~.....~../...J...~!]...~'~..~...x. ........................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) ~:~.~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 end 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 p~formed in the m.anner,~s~et forth in the appN~ation filed th__erewith. Sworn to before me this (' "N ~q ,.~.,.?/~,c~[~.~. ~u~r~ ~,,'/~, ,, ,,,~ x'~,, day of ..... .... of app,,eant) Notary PuN ic,~-~.....,'~....~'C~l~y~',~,r,:~ ~,, .~ ._