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Home My WebLink About408-zFORM NO. 4 TOWN OF SOUTHOLD BU~£DING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ......................... Date ......................................................... THIS CERTIFIES that the building located a~(.~..~.~.~..~g,~..~9~]:.(...~.~. Stree,t ~u ......................... DIOCK ~NO .........................Lot No ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated Au~uet 8 ,58 ur ............................ ...................................................... 19 ........ ~ p suant to which Building Permit No. ~L~0~ doted ..................... ~.~.~..?. ............., 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 .............. PRIVATE D~ELLI NQ T~i~ ~ti~i~te i~ i~.~ to .............. ~.~r.%9...~.~...~B.?.~9~!*...?~?.~ ................................................. (owner, Jessee or tenant) of the aforesaid building. Building Inspector FOI~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 UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4o8 Z Date ....................... A~?)J.$..~ .....(~ ............. 19.,~:~.. Permission is hereby granted to: ..... ~4aZ:.iO.....~ ~.tO z~ ........................................... ...L.56.,.~ ~...f~.em~a'~.,a~r.e .................................... ................ B~i~4~.n.~.....~o.Z, ................................ to ........ ~U.~. ~L4~.. ;te;,~..d.*¢~eZ241~ag ......................................................................................................... at premises located at .......... ~d;:.J:..VC:~4~..~O(~.....:¢/f.~...l?&.~...~'~r~C~,.R~ ....... .(...G~.~.~.~'t.W.P..h..J-.....O..D...A ) ............................................................... ~.O,~,~.~t~.~l,,~.......~., .~.~ .............................................................. pursuant to application dated ........................... ~.~J~g~,~.~.....-~. ............... 19..~..~., and approved by the Building Inspector F~e $...dLG.DO ........ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ......................... ............... 19 ........ Permit No ............................... Disapproved a/c ..... : ........................ .~X ........... :..~. ............................... (Building Inspector) Application ........... APPLICATION FOR B~JILDING PERMIT INSTRUCTIONS a. This application must be completely tilted 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 [~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 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 issuanae 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 laws, ordinances end regulations. .............. :,/. ..................... (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................ .O.~m..~.~ ................................................................................................................... Name of owner of premises .......... ~aili.~...E,....~es.t;o~ ...................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~/~ ~/~,'Z-t(1 (~/~fV~h~,,,~.~t~ 1. Location of land on which proposed work wil[ be done. Map No: ............ ~ ........................... Lot No: ...,~, .............. Street and Number .~.~)~.~.. ....... .~...~...~ .......... ~.~...l'~e~,~.,~S.o. ll.th.oZd ............................................................... Municipality 2. State existing use and o~ccupancy of premises and intended use and occopancy of proposed construction: a. Existing use and occupancy ................... .~.a....°.a.~.t.....1..~ ...................................................................................... b. Intended use and occupancy ............... .~.O,il....O.~.~..,~.fl~.$l~...~l,w.~,ll,ilo.$ ..................................... '. ................... 3. Nature of work (check which applicable): New Building....~.. .............. Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ........ ~..,,..0...0..0. ...................................... Fee I ~)' ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... .~. .................... Number of dwelling units on each floor ......... Z, ................ 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 .......... ~ ............... Number of Stories ........................ ~ .................................................................................. Dimensions of same structure with alterations or additions: Front ...... ,,~ ....................... Rear .......... ~ ................... Depth ................... ~ ........ Height .......... ~r, ................ Number of Stories ....... ~: ...................... 8. Dimensions of entire new construction: Front ....... .~,~. .............. Rear ......... ~ .............Depth ....~.~ .................. Height .......... ~ ............... Number of Stories ............Q~Q ......... 9. Size of lot: Front .......~ ............. Rear ......... ~ ........... Depth ........ 2~. .......... 10. Date of Purchase ....... ~..~.~ ............................. Name of For~r Owner ..... ~.....~....~ ........................... 11. Zone or use district in which premises are situated ........ ~ .......~_~...¢.~s.~ ............................................... ]2. Does proposed construction violate any zonfng law, ordinance or regulation? ................. ~O .............................. 13. Name of Owner of premise~$~...~..~.~.%Q~ ....... Address ~&~.~...~.,...~., ........... Phone NO. Name of Architect.....fl.,...~...,~o~ ........................... 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. STATE: OF NE~YgB~ ~ ) S S COUNTY OF .~~ ) ' .... ........................... ~_~.~ ....... ~.~2~ .................. be ng du y sworn, deposes .and says that he is the applicant (Name of individual signing application) obove n~med~Me Is ~ne .................... ~..~= ........................................................................................................................ (Controc~or, o~ent, corpo~o~e officer, e~c.) of s~id o~ner or o~ne~s, ~nd [s duly ~uthorized 1o perform or h~ve performed the said ~ork and ~o m~ke ~nd file this ~pplicQfion} thQt ~ll st~emenls con~o[ned [n lh{s ~ppl[cotion ~re ~rue 1o the best of his knowledge ~nd belief} ~nd th~ 1he ~o~k ~[ll be performed in ?he manner set fo~h [n the ~pp[icotion filed ~here~]~h. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ...... .~....~ ............ ~..~:~ ............ .,.<'.~ ........ ./.~ ........ ~>,. ........ ~,~ ........ ............................... .CL ......... ............... 5.; ............ ................... (Building Inspector) Application No....(~.Q.~.~... .......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This opplicotion must be complefely 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, relationshlp 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 BuiIdlng 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 Certificat, e of Occupancy shall have been granted by the Building Inspector, APPLICATION IS HEREBY MADE to the Building Department for the issuanoe 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 alteratlons, 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) ......... ~,,.~) ......... ~f)~,Z~'~t....~.t ~e...~..~,~'.~,~.~.,~.:~,...,..~.s....~,~..o. .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................................... Q~,z~(~?, .................................................................................................................. Name of owner of premises ........... !;~9,~o..~.]~...~'~¢~?~. ..................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate, officer) ~ ~ ~¥//]~_.4.;~. ~./,'~. ~., ,.,~-~"~',"~"'~ 1. Location of land on which proposed work will be done. Map No: ........... ~'.~ ......................... Lot No: ..Z~: ............... Mun~c~pahty .......................................... 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................... ~.s~.~]...~.~ ........................................... b. Intended use and occupancy ................ >~....O~...t.~...~,...,,,~,t)~tj9 .......................................................... 3. Nature of work (check which applicable): New Building...~ ............... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ....... ~ii!~i~.~.0...0..0. ....................................... 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 ............................ 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 ...... .Q~.~ ............... Rear ........ 8Q~ .............. Depth ..].~-g.~ ................... Height ......... ~ ................ Number of Stories ...........~ .......... 9. Size of lot: Front ...... ~. ............. Rear ....... ~QL ........... Depth ....... .~JL~,]. ........... 10. Date of Purchase ........ '~..~ .............................. Name of Former Owner ..... ~.~...~x,...~ ........................... or use district in which premises are situated .............. ~.....~¢~ ........ ~ ....................................... 11. Zone 12. Does proposed construction violate any zoning law, ordinance or regulation? ................ ~O ............................... 13. Name of Owner of premis~.9...~k:~..~?~.~ ........ Address~¥1~.~..~'[.,...~, ........... Phone NO.~..~.~ Name of Architect....g.~...~...~]'~g.~ ............................ Address .~..]~.~Z~ .............. 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. STATE OF NEWtOn/~/6 ) S S COUNTY OF '"~:~'")~/__ ~ ................................. ~.~~......~;'~ ........ being duly sworn, deposes and says that he is the applicant (Name of i~ividual signing application) above named.~e 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 m.agner set forth in the application filed therewith. Sworn to b~fore me this