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Home My WebLink About438-zFORi~f NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...~/S....JAllmar.tA...~.e ...................... Street Map No....~.: .......................Block No...7*;~..~ ........................ conforms substantioiJy to the Application for Building Permit heretofore filed in this office dated ....................... .~.]p~.,~l~e~...C) ...... 19.~..., pursuant to which Building Permit No ...~..~,.~j ............. , dated ....................... ~.eJ).t*P~[J~b.~.....cJ....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 ............ ......... ~tt.[.¥ A~ ~,~. · .0 ti~.,. · .~.AH Z: ~...T.)~/~ ~Z. ~G .............................................................. : ...................... This certificate is issued to ....~T.,....D:[e,~ ............. (..~.~'~.) ................................................................. (owner, lessee or tenant) . of the aforesaid building. Building Inspector Exam i ned ....... -,~ ............................. 19 ........ FORM NO. 1 TOWN OF SOUTHOI. D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................ ~ .............. 19....!...Permit ~'~o ................................. Application N o...~..~.~...~ ........... ~ ~,..., .~,, ~ .................. ~"~"~"'~' ............ .'-; ...... v~"~"g:'""~ ........... ....................... ..................... · ~ ~, .~ ~', ~ ~ ~',,~ (Building Inspector) "~'~ '~ ~ ~ V APPLICATION~OR BUILDING PERMIT INSTRUCTIONS a. This applicatior~st be ~¢;ompletely 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 p~omi~es,'reia~t,~n~ship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be dra~,~of~ th~ diagram which is part of this location c. 'lZhe work covered by this application' may not be commenced befdre ~ssuance of Building Per,it. d. Upon approval of this application, the Building inspector will issue a Building P~rmit 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 p.urpose whatever until a Certificate of Occupancy shall have been g~nted by the Buildir~g~lnspect°r'· APPLICATION~. IS HEREBY MADE to the Building De~artment for the issuance of a BulldOg Permit pursuant to the Building Zor>e Ordinance of the Town of Southold, SuffoI~County, New York, and other applicable Laws, Ordinances or Regulation. s, for the construction of buildings, additions ~alterations, or for removal or demolition, as herein described. The~ appl, i'~ant agrees to comply with all applicable [g~s, ~rdi~,ances and regulations. ?, '2 ....... ................................. ¥ ~,~ ~ [*,,~' ~..~,~'~ (-'~ignat~'~9;~a~l~ic~r~, or~n~.~, if a corporation) State whether applicon'~,.is.~qwr~er~ lessee, aget~t, a~ch,~tect~ ~.ngi~e~, ~neral controc'~,~can plumbe, r or builder. ........... , ... W~....~.....~, ................................................. ~ ....................... . ..................... : ........................ ~.~ ..................... No e of ow,er of premises ......... ........................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) ~ of~'/~,X t'~/~/,o/~,~/~ 1. Location of [and o~ which proposed work wH[ be done. Mop No ........... ~.~ ................. B ac < ........................ Street and Number .... ~ ~ ~- ~ ~ . .. 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Ex~sting use and occupancy ......... ~ ~ b. lntended use ond occuponcy ................... ~ 3. Nature of work (check which applicable): New Building .................... Addition ....... ~ .........Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ~2'~/0 ~ F ~-~"~ (to be paid on filing this application) FEES: If dwelling, number of dwelling units.....~..~....~... ........... Number of dwelling units on each floor ............................ If garage, nurnber 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 ....... ~....~1.~ .................................................................................... Dimensions of same structure with alterations or additions: Front ........... ~.~..~( ...... Rear,....:~ .............. Depth ....... ~.~ ........ Height .....Z~-. ............Number of Stories ...... ~..~.~ .......... 8. Dimensions of enti;e new construction: Front ....... ~ ....... Rear ........ ~.~ ...... Depth ....~.q~ ...... Height ..... ~. ............... N~ber of Stories ........ ~.~....~.2 ', , '---,~. Size of lot: Frgnt ..... ~.~'~ar ....Z.~.~..~. Depth ...~,.~Z ........... 10. Zone or use district in which premises are situated ............. .~ .............................................................. 11. Does proposed constructi~ violate any zoning law, ordinance or regulation? ....... ~ .................................... ... 12. Name ~f Owner of premises ..... Address ~.. .Phone NO..Z.~. ........... N~bme of'Architect...~ .............. ~ .................. ' ..Address ........... ~.~ ............................ Phone NO. Name of Co~tractor ..............~ ..................... Address ........... .~ .............................. Phone NO. PLOT DIAGRAM Locate clea}ly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block n~mbers or description according to deed, and show street names and indicate whether interior or corner lot. ST~T~ o~ ~EW YO~K, ) ~ ~,'L ~ ~ ?~f: ~ COUNW o~ ..~..~.~..) s s.. ~ ~ ~,o~,' -- '~' ~ ................................................. ~....~.~being duly sworn, deposes and says that he is the applicant (Name of individua~ing apbl~ation) above named. He i~ the ................................ ~ .................................................................................................... ~ t-- .~ ~ : . . (Contractor, agent corporate officer etc) of said owner or owners, and ~s duly' a~Eonzed to perform or have performed the said work and to make and file this application; that all statements co~tNned in this application are true to the best of his knowledge and belief; and that the work will be performed in the man,er set forth in the appl~atio~ file~ therewith. Sworn to before me this / / , ~ ~_ -- ............ .?].~d~ o~ ......... ~... ?.~..C... ~/~ / , V , . .-~ ~ (Singature of ~pplicant) FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am ned ....... ........ ^pproYed ........................ .C: ............ Application No .........~T./...,~, ...~.. ...... '- ~ ~ ~'- -, k~ APPLICATION~0~:B~LDING PERMIT 5~.N~ X ~ STRUCTIONS a. This application ~t be completely filled in by typewriter or in ink and~ubm tted in duplicate to the Building b. Plot plan showing location of IQt,gnd ~f buildings on pr~ses, relatiqfi~hip'~to adjo n ng premises or public streets or areas, and gmng a detaded descrlphon of layout of property must be drawn on the diagram which is part of this location. c. The'work covered by this applicatibn may not be commenced before issudnce 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 CerHficate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buildin Building Zone Ordinance of the Town of Southold, ,~ Regulations, for the construction of buildings, addit t D~partpqent for the issuance of_~_ Building Permit pursuant to the #.f4~lk C~[Jnty, New York, and othbr applicable Laws, Ordinances or ins ~r ~erat~ons, or for removal 6r demolition, as herein described. ~ws, ~inances and regulations. ~ The applicant agrees to c~omply with afl app~lic, qbfe~ · ,/~,~ .,. ~ . ~-~ ~ ....... ~. ............................... '~ -' ~r~ o~, app~f~/o~me, i~ a corporation) --::~':-- ~ , ~ ~ . .............. ~.~ ................... z::.::..~: .................... ~"~'~'"~x".~ ~'.~::~':~' ................................................................... ~ome o{ ownor o~ premises .................................................................................................... If oppUcont is o corporote~ sionoture o{ du~y outhorized officer. ................................................................................................(Name and title of corporate officer) ?~/~/~ ,/ ~',,¢.j" Z~,,~,,,~'~///~ ~ 1.Location of land on which proposed work will be done. Map No ........ ~. .................... Block .................................. Street and Number ....... ~/~.~.~~,~ ........... ~ .................................................................................... 2. 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 ........... 6.~....~...(_,~...~'. ................. ' ............. 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, commerica[ or mixed occupancy, specify nature and extent alc each type of use ................................ 7. Dimensions of existing structures, if any: Front....~...~....~.... .......Rear ....~.....~.~ ......... Depth .~..~..~.~../~..~..~..~.~..Z~.~.. f Height ..../.....~...~...~.. .......... Number 0f SJ'ories ..... ~...~...~......(~../.?. ..................................................................................... Dimensions of same structure with alterations or additions: Front ....... ..~....~...~...~.. ......... Rear ........ ~..~;...~.....'~.. ....... Depth .......~..~...~.... ........... Height ....... /..~..../~...~.. ....... Number of Stories ..... ~'./~...'ff......~'...~.. ....... 8. Dimensions of entire new construct.ion: Front......~.....~.F./~'.. ...... Rear ......~....~.f..~.. ..... Depth ......~....~....~... ...... Height .....~...~.r.~.. ........ ,Number of Stories ...~.~...~.....~./..,~. .... 9. Size of lot: Front ...... ~.~...~.~-... ..... Rear .....~..~..~: ...... Depth .....~.....~.../...~. 10. Zone or use district in which premises are situated ............ l~...~..~..~.'.~.~./~'..~.~.~...~.. .............................................. 1 1. Does proposed construction violate any zoning law, ordinance or regulation?......¢~.,.~ ..................................... 12. Name of Owner of premises.~.~.~r~....Address ..~'..~...~..4.~.~..I,f..~....Phone NO../....~,...~.3... Name of Architect ..................... k~:/. .......................... Address ................. ,~...1. ...................... Phone NO.. ¢ ~ Name of Contractor .................. .z'z~ ............................. Address ............. ...~'4 .......................... 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, COUNTY OF .. .......... 2 ............... ~ ...... ~....;..n....~..~oinO dul~ swom~ deposo~ ond soys that he is the oppllcont ~bove no~od.,He ~ the ................... ...~ .................................................................................................................................... ' ~" ' ~ , (~ntractor, agent, cor~rote officer, etc.) of said owner or owners, and is duly outborlzed 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 appJi~ation filed ther,~with. .......... ~. ............ ~,y o ....... ~...~ ......... - * ~ . * (Singature of applicant) Notary Public~..~~..~......f~oun~y /