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Home My WebLink About444-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OC;C~UPANCY ........................ Dote .......................................................... , ........ THIS CERT{FIE$ that the b~ild~n9 located m..~..~A..~..~..~..G~a~L~g ................. 5tree~ Map No ...... ~.~ ........ Block No ......................... Lot No ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in t~is office dated ............................. ~.~....~., 19.~..., pursuant to which Building Permit No ...... ~ ............... dated ............................ ~....~ .......... , 19..~.~.., was issued, and conforms to all of the requirements of the applicable provisions of the Jaw. The occupancy for which this certificate is issued is .............. ................................................................ ................................................................................ This certificate is issued to ..~.~.~...~,~ ............... f...~[~) ............................................ (owner, lessee or tenant) of the aforesaid building. -- Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ....................... !. ............... 19....!..Permit Application i'~o ....... ~ ......... /.. ........ (Building Inspector) ( APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin 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 p~operty must be drown 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 laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Name of owner of v .............................................................................................................................................................. 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 .................................. Street 'and , ~um~,~r ............................................ 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction:. a. Existing use and occupancy ............ .,, .q .................................................... 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 .............~!.~...0..0..~. .................................... Fee ....... ~.~..j..0..0.. .................................. (to be paid on filing this application) 9. 10. .12. FEES: If dwelling, number of dwelling units ..................~. ......... Number of dwelling units on each floor ........... ~ .............. If garage, number of cars ........................................................................................................................................ If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................ t Dimensions of existing structures, if any: Front ...... ~.~. ................. Rear ......... .~.~. .............. Depth ......~.O..~. ................ Height ............................ Number of Stories .............................. .~ ~ see below Dimensions of some structure with alterotions or additioms: ~ront ................................ Reor ................................ Depth .............................. Height .............................. Number of Stories ................................ see below Dimensions of entire new construction: Front ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ Size of lot: Front ............................ Rear ............................ Depth ............................ Zone or use district in which premises are situated ........... ~.e...~..~..~.e.~.~..~...~..~. .......................... i ............................... Does proposed construction violate any zoning law, ordinance or regulation?......~.~ .......................................... Name of Owner of premises ........................................ Address ............................................ Phone NO ..................... Name of Architect ...................................................... 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~xYORK,/~ ) ............... (4~ .~,~.. ............................................... ~-.~.. ......... g duly sworn, deposes and says that he is the applicant (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 ali 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 flied therewith. Sworn to be,fore me this /~'1 / ./..'.~.. ~. day. ~....~~..~.~.'..~..~. ....... 19.~...~[. (Singature of applicant) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OmCE SOUT,O'D, N. Examined .... ~...~..........~...~ 9...~...~."- Approved .................... !..k. ................ 19...~.....Permit N o..~'.././..'..~T.~....~..~ ...... (Building Inspector) Application No,...~....~,.., ,~. .......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate tc~ 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 p~Jrpose whatever until o 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 laws, ordinances and regulations. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. Ow~e:L'"' William Arasimowicz Name of owner of prem ses .............................................................................................................................................. 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 .................................. Street and Number ..... ~ .?.~.e .G.~..o.~ng . 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ .~...e.~/..t..d..e...~.g.e. .................................................................................. b. Intended use and occupancy ~...m~...e. 3, Nature of work (check which applicable): New Building .................... Addition ....~ ............. Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4, Estimated Cost ........... ,~..,,,,~O0.~ .................................... Fee ............................. ,~.~.~l~O ................................................. (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 ................................................................................................... i .................................... 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 ....L~O~ ................. Height ............................ Number of Stories .............................. .~. ............................................................................. Dimensions of same structure with alterations or additions: Front ...t~.O...l~.~.],P.~' ....... Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front....~...?....~..?..]'..O..?. ..... Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Zone or use district in which premises are situated ........... ~t~.~.~e]~t-~,o.& .......................................................... 1 1. Does proposed constructiot~ violate any zoning law, ordinance or regulation?.....~O .......................................... 12. Name of Owner of premises ........................................ Address ............................................ Phone NO ..................... Name of Architect ...................................................... Address ............................................ Phone NO ..................... Nome 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 c~cc.o~r, ding to deed, and show street names and indicate whether interior O,r corner lot. ',', L. ......... STATE OF NEW YORK,- ~, . , /~ SS. COUNTY OF ...... ~ ~Z.~ ....... ) ' ................ (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 per~ormed 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 applic6tion filed therewith. (Singature of applicant)