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Home My WebLink About490-zF0,RI~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. CE~nF~C,~TE OF' OCC~PANC~ No ........... ~...77...3.. I~ate ............................... THIS CERTIFIES that the building located at .Oak. B.t,.,...~tt~to~j~a~ ...................... Street _Map No..l~g~llO....-Block No ....... ~.~......Lot No ............ .~0...~, ..~. ................................................. Heiqht~ conforms subs~sntia]ly to the Application for Building Permit heretofore filed in this office dated ............... ~ct:~e~..J~ ....... 195~... pursuaut to which Building l~mi~ No ....... ~..49(~ .... dated ..............b~B~'~o~'...6 ........ 19.55, was issued, and conforms to all of the requirements of the applicable provisions of the ]aw. The occupancy for which this certificate is issued is This certificate is issued to (owner, lessee or tenant) of the aforesaid building. ................... ~!.:?:::?..: ......... (,...!..<!/..~::~..~ ..................... Building InspectorI TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exem,ned ............ Approved ............ ...~...~.....~......(~. ...... :9..~erm~t ~o. ~ ~ ~ ......................... .......... ................... ........ , ......... Application No. ,z_/ }"c~ 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 ond of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is part of this location. c. The work cov, ered 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 Certlficafe of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc,e of o 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 app[icant agrees to comply with all appllcable laws, ordinances and regulations. ..... ...... .................... (Signature of applicant, or name, if a corporation) (Address of applicant) Store whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem~ses....b..~.. ........ w.,..'r:..7.1....-'..~e.,,.,.*.: ............ ~..~.. .............................................................................. If ~pplicont is o co~por~e, si~noture o~ duly ou~horizod (Name ond title of corporate officer) wo. w:,, be I. Location of land on which proposed ~o:. .. Street and Number .................... '....~......~. .............................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy . ~~.:~. ........................................................................ 3. Nature of work (check which applicable): New I~uilding .................... Addition .................... Alteration ..................... Repair .................... Removal .................... Demolition .................. .._Other Work (Describe) .................... ' 4. Estimated Cost....~.....,O...O.......'~.. ....................................... Fee .~......~.~C~ ........................................................................... (to be paid on filing this application) 5. It 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 ...... ./.....~.. ............. Rear ...../..?,.. ................ Depth ........~....,~.. ............ Height ............................ Number of Stories ....~.~.. ......... 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. [;)ate of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore s~tuated ................................................................................ 19. Does proposed construction rio}ate on,/ zoning Iow, ordinonce or reguloHon? .................................................... 13. Nome 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 NEW,-YqB , /}/,'7 ) S S COUNTY OF ' .................................... ~ ........................O /~~ ....... Being duly sworn, deposes and soys that he is the applicant (Name of individual si~ning application) · ~ abow~ named. He ,s 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 knowled~ and belief; and that the work will be performed in the manner ~]p~n ~[~applica~ filed therewi~. ~/ Sworn to before me this ~ ~ R~[i~ll[~ $ta~ ,. ~~ ~ ~~ n SUffolk C ~l~.~- / *' ~ FORI~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI-IOLD, N. Y. Exommed ........................................ 1 c) ........ Approved .......... ~.....~. .......... 19..x4.].?...%ermit No. ~*''~ cfi ~ O .................... .......... ................................ ........... ......... (Building Inspector) Application No. ~:] ;; q) APPLICATION FOR BUILDING PERMIT Dote ............................................................ 19 ............ INSTRUCTIONS o. This opplicotion 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 co*ered 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 pui'pose 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 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 applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, .?~gent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer· (Name and title of corporate officer) 1. Location of land on which prop,,osed wot~k will be don% Map ~o.. .q?. ............. ( ....... ~x.... Lot No ..................... Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............. ~ ............................... { .............. .~ ................................................... , ............... property lines. Give street and block whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................... Addition ...... L,:Z...........Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated uost....~....:. ........ :.'; ....................................... t-ee .,,~: ..................................................................................... (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 ....... ...~cm.....~. .............. 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 ................................ . ,'/ / './ 7 8. Dimensions of entire new construction: front ....... ? .................... Rear ............................ Depth ............................ Height ............................ Number of Stories 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .............. ::'.n.'.: .................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... LI /1 13. Name of Owner of prem'ses ........ ~ ~....:/c.~.~.. C.'~' ............ ~ 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 indJcata all set-back dimensions from numbers or description according to deed, iand show street names and indicate STATE OF NEW,~¥O~[~ ~ ~./. ) COUNTY OF ....':'e:'X:~..~':'tL~J?~....) S S. .................................. :'../!~.-:~:.;.:. ......... (.::...:::.'::::':..'.:~'~'.'.:::Z': ....... being duly sworn, deposes .and says that he is the applicant (Name of individual signing application) above named. He Js .,,. ....................................... ~-.~ .................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and Js 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 beJief; and that the work will be performed in the manner s~t forth in the applica~od filed therewith. Sworn to before me this . ~a~ ~ts~ ~o~ ~/ ~ ~f~ 1~ ~ot~ Public, .~....~~....~.~Bu~ ~r,~ ~. i~D-~